For the last few months, family physician Dr. R. Russell Thomas Jr. has split his time between visiting patients at his practice in Eagle Lake, Tex., and treating children who reside more than 300 miles away in Sheffield, Tex. via telemedicine. His virtual tool belt includes an electronic stethoscope that enables Dr. Thomas to hear a patient’s heartbeat in real time and a high-definition camera to view and diagnose skin lesions.
The telehealth services are part of a new initiative at Rice Medical Center, a 25-bed, critical access hospital in rural Eagle Lake – population 3,700. Dr. Thomas has thus far used the technology to treat patients at an at-risk children’s academy and a local primary school. Soon, he and other physicians will also use telemedicine to consult with cardiologists and internists who practice 70 miles away in Houston.
“I look at telemedicine not so much as a practice like cardiology or orthopedics, but more [as] a tool like a percussion hammer or an otoscope,” Dr. Thomas said in an interview. “It’s a tool to practice whatever it is that you do.”
Dr. Thomas is far from alone. Analysts predict vast growth in the telemedicine industry in the coming years. The number of health providers offering telemedicine is expected to rise from 22% in 2014 to 37% in 2015, according to research by Towers Watson. Another report, by BCC Research, shows the global telehospital/clinic and telehome market is expected to reach about $43 billion in 2019, up from $19 billion in 2014.
The explosion of telemedicine is driven by two primary factors, said Dr. Joseph P. McMenamin, a Richmond, Va., attorney who specializes in medical malpractice defense and telemedicine.
“As a society, we are increasingly reliant upon and enamored of electronic methods of communications,” Dr. McMenamin said in an interview. “In one sense, it’s just part of a larger trend. The other, more specific reason, perhaps, is the widespread dissatisfaction with the way our health care system operates today. We are blessed in the United States to have some of the finest physicians in the world. … and then we have this terribly complex, burdensome system for getting people to where they need to be to get care. Telemedicine, by comparison is quick, convenient, and relatively inexpensive.”
Telemedicine is poised to change the way doctors practice. This first of three articles lays out the landscape for how telemedicine is shaping up across the country.
But for doctors, the practice of telemedicine is strewn with challenges. Barriers include reimbursement, licensing, malpractice, and regulation. Topping the barriers is a lack of uniform standards about practices. A key question: What constitutes the responsible use of telemedicine?
States have differing ideas. Some require a physical examination by a physician prior to telemedicine. Some allow that encounter can be conducted via telemedicine, while others mandate the visit is in-person. Alabama, Georgia, and Texas require an in-person follow-up visit after a telemedicine encounter, according to 2015 data from the American Telemedicine Association (ATA). Sixteen states and D.C. have informed consent requirements for telemedicine patients. Still other states have no defined rules for the practice of telemedicine.
To promote consistency and better usage, the Federation of State Medical Boards in 2014 issued a model policy to state medical boards about the recommended practice of telemedicine. The policy maintains that the same standard of care applied to face-to-face encounters be applied to telemedicine encounters, said Lisa A. Robin, chief advocacy officer for the Federation of State Medical Boards (FSMB). At least 29 state boards have telemedicine rules that are consistent with the model policy, Ms. Robin said in an interview.
“As telemedicine continues to evolve, we believe there must be a very strong focus on ensuring patient safety through sound policy making and regulatory practices,” she said.
From practice debate to court dispute
Medical specialty societies are beginning to weigh in on acceptable telehealth practices for doctors. In July, the American Academy of Pediatrics issued guidance advocating that use of telemedicine for episodic care should be done within the context of the medical home and that fragmented telemedicine services should be avoided. Guidance issued by the American Medical Association makes it clears that physicians who prescribe using telemedicine need to first establish a patient-physician relationship. In September, the American College of Physicians (ACP) also issued policy in support of expanded telemedicine use, but cautioned the practice should be between a physician and patient who have an established relationship. The FSMB guidance also states that doctors should establish a relationship with patients before practicing telemedicine.