Nor is telehealth an easy proposition.


As chief medical officer and chief medical information of- ficer for the Houston-based Brighter Day Health, Dr. Kim man- ages the technology and operations involved to ensure success- ful care delivery. That success also means “redefining how you communicate and work with people remotely,” he said, adding that continuity of care also is important. “I specifically design my clinics so I can tell my patients, ‘I’ll just see you next week.’” That meant one incarcerated 15-year-old girl could see Dr. Kim weekly, instead of waiting in long lines for an appoint- ment at a community mental health center. Debbie Voyles, director of TTUHSC’s telemedicine program, adds that privacy and security can be concerns with telemedi- cine. To address those concerns, the program has a number of protocols in place: Patients visit an established medical site, which could be a school or a rural-based clinic where they routinely seek care. Care teams document the visit. Patients sign consent forms and provide copies of identification and insurance cards.


“The people on the other end know who the patients are, and the patients know them. That’s where our security is built in to make sure we are appropriately treating,” she said. “Tak- ing a credit card for $39 to treat or prescribe a medicine based on a survey you fill out or a phone conversation? I don’t think that’s good quality care.”


Licensure, credentialing barriers Despite the benefits of telemedicine, some regulatory and leg- islative barriers still exist. For one, because telehealth programs typically involve phy-


sicians treating patients in different geographical locations, state licensing restrictions can deter adoption. Dr. Kim recently submitted his 14th medical license application. He works in several states for his multistate company. He’s encouraged, however, by FSMB’s proposal for an inter- state medical licensure compact that would allow physicians to practice in multiple states without having to go through each state’s individual licensure application process. State boards would mutually agree to a common set of requirements to help streamline licensing, but participation would be voluntary. Dr. Chaudhry says the proposal, more than a year in the making, is not exclusive to telemedicine. But demand for the technology bolstered support for the idea. Neither TMA nor AMA has taken a position on the compact, but AMA is working with state medical associations and FSMB as it’s developed.


Some physicians have expressed concern such a compact could undermine states’ licensing and disciplinary authority, especially in Texas, which has some of the toughest licensure rules in the country. As proposed, however, Ms. Robinson says the compact would include eligibility requirements that exceed Texas rules, by requiring board certification, for example. Other standards would mandate a clean criminal, state licensure, and prescrib- ing history. TMB recently decided to move forward in discussing the


Telemedicine by the numbers 10,000,000


telemedicine, most often for radiology, stroke, and intensive care unit services.


>50% 20


43 9,748 states (including Texas) and the


District of Columbia require private insurers to cover telehealth as they do in-person services.


states (including Texas) and the


District of Columbia provide some form of Medicaid payment for telehealth services.


Texas Medicaid patients


received telemedicine services in 2011, a 113-percent increase from 4,269 patients in 2009.


Sources: American Telemedicine Association, Texas Health and Human Services Commission, and National Conference of State Legislatures


people use


some form of telemedicine, a number projected to double in the next few years.


of U.S. hospitals use


July 2014 TEXAS MEDICINE 23


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  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68