Page 34 - Network Magazine Summer 2019
P. 34

Its Legal Challenges
The advent of internet-enabled technologies and the expansion of telecommunication services has made a new form of medicine possible, appropriately branded telemedicine. The simple definition of telemedicine is the use of electronic communications and software to provide clinical services to patients without an in-person visit. At this point, many of you have probably heard of telemedicine. In fact, the idea is certainly not new. As far back as the 1950s hospital systems and medical centers attempted to share information and images via the phone. One of the first reported successes of this foray occurred in this state when two Pennsylvania health centers trans- mitted radiologic images over the phone.
Unlike telehealth, which is a broad term referring to any health services conducted with the aid of internet tech- nologies, telemedicine specifically entails replacing the traditional doctor’s visit with a secure online interaction. There are two primary forms of telemedicine technolo- gies, “synchronous” and “asynchronous.” “Synchronous” technology allows real-time communication between the patient at the “originating site” and the practitioner at the “distant site.” “Asynchronous” technology, also known as “store and forward,” refers to the transmission of medical information from the “originating site” to the “distant site” that the practitioner then reviews at a later time. Policy- makers and physicians alike strongly prefer “synchronous” technology as having a live, interactive conference is much less likely to impact the quality of care. Many of the existing insurance carriers that offer reimbursement for telemedicine services strictly prohibit "asynchronous" technology.
The popularization of telemedicine arose from its theo- rized diverse applications, especially its use for providing specialty care for remote patients who have previously lacked the availability and means to seek such care. Other applications include "follow-up" visits, remote chronic disease management, remote post-hospitalization care, preventative care support, school-based telehealth, and assisted living center support. "Follow-up" visits are
often missed or rescheduled. Telemedicine eliminates this inefficiency and increases the convenience for the patient and provider. Utilizing telemedicine for chronic disease management decreases cost and allows patients to maintain better control over their health. Readmissions due to a lack of proficient post-hospitalization care can be significantly reduced by employing telemedicine to assess and advise patients whether to return to the hos- pital. Mental health and addiction treatment can benefit patients by ensuring they receive the immediate care and support they require. By instituting telemedicine in school systems, children can receive immediate diagnoses from practitioners without ever having to leave school. This di- agnostic triaging can determine the severity of the child's condition and thereby reduce the unnecessary and costly process of parent pickups and immediate emergency center care. Parents can be provided with instructions and reassurances all in a convenient, streamlined manner. Assisted living centers now have an avenue for less urgent issues that arise at night or on the weekend that forego hospitalization. On-call practitioners can now provide immediate care. With a multitude of applications and availability of technology telemedicine should be widely available; however, two hurdles, regulation and reimburse- ment, continue to block the way.
Though the idea is old, the adoption and practice of tele- medicine are still in its infancy. Not only did the concept of telemedicine have to wait for the production of expensive and complex equipment capable of reliably connecting doctors to their patients, but it also had to wait for the ad- aptation of the legal and regulatory framework to support it. Much like the adoption of universal electronic medical records, the process to implement widespread access to telemedicine has been arduous. Even in this modern technological age, long after the necessary equipment and network infrastructure have been developed, legisla- tures have been slow to pass bills that specifically outline the regulations on telemedicine and the limitations on insurance carriers reimbursing practitioners.
The regulatory environment for telemedicine presents various key issues that state medical boards and leg- islatures have worked to define and resolve. Chiefly among those issues, online prescribing, physician-patient relationship, cross-state licensing, and patient consent for treatment have posed strenuous challenges. Online pre- scribing of medications via telemedicine, especially that of scheduled drugs, typically requires an initial in-person physical exam. How the physician-patient relationship is established for telemedicine differs from state to state. Some states require the first "new-patient" visit to be in person with subsequent "follow-up" visits allowed to be

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