Telemedicine and advanced medical practice in Uruguay

Jonás Bergstein
Bergstein Abogados, Montevideo
jbergstein@bergsteinlaw.com

Ignacio Torres Negreira
Bergstein Abogados, Montevideo
itorresnegreira@bergsteinlaw.com

Introduction

Telemedicine, understood as the practice of medicine at a distance through the use of information and communication technologies (ICT), has evolved from a futuristic possibility into a vital component of modern healthcare systems. In Uruguay, its development has been gradual, yet consistent, with a significant boost seen during the Covid-19 pandemic. This article discusses Uruguay’s national legal framework, the conditions under which telemedicine has been deployed, its demonstrated benefits and the regulatory, technical and ethical challenges that must be addressed to establish advanced medical practices.

Legal framework

Telemedicine in Uruguay dates back to early trial programs launched in the 2000s. However, the turning point was the launch of the Salud.uy Program in 2012, which marked the beginning of a national digital health strategy. This initiative laid the groundwork for the national electronic health record (La Historia Clínica Electrónica Nacional or HCEN), establishing standards for interoperability and technical infrastructure.

In 2020, during the public health emergency (Covid-19), Uruguay enacted Law No. 19.869 to regulate and promote telemedicine and related services (the ‘Telemedicine Law’), formally recognising telemedicine as a legitimate method of providing healthcare services within the national integrated health system. The law defines telemedicine as the provision of healthcare services according to which  distance is a critical factor, delivered by licensed healthcare professionals using ICT to exchange valid information for diagnosis, treatment, disease prevention, research, evaluation and continuing professional education, all with the goal of improving individual and public health.

The law enshrines guiding principles such as universality, equity, efficiency, quality, complementarity and confidentiality, and sets forth basic requirements for the delivery of remote medical care. It mandates the collection of prior informed consent from the patient, who must be given clear and detailed information and whose personal data must be protected securely and comprehensively.

The law was subsequently regulated by Decree No. 127/024 (2 May 2024) and implemented through Public Health Ministry Ordinance No. 937/024 (9 October 2024), which outlines the technical, administrative and security requirements for the accreditation of healthcare institutions and their telemedicine services.

Operational guidelines

Uruguay’s regulatory framework recognises two core modalities for telemedicine services:

• synchronous (real time): involving real-time communication between the acting physician and the patient, or between the physician and a specialist, with the latter providing diagnostic or therapeutic guidance; and
• asynchronous (time shifted): according to which interaction occurs without the simultaneous presence of the physician and the patient, allowing for deferred review of the transmitted information in non-emergency contexts.

Healthcare institutions offering telemedicine services must comply with several requirements: (1) specific informed consent must be secured from the patient; (2) guarantees must be provided in regard to data confidentiality and security; (3) continuous training of medical and technical staff must be provided; and (4) institutional traceability and quality standards equivalent to in-person care must be adopted.

Cross-border consultations with foreign healthcare professionals or institutions are permitted, supporting collaborative and international medical practice. Furthermore, a National Telemedicine Providers Registry has been established, integrated into the Unified Health Services Registry (SURSS), centralising regulatory oversight and monitoring.

Clinical impact

Telemedicine’s greatest added value in Uruguay lies in its capacity to reduce long-standing disparities in the geographic distribution of healthcare services and specialists. In a country with a highly urban-centric healthcare system, digital medicine enables the delivery of high-quality services to remote or underserved areas.

Specialties such as psychiatry, nephrology, cardiology, rheumatology and traumatology have successfully adopted this model, reducing waiting times, avoiding unnecessary travel, improving access to second opinions and ensuring the continuity of care for vulnerable populations.

However, the broader adoption of telemedicine remains limited by technological infrastructure gaps, cultural resistance and the lack of specialty-specific clinical protocols.

Towards the advanced practice of telemedicine

Although Uruguay's current regulatory framework is a major achievement, the transition to an advanced telemedicine model demands a more ambitious strategic agenda. The key challenges in this context include:

• specialty-specific protocols: the development of clinical guidelines for each medical field is urgent. The Ministry of Public Health must lead this effort in collaboration with scientific societies, healthcare providers and professional associations;
• functional interoperability of the HCEN: the technical and operational capabilities of the national electronic health record need to be strengthened to ensure smooth integration across different providers;
• ongoing training and digital ethics: institutions must ensure continuous professional development in regard to digital competencies, remote communication, ethical standards and cybersecurity; and
• quality assessment and monitoring: the national registry must be complemented by regular audits, performance indicators and patient-centred evaluation mechanisms.

Telemedicine and data protection

The use of telemedicine must strictly comply with Law No. 18.331 on personal data protection, its regulatory decrees and the related legal provisions. This law stipulates that health-related data may only be collected and processed by authorised professionals or institutions, under the principles of professional secrecy and legal legitimacy.

Patient health records contain highly sensitive information, including details of the past and present health conditions of the patient, treatments, addictions, genetic and biometric data and even their religious beliefs and sexual orientation. Accordingly, the law imposes enhanced data protection safeguards.

Healthcare providers are required to implement robust security measures for both paper and electronic medical records. Access is limited to those involved in the patient’s care, authorised administrative staff, the patient, their family (in some cases) and the Ministry of Health.

The current regulations obligate institutions to: (1) define access protocols and key custody mechanisms; (2) ensure the secure authentication of authorised users; (3) maintain the confidentiality and integrity of all exchanged clinical data; and (4) utilise up-to-date encryption for real-time audio and video transmissions.

If telemedicine tools are provided by the attending physician, they remain personally responsible for meeting these standards, alongside the institutional duties of the healthcare provider.

Conclusions

Uruguay has established a robust legal and technical framework to support the development of telemedicine, recognising it as a legitimate and necessary mode of healthcare delivery. To transition towards the ethical, advanced and sustainable practice of telemedicine, however, it is essential to consolidate the regulation, invest in professional training and guarantee equitable territorial implementation.

It is time to shift from a reactive regulatory approach to a proactive and permanent digital health policy. Only through a comprehensive strategy can telemedicine evolve from an emergency solution into a guaranteed right, ensuring access to healthcare under conditions of quality, security and dignity.