Audio-only telephone calls just don’t cut it as telemedicine.
At least not according to freshly-minted guidelines for states’ use of telehealth and related technologies. Those guidelines, in fact, have brought up the question of whether video is an essential component of telemedicine.
“Generally, telemedicine is not an audio-only telephone conversation, e-mail/instant messaging conversation, or fax,” states the Model Policy on the Appropriate Use of Telemedicine Technologies in the Practice of Medicine, which the Federation of State Medical Boards recently approved. “It typically involves the application of secure videoconferencing or store-and-forward technology to provide or support healthcare delivery by replicating the interaction of a traditional encounter in person between a provider and a patient.”
While the guidelines are really just a model that individual states can adopt - verbatim or otherwise - that definition is a sticking point.
The American Telemedicine Association, in fact, recently proposed changes to the document that called for deleting the reference to telephone and e-mail consultations, a suggestion that the FSMB did not take.
“For decades, physicians have routinely provided telephone consults for weekend coverage, follow-up care and in many other circumstances,” the ATA wrote. “Also, a growing number of the nation’s largest medical systems have approved the use of secure e-mail for communication with patients, even though such communications many not be covered as a fee-for-service payment.”
Indeed, Deloitte predicts some 75 million e-visits will occur in 2014. And if that seems overly optimistic, Kaiser Permanente conducted approximately 10.5 million consults via telephone, e-mail and video technologies last year alone.
“State policies that prohibit any such use could set back the practice of medicine and significantly limit the delivery of care,” the ATA wrote.
That said, the FSMB undertook what could be considered a noble goal.
“The model policy states that the same standards of care that have historically protected patients during in-person medical encounters must apply to medical care delivered electronically,” the group stated, adding that a core element of that is to establish a patient-provider relationship adhering to “widely recognized standards of care.”
So, can physicians achieve those same standards of care with audio, e-mail and text consults, or is the face-to-face visit that video enables absolutely necessary?
