Before the expansion of internet and other communication technologies, health care was almost exclusively an in-person service. This often creates a mismatch between capacity and need, particularly for less-used specialties and sub-specialties. Telemedicine in all its permutations offers a wonderful opportunity to reduce the costs of providing a service, improve quality by matching the best medical resource to a patient’s need and increasing patient satisfaction by more convenient and timely access. Despite the obvious advantages, the field has had slow growth, often inhibited by reimbursement and regulatory policies that stifle its use. In particular, state medical boards and other regulators have attempted to require that anyone providing services to a resident of a state be licensed there and there usually is limited reciprocity. Ideally, the federal government would step in and force national recognition of medical and other health care licenses, but as usual politics has gotten in the way of common sense and the common good. The Federation of State Medical Boards has tried to provide some standardized guidance and has issued a new model policy on use of telemedicine. (Telehealth Policy)
The primary feature of the policy is the continued insistence that a treating physician must be licensed by the medical board where the patient is located. This is simply absurd and has no rational basis. The model rule also defines what is required in establishing a physician-patient relationship. In evaluating and treating a patient, the guidelines say it is never appropriate to prescribe on the basis on online questionnaire, which may or may not be a good limitation. So long as the physician or other provider has a trustworthy knowledge basis about the patient, has a history with the patient or other factors are present, an online interaction may be adequate. The rule appears to require a specific informed consent to the use of telemedicine, which also has no rational basis. There are further provisions relating to continuity of care, keeping of medical records, privacy and disclosure by any operator of an online medical service of certain information to the patient. In addition to the expected resistance from some segments of the physician community, which has a long history of turf protection, there is a risk that these sorts of regulatory endeavors get hijacked by particular vendors and used to disadvantage competitors. If you look at the list of subject matter experts, that may have happened here. Overall, this model regulation serves only the interests of local physicians and established telemedicine vendors trying to create barriers to entry.