Many legal obstacles have long stood in the way of telehealth. There are licensure laws, prescribing laws, practice of medicine requirements, credentialing rules, insurance coverage issues, and concerns about privacy, among others. These hurdles have until recently relegated telehealth to the most geographically remote corners of health care where the only means of obtaining medical care is by phone or computer connection to a provider hundreds of miles away. But now, with physician shortages and the ubiquity of the smart phone, telehealth is beginning to show up all over the place, and there are rumblings that it could fundamentally change the practice of medicine.
- Is telehealth changing the nature of the relationship between patients and their providers?
- Is it changing how and when people engage the health care system?
- Is it changing how physicians communicate with each other and with patients?
- Is it sufficiently different from the in-office practice of medicine as to require its own protocols and standards?
- Is telemedicine fundamentally different from traditional forms of medicine?
Technologies often precede the development of rules on how to use them, and this certainly appears to be the case with telehealth. To the extent there are laws and standards in this area, they reflect different notions and some confusion on how telehealth will affect the practice of medicine. For example, some states have created new laws for telehealth (such as special licensure, e-prescribing laws), which treat telehealth as something fundamentally different from the ordinary practice of medicine; whereas others states continue to require telehealth providers to comply with their traditional practice of medicine laws.
But there do seem to be efforts underway to sort out this confusion. In the United States, these efforts are primarily occurring in the private sector through collaborative initiatives to develop standards and guidelines. The American Telemedicine Association is helping to lead this effort by convening workgroups to think about the issues facing telehealth and develop evidence-based standards and guidelines for telehealth across a range of medical specialties (e.g. telepathology, telemental health, teledermatology). Physician medical societies and academic-based organizations such as the Center for Connected Health in Boston are also playing important roles. Elsewhere in the world, the Europeans have created Telescope which is an organization partially funded by the European Commission charged with developing a comprehensive Code of Practice for Telehealth Services. Other organizations such as the Telecare Services Association in the UK, the Australian government’s IT-014-12 Telehealth subcommittee and the The Royal Australian College of General Practitioners are also developing telehealth guidelines and standards.
I hope that the standards and guidelines being developed today by ATA and other private organizations will lead to a better understanding of the risks and benefits of telehealth, and comprehensive standards and practice guidelines that ensure that these new technologies are used safely and effectively. Perhaps in time, these developments will inspire new state and federal laws for telehealth that more appropriately address the issues and risks associated with telehealth based medicine.