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New video medicine proposal raises telehealth concerns


By Joseph Conn
Posted: April 25, 2014 - 12:30 pm ET
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A controversial proposal that favors video-conferencing over the use of phones, e-mails and texting for remote health services is scheduled to come to a vote Saturday at the Denver meeting of the Federation of State Medical Boards.

If the federation approves the policy and its member boards adopt it, “the exclusion of telephone only will set the field of telemedicine back a decade,” said Dr. Henry DePhillips. He's the chief medical officer for Teladoc, a 12-year-old Dallas-based firm that offers an Internet and telephone-based physician virtual visit service to health plans, employers, hospitals and integrated delivery networks.

“The socially and economically disadvantage are the ones that are going to suffer the most and that would be a tragedy,” DePhillips said.

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The FSMB workgroup's proposal, which aims to update a 2002 federation policy guide on the appropriate use of the Internet, could serve as a model for the not-for-profit federation's 70 member boards nationwide. It is these member bodies, not the federation itself, that have regulatory authority in their respective U.S. states, territories and the District of Columbia.

The chronically ill might be adversely impacted by the policy, said Amy Comstock Rick, CEO of the Parkinson's Action Network, a Washington patient advocacy group.

The use of telemedicine has experienced “hockey stick growth in the past 24 months” and “virtually all of that growth has been based on telephone-based telemedicine,” DePhillips said.

“We really applaud the FSMB for moving forward with a telemedicine policy,” Rick said. But she also takes issue with the policy's slant toward video over audio conferencing.

“That is a term (video) that could be outdated in six months,” Rick warned. “And we could easily imagine a doctor-patient interaction that is only audio and combined with an app (supplying data from a mobile monitor, for example) and that might be completely fine. It's always scary to be narrow in your definition of technology because it's changing so fast all the time.”

Such concerns may be premature, said Lisa Robin, the federation's chief privacy officer. Typically, Robin said, state boards “cut and paste” from federation guidelines, tweaking them to their own needs. Plus, “I think this certainly has been misinterpreted some,” she said.

The main issue is getting the necessary information in a first visit for diagnosis and treatments, she said. The workgroup and comments from the board suggested that an audio-only first meeting between patient and doctor might not supply the doctor with all the information needed to do a proper diagnosis, she said. “If it was the only encounter between these parties for diagnosis and treatment … (an audio-only interaction) might not meet standards of care,” she said.

The model policy says that a physician-patient relationship must be established for physicians to engage in telemedicine, but that a relationship can be initiated “whether or not there has been an encounter in person between the physician (or other appropriately supervised healthcare practitioner) and patient.” Also, it says that a relationship “may be established using telemedicine technologies provided the standard of care is met.”

In defining telemedicine technologies, the model policy describes them as “technologies and devices enabling secure electronic communications and information exchange between a licensee in one location and a patient in another.”

But in defining telemedicine as a care type, the 11-page draft obtained by Modern Healthcare says that, “Generally, telemedicine is not an audio-only, telephone conversation, e-mail/instant messaging conversation or fax. It typically involves the application of secure videoconferencing or store-and-forward technology to provide or support healthcare delivery by replicating the interaction of a traditional encounter in person between a provider and a patient.”

The policy does not affect physician phone conversations or other electronic messages with established patients, Robin said.

The policy also appears to oppose interstate telemedicine relationships, recommending that a physician must be licensed or under the jurisdiction of the medical board of the state where the patient is located. But Robin said the policy merely reflects state laws, noting that 30 states still require a face-to-face visit for a physician to write a patient a prescription, so advocating for video conferencing as a substitute for a face-to-face encounter is a step toward embracing technology.

The federation is helping coordinate an initiative by state boards to come up with telemedicine friendly, multi-state physician licensing compact, Robin said. That could be ready in less than a year, but would require action by state legislatures, she said.

Follow Joseph Conn on Twitter: @MHJConn


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