Telemedicine Guidelines Leave Plenty Of Questions - InformationWeek

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Healthcare // Policy & Regulation
Commentary
7/17/2014
11:45 AM
Jeremy Johnson & Catie Bitzan Amundsen
Jeremy Johnson & Catie Bitzan Amundsen
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Telemedicine Guidelines Leave Plenty Of Questions

Federation of State Medical Boards and American Medical Association telemedicine standards provide a good starting point, but their definitions are too narrow.

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Technology moves fast, and laws and regulations pertaining to telemedicine are struggling to keep up.

The Federation of State Medical Boards (FSMB) and the American Medical Association (AMA) recently issued separate guidelines designed to assist states as they grapple with how to regulate this quickly evolving mode of care delivery. The "Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine" was released by the FSMB, which represents all 70 state and territorial medical certification bodies. It replaces the 2002 Model Guidelines for the Appropriate Use of the Internet in Medical Practice. The AMA released its own set of guidelines, "Coverage of and Payment for Telemedicine".

[Doctors across (state) borders? Read Sorry, AMA: You're Wrong About Telehealth.]

While neither set of guidelines is binding, states are likely to draw on them when examining potential revisions to their own laws and regulations. It is too early to tell whether there will be a nationwide push toward standardization or whether providers, insurers, and vendors must continue to deal with inconsistent state telemedicine laws and regulations from one state to another. The only thing we know for sure is that both sets of guidelines will likely leave state legislators with plenty of questions.

(Source: Wikipedia)
(Source: Wikipedia)

Narrow definitions of "telemedicine" could lead to restricted patient access
Both the FSMB guidelines and the AMA guidelines establish an overly narrow definition of "telemedicine." As a result, they fail to recognize several forms of electronic communications as potentially beneficial, valid modes of healthcare delivery.

The FSMB guidelines define telemedicine as: "the practice of medicine using electronic communications, information technology, or other means between a licensee in one location, and a patient in another location without an intervening healthcare provider." While this definition appears broad, the guidelines further provide that both secure videoconferencing and "store-and-forward" secure communication technology may be part of a telemedicine practice but that, generally, audio-only, email, and instant messaging technologies are not telemedicine. The FSMB definition is not without controversy, with a group of insurers, providers, and patient advocates warning that the definition could restrict access to telemedicine for those patients who strictly rely on audio devices, email, or text messages.

The AMA guidelines define telemedicine as comprising three categories: "store-and-forward," remote monitoring, and (real-time) interactive services, but the AMA similarly carves out audio-only, email, and instant messaging technologies from the definition.

Restricted access will be a significant issue. The definitions proposed by the guidelines would generally require the provider and the patient to have a robust Internet connection in order to conduct "telemedicine," which will be an issue for people in remote, rural areas. There is also the issue of limited accessibility for those with physical impairments. For example, blind patients may be reliant on audio-only interactions.

The definition of telemedicine is likely to evolve in the coming years. As more technologies develop and more medical boards assess statewide Internet capabilities, a more flexible definition will be necessary as more issues and restrictions are addressed.

Is an in-person meeting necessary?
To establish a valid provider/patient relationship, many states require that the initial encounter between the provider and patient be in-person. This is often the biggest hurdle for providers seeking to practice telemedicine.

The FSMB and AMA guidelines both suggest, however, that there may be ways around an in-person meeting. The FSMB suggests that

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Jeremy Johnson is a healthcare attorney with Gray Plant Mooty in Minneapolis where he has significant experience advising healthcare providers on emerging care models, including telemedicine. View Full Bio
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Alison_Diana
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Alison_Diana,
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7/25/2014 | 5:05:30 PM
Re: FSMB Guidelines do not rule out the use of the telephone
Yes, I actually wrote about Verizon Virtual Visits when it came out. Perhaps, in Presbyterian's case, they insist on an initial face-to-face meeting with the physician because it's a state law? Or perhaps their telemedicine program allows doctors to prescribe more medications than typical telemed programs (which often steer clear of medications like opiods, sleeping aids, and anti-anxiety pills)? Or for another reason all together!
Alison_Diana
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Alison_Diana,
User Rank: Author
7/22/2014 | 5:20:33 PM
Re: FSMB Guidelines do not rule out the use of the telephone
I hear you about 'patients' seeking controlled or abused substances -- and most (if not all) telemedicine organizations I've spoken to refuse to prescribe narcotics or other medications commonly abused (like sleeping pills or anti-anxiety drugs). Often they list them on their website or give a brief recap when patients call, depending on the condition people contact them about. That's a smart approach since it eliminates that concern.

And i certainly understand physicians' worries about not knowing who they're treating, whether there's coercion or falsehood occuring, or something else happening on the (darkened) end of the phone. Perhaps, with such a high percentage of consumers now owning smartphones with video capabilities and the decreasing cost of data sharing, this will soon be a moot worry as anyone wanting to use telemed will soon be able to make a video connection?
Alison_Diana
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Alison_Diana,
User Rank: Author
7/22/2014 | 3:30:52 PM
Re: FSMB Guidelines do not rule out the use of the telephone
The problem with requiring telemedicine patients to have a primary care physician is that many people today do not have one. Instead, they rely on walk-in clinics or emergency rooms -- or telemedicine, if available. I agree that, in an ideal world, patients would have one doctor as their hub (it's how our family operates!), but for whatever reasons that model exists for fewer patients today than it did 10 or even five years ago. Should telemedicine not be an option for those patients who don't have a GP or access to videoconferencing?
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