Technology can improve patient care, but that’s no substitute for face-to-face exams. No one knows that better than Douglas Curran, MD. When a concerned mother contacted him about her teenaged daughter’s bladder infection, he simply could have called in a prescription. But when he realized he hadn’t seen the girl in quite some time, Dr. Curran insisted on examining her in person.
“I noticed right away that my patient had put on a considerable amount of weight. When I examined her, I realized she was in labor. Her mother had no idea.”
T
he Athens family physician says this experience illus- trates the need to examine patients in person and the value of an established patient-physician relationship. “Physicians can’t rely on the telephone or the Internet in ev-
ery situation,” said Dr. Curran, a member of the Texas Medical Association Board of Trustees. Like other physicians, Dr. Curran believes a physician’s re- lationship with a patient is a sacred connection that fosters trust. Evolving technology, however, challenges them to com- municate and consult with patients electronically without frag- menting the relationships or compromising patient safety. The emerging practice of telemedicine allows physicians to consult with patients over the telephone, through live Internet chats, with a webcam, or by other electronic means. Physicians and lawmakers are examining telemedicine’s ability to expand patient access to care via technology while ensuring safe, high-quality health care. TMA physicians testi- fied on several telemedicine bills in this year’s session of the Texas Legislature. TMA worked to make sure the bills guar- antee appropriate care and that tele- medicine practitio- ners comply with Texas Medical Board (TMB) rules. TMB’s telemedi-
18 TEXAS MEDICINE June 2013 Thomas Kim, MD
Sidney Ontai, MD
cine rules cite a physical examina- tion as a minimum criterion for estab-
lishing a patient-physician relationship. They say distant site providers who use telemedicine must establish a proper pa- tient-physician relationship that at a minimum includes:
• Establishing that the person requesting the treatment is who he or she claims to be;
• Diagnosing through acceptable medical practices such as patient history, mental status examination, physical exami- nation, and appropriate diagnostic and laboratory testing to establish diagnoses and identify underlying conditions or contraindications, or both, to treatment recommended or provided;
• Discussing with the patient the diagnosis and the risks and benefits of various treatment options; and
• Ensuring the availability of appropriate follow-up care. TMB rules define a distant site provider as a Texas-licensed
physician, physician assistant, or advanced practice nurse
“who is supervised by and has delegated authority from a licensed Texas physician, who uses telemedicine to provide health care services to a patient in Texas.” They also stipulate that an online or telephonic evaluation solely by questionnaire does not constitute an acceptable standard of care. To read TMB’s rules online, visit
bit.ly/12qwQM0. Access
TMB’s frequently asked questions telemedicine page by visiting
bit.ly/115XBCu. Norman Chenven, MD, Austin Regional Clinic (ARC) found- er and chief executive officer, is a consultant to Teladoc, a telemedicine company that has done business in Texas since 2005. He says telemedicine’s enhanced access to care inevita-
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60