Telemedicine Guidelines Leave Plenty Of Questions
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User Rank: Apprentice
7/17/2014 | 1:50:09 PM
FSMB Guidelines do not rule out the use of the telephone
Jeremy, the FSMB does not rule out the use of the telephone in patient interactions with physicians.  But a telephone conversation alone between a doctor and an unknown patient does not establish the doctor-patient relationship. There are obvious reasons why it shouldn't and doesn't.  First of all, identification would be a problem.  Also, most states require, as part of the establishment of the doctor-patient relationship, an examination.  The FSMB guidelines allow for a state to permit this to occur via videoconferencing if that is the standard of care.  Unless there is an established doctor-patient relationship, prescribing prescription medication may get the doctor in trouble with his medical board.

For known patients, those who already have established a doctor-patient relationship, the FSMB guidelines do not rule out telephone interactions.  So the "controversy" that the definition "could restrict access to telemedicine" is overblown.  People need to have a "medical home" - a primary care provider - so that when they do have a medical problem they have the option of seeing the doctor in person or calling the doctor for a prescription.

Regarding email contact, that method could be a HIPAA violation waiting to happen if PHI (protected health information) is exchanged in the email. The same for instant-messaging.  Although HIPAA does not require encryption, those who choose not to use encrypted forms of communication must explain why.

If "robust" means broadband, then, yes, an Internet connection would be required for a videoconferencing visit with a physician, primarily as the initial visit in which the doctor conducts a patient exam.  Smartphone users are very familiar with Skype and Facetime.  But they are not meant for confidential medical interaction.  They don't have the same protections that videoconferencing programs have that are designed for medical purposes.  

As to the aspect of vision-impairment, as long as the doctor can see the patient, there is no problem.  The videoconferencing is for the doctor's ability to see and examine the patient.
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