I have been very impressed with the work the Center for Telehealth & e-Health Law (CTeL) has been doing to educate people about telemedicine.
I have been very impressed with the work the Center for Telehealth & e-Health Law (CTeL) has been doing to educate people about telemedicine.
Greg Billings at CTeL keeps people informed of the latest happenings that affect the world of telemedicine. For example, he posted a note over the weekend on the North Carolina Medical Board and how it views telemedicine by its licensees. Here’s the link to his note. I had the opportunity to speak to the North Carolina Board about five years ago when I worked for the Arizona Medical Board, and I have a great deal of respect for the work that agency does. It didn’t surprise me that the North Carolina Board is being proactive on the topic.
Dr. Scott Kirby, the board’s medical director, said that licensees need to exercise caution in selecting a telemedicine provider before agreeing to see and treat patients via telemedicine. In this regard, I believe Dr. Kirby is referring to the relatively new Internet business models that connect patients with licensed physicians, often at odd times of the night or on weekends, by telephone or via videoconrerence. I think that it’s always good to be careful to make sure that down the line your licensing agency doesn’t hold you accountable for unprofessional conduct.
Dr. Kirby points out that physicians must do an appropriate examination BEFORE diagnosing or treating a patient they’ve never before seen. This examination cannot be the illegal Internet prescribing sort (the kind where the patient fills out an online questionnaire, does live-chat with a physician, and then purchases an over-priced prescription for an erectile dysfunction drug), but must be “substantially equivalent” to an in-person exam. Although he leaves it up to licensees to decide how to conduct a substantially equivalent exam with a patient at a remote location, this can be done with a patient “presenter” at the patient’s location. The presenter, a lower level licensed healthcare professional, understands he or she is the “hands” of the physician in the event palpation is required. With proper training, the presenter can help the doctor understand the patient’s condition or problem. The doctor could then decide to treat the patient and/or to schedule an in-person appointment for further evaluation.
The other condition to establish the doctor-patient relationship, per Dr. Kirby, is appropriate follow-up care. The telemedicine visit should not be a “one-off” event because the physician now has the responsibility to see that his treatment plan for the patient is working… or not. If it isn’t, then the doctor should modify the treatment plan. Then, should the doctor’s modified treatment plans fail to help the patient, ethically he must refer the patient to another physician.
Dr. Kirby says the other requirement for a diagnosis via telemedicine is to take a complete medical record which “must be available to the patient and to other treating health care providers.” So telemedicine doesn’t relieve a physician of the paperwork associated with in-person visits. In fact, it’s probably more crucial to the doctor to make sure what is said is documented during the telemedicine visit or soon after and not trust your memory several days later. Normally, medical boards will tell physicians accused of falling below the standard of care that if it isn’t in the record, it didn’t happen, no matter how sure a doctor is that it was discussed and the patient understood.
Of course, GlobalMed understands what it takes to put together a good telemedicine program, whether at the practitioner level or at the hospital level. Our advice is always free.
