cludes member companies such as Verizon, WellPoint, CVS, Walgreens, Teladoc, and Doctor on Demand. Meanwhile, Texas and other states have considered their
own legislation to open up telemedicine use. TMA testified on a handful of bills introduced during the 2013 legislature, and officials expect the issue to resurface in 2015. TMA and the American Medical Association are vigilant- ly monitoring legislative proposals at the state and federal levels to ensure that in all of these discussions, patient safety is paramount. At the same time, organized medicine is working within those bounds to remove potential bar- riers to appropriate telemedicine use related to licensing, credentialing, and payment. FSMB President and Chief Executive Officer Humayun J.
Chaudhry, DO, says his organization’s policy, which includ- ed input from every state medical board including TMB and from AMA, is part of an effort by the state regulatory boards to keep pace with the rapidly changing environ- ment of telemedicine. “I’m asked about what impact this will have on the financing and profitability of one technol- ogy or industry or another. I have no idea. We don’t get into that. Our primary mission is to protect the public and promote patient safety.” The policy redefines telemedicine as care that “typically involves the application of secure teleconferencing … to provide or support health care delivery by replicating the interaction of a traditional encounter in person between a provider and a patient.” It is not “an audio-only telephone conversation, email/instant messaging conversation, or fax.” Nor does “treatment, including issuing a prescription based solely on an online questionnaire … constitute an acceptable standard of care.”
Patient safety first Dr. Chaudhry says the updated guidelines reflect the fact that technological advances allow physicians to remotely, but safely, treat patients as if in the same room, but with- out first requiring an in-person encounter. At the same time,
“we do feel that the standard of care for an in-person en- counter should be similar to what goes on online.” The policy does not intend to exclude tools like phone and email. But by themselves, “they are going to have a harder time meeting all of the other requirements about the standard of care,” he said.
In addition to establishing a physician-patient relation- ship, those standards include requirements that telemedi- cine physicians:
• Disclose their credentials and verify the patient’s iden- tity and location;
• Perform a documented medical evaluation of the patient before treatment, including obtaining a clinical history, medical records, and informed consent;
• Maintain patient privacy and security; and • Provide avenues for follow-up and emergency care.
Glossary
CONNECTED CARE: An evolving term used to describe telemedicine or tele- health activities.
TELEHEALTH: Refers to a broad scope of remote health care services that may include clinical care but also encom- passes educational and administrative components, according to the U.S. De- partment of Health and Human Services Health Resources and Services Admin- istration (HRSA).
TELEMEDICINE: Refers specifically to the delivery of remote clinical services. Telemedicine is not considered a sepa- rate medical specialty.
TELEMONITORING: The process of using audio, video, and other telecom- munications and electronic information processing technologies to monitor the health status of a patient from a distance.
USES AND APPLICATIONS: Technolo- gies include videoconferencing, the Internet, store-and-forward imaging, streaming media, and land and wireless communications, according to HRSA. The American Telemedicine Associa- tion considers patient consultations via video conferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education, consumer-focused wireless applications, and nursing call centers part of tele- medicine and telehealth.
July 2014 TEXAS MEDICINE 21
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