American Telemedicine Association President-Elect Ed Brown, M.D., founder and CEO of the Ontario Telemedicine Network, coined this phrase at the American Telemedicine Association annual meeting.Dr. Brown made the point that telemedicine is growing out of the status of an innovative add-on technological extender to conventional health care, to an essential part of all patient health care.
As a corollary, Dr. Brown suggested that telemedicine, far from being overly technological, is actually personal and brings personalized medicine to the patient.
From my vantage, telemedicine offers an opportunity for integrative medicine, as it combines technological approaches, connecting clinicians and patients in remote locations virtually, rather than in-person, with health approaches such as individualized life and wellness coaching. The end result with be a seamless web of medical measurements and observations, and, patient education for increased awareness of lifestyle choices and self-care.
I agree with Dr. Brown that, like Internet access, telemedicine will become ubiquitous in health care within a short time frame. Moreover, telehealth practices are consistent with the Affordable Care Act in terms of creating outcome data, patient satisfaction, and other markers as to how successfully the health care system is delivering care.
Legal issues dominating the conference have included:
- licensure issues – i.e., the regulation of physician licensure by state (and licensure of psychologists, social workers, nurses, and other clinicians by state) and the need to ensure that when one is seeing a patient in the remote, the clinician comply with remote state licensing rules
- legal issues associated with e-prescribing (i.e., whether an in-person, face-to-face exam is meeting)
- whether the legal and regulatory framework needs to be upgraded (i.e., toward more allowance for cross-state clinical practices, including prescribing, via telemedicine, without an in-person physical exam or “established physician-patient relationship”)
- whether an in-person exam is required by statute or case law as part of the standard of care
- how to address HIPAA issues, including new rules regarding business associates and business associate agreements, as well as state privacy and confidentiality laws
- how legal issues vary depending on whether one is practicing tele-health generally, tele-psychiatry, telepsychology, tele-dermatology, or another form of telemedicine.
I addressed many of these issues in my talk on “Overcoming Legal Issues to a Multi-State Telemedicine Practice,” with a focus on physicians and other clinicians, and mobile app developers and other technologies companies operating in the telemedicine space.
The lack of uniform licensure across states–in large part, a function of the Tenth Amendment reservation to the states of the power to govern health, safety, welfare, and morals–continues to frustrate advocates of a more ubiquitous telemedicine practice. And, depending on statutory language, even a phone call from a physician to a patient who has traveled out of state for vacation can constitute telemedicine practice
For consultation regarding legal issues related to your telehealth practice, contact the Cohen Healthcare Law Group.
Contact our healthcare law and FDA attorneys for legal advice relevant to your healthcare venture.
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