July 7, 2012

Telemedicine – the Beauty and the Beast

There are several good definitions of telemedicine and I will cite the one from the American Telemedicine Association, which reads as follows, “Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients' health status. Closely associated with telemedicine is the term "telehealth," which is often used to encompass a broader definition of remote healthcare that does not always involve clinical services. Videoconferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education and nursing call centers are all considered part of telemedicine and telehealth.

Telemedicine is not a separate medical specialty. Products and services related to telemedicine are often part of a larger investment by health care institutions in either information technology or the delivery of clinical care. Even in the reimbursement fee structure, there is usually no distinction made between services provided on site and those provided through telemedicine and often no separate coding required for billing of remote services.

Telemedicine encompasses different types of programs and services provided for the patient. Each component involves different providers and consumers.”

This is broader in scope than I had envisioned, but in many ways more inclusive than I would have defined telemedicine. And yes, telemedicine has a national association. It needs one for all the issues that telemedicine encounters when crossing state and international boundaries.  

The beast is the many state medical associations and groups that have succeeded in putting limits on telemedicine by lobbying state legislatures. They are attempting to restrict it even further. At present, over 30 states have laws requiring that doctors have a physical examination requirement (PER) before any prescription is issued. These have become so restrictive that some patients are dying because they cannot obtain access to doctors. Fortunately, in some of these states, universities are stepping forward and establishing telemedicine programs utilizing nurses, nurse practitioners, and physician assistants that travel to rural areas and do the physical examinations for the doctors and communicate via video conferencing.

This study by the University of Tennessee while small, shows what can be accomplished and bring in the primary care physicians of the patients at the same time. For those wanting to check if a university in their state has a telemedicine operation, you will need to use your search engine and type in something like “telemedicine by universities”. There may be a list, but I have not located it. It is unfortunate that more universities with medical programs are not doing more to promote telemedicine.

Telemedicine is fraught with legal landmines and areas where the law has not kept pace with technology. Some medical practices such as psychology is pushing the envelope in hopes that they will be an influence to prevent state and federal lawmakers from passing laws that further restrict good medical practices. Read this article about some of the activities of the American Psychological  Association.

Even patients are wanting to be able to use telemedicine when traveling outside their home state or across international borders. However, most states currently do not allow doctors to practice across state lines unless they are licensed in the state. Reciprocity is a term foreign to the medical profession and state medical associations or chapters of national associations are mounting stiff opposition to this. I think that a patient that lives in Minnesota, for example, and travels to Florida for a few months should have the legal right to stay in contact with their doctor back home in Minnesota for new prescriptions and consultations via telemedicine. Currently this is not legally permissible.

There are patients that obtain extra prescription before traveling, but even some states are working to prevent these prescriptions from being filled in another state. Some pharmacies that are regional or have outlets in many states do fill these prescriptions because they have access to the patient's file and can see the doctor list for the patient and prescriptions previously filled.

For those wanting to do more reading, here is a magazine that is still on the Internet but last copyrighted in 2002, in other words a dead magazine. It does list a few organizations that are still active on the page, bottom center.  There is also a journal for telemedicine here.

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