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Does E-Health Stand a Remote Chance?

Gienna Shaw, for HealthLeaders Media, February 13, 2011
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The legal problems

Other obstacles include questions about licensing and credentialing requirements, who is responsible for maintaining patient records, how to get reliable and accurate access to patient histories, and how to deal with differing state regulations for ordering prescriptions. 

Before a physician can practice in a state or get privileges at a specific hospital, he or she must go through a rigorous process of licensing, background checks, credentialing, continuing education, and periodic recredentialing. The process is pretty straightforward. But telemedicine has blurred these legal and regulatory lines now that physicians can physically be in one state and simultaneously administer care to a patient in another state, according to CTeL.

Several professional organizations are currently working on reciprocity agreements between states, for example. One possible solution is to grant physicians a limited license to practice remote care or to offer multistate licenses at reduced fees. In May 2010, CMS proposed regulations designed to make it easier for hospitals to credential physicians who provide telehealth services at their facilities.

The present credentialing and privileging process requirements for telemedicine providers is “duplicative and burdensome for physicians, practitioners, and hospitals,” the agency said in its announcement of the proposed rule in the Federal Register. “It is particularly burdensome for small hospitals, which often lack the resources to fully carry out the traditional credentialing and privileging process for all of the physicians and practitioners that may be able to provide telemedicine services.”

The agency says it will publish a final rule in March 2011.

Another regulatory issue that crops up is whether the remote physician can (or should) prescribe medication for the patient, especially across geographic boundaries. If the physician doesn’t have a complete patient history, the answer to this question is simple: Don’t do it, says David. Physicians should also be aware of country-by-country and state-by-state prescribing and e-prescribing rules.

There is also the question of who is responsible for updating and maintaining medical records. It actually doesn’t matter, so long as you have a signed policy in place with an agreement as to who will update the patient’s medical record with information about the remote visit, David says. As with traditional visits, the referring organization or primary care physician would keep the full patient record, while the specialist would keep records pertinent to the consult. Alternately, a third party can coordinate. Just make sure you come to an agreement up front, he says.

The technical issues

It’s generally true that, over time, the quality and functionality of technology tends to improve while costs tend to drop. Early telemedicine adopters may have paid $200,000 for an in-hospital studio 15 years ago. Today, a similarly equipped setup might cost $30,000, says David. And it will have better equipment and capabilities.

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2 comments on "Does E-Health Stand a Remote Chance?"


Sherif E Issa (2/17/2011 at 5:58 AM)
I think at this stage; m-health or Tele-medicine succeeds better when presented as simple, mostly SMS based applications. A reminder to take your medication, or vaccination, or follow-up with pregnant women are some examples. These tools are very well accepted in developed and developing communities alike. But for more complex, fully fledged Tele-medicine applications, I can speak from my experience here in Egypt where we launched a 'Tele-Derma' project. Dermatology was an ideal candidate due to its highly visual nature.... several major entities collaborated to make this project a success – and it was – but only from a technical point. Pictures were taken, data logged in, information sent to experts and a full diagnosis + prescription was sent back.. all through broad band mobile technology; so it worked like a charm. Expert doctors were even more able to organized their schedules better, that was a bonus. On the human level however nor doctors or patients wanted to lose the 'personal' touch they enjoyed for years... some patients actually preferred to go to junior doctors in their local community where they can see and interact with him rather than get treated by an expert hundreds or thousands of kilometers away.

roger (2/15/2011 at 6:41 PM)
An excellent article, Gienna, identifying the areas that most people want to know about telemedicine and telemedicine equipment: ROI, ease of use, regulations, reimbursement. As I said, the important areas. I would suggest some other aspects that are crucial in designing the solution that best fits a practice or facility: Scalability - Is the system designed to accomodate other peripherals used in other modalities? Interoperability - Too many vendors have their own "secret sauce." In other words, the equipment they offer works with their systems, but no one else's. Connectivity - Does the equipment require special adaptors, connectors or interfaces to work with your system? If so, you're looking at a jangle of wires and cables and the likelihood that it still won't play well. Regarding Dr. Webster, we're proud to say that she chose GlobalMedia's telemedicine solutions that were designed for her needs at Loyola. Roger Downey GlobalMedia