Telemedicine should be used to enhance the delivery of medical care, but only between a physician and patient who have an established relationship, according to a policy statement from the American College of Physicians published Sept. 7 in the Annals of Internal Medicine.
“Telemedicine is rapidly growing and can potentially expand access for patients, enhance patient-physician collaboration, improve health outcomes, and reduce medical costs,” said lead author Hilary Daniel, an ACP health policy analyst. “However, the potential benefits of telemedicine must be measured against the risks and challenges associated with its use, including the absence of the physical examination, variation in state practice and licensing regulations, and issues surrounding the establishment of the patient-physician relationship,” she said.
The ACP notes that telemedicine is a reasonable alternative for patients who lack access to relevant medical expertise in their location, and that its practice can reduce medical costs and increase access to care. Episodic, direct-to-patient telemedicine services should be used only as an “intermittent alternative” to a patient’s primary care doctor when necessary to meet immediate acute care needs, according to the policy (Ann Intern Med 2015 Sep 7. doi: 10.7326/M15-0498).
A valid patient-physician relationship must be established for a responsible telemedicine visit to take place, although that relationship can be created through real-time audiovisual technology. A telemedicine doctor who has no existing relationship with a patient must take steps to establish a relationship based on the standard of care required for in-person visits, or by consulting another physician who has a relationship with the patient and oversees the patient’s care, the policy advised. Doctors should use their best professional judgment when deciding whether telemedicine is appropriate for a patient and never compromise their ethical obligations to deliver clinically appropriate care for the sake of new technology.
The college calls for the lifting of geographic site restrictions by Medicare that limit payment for telemedicine and telehealth services. Additionally, ACP supports payment by public and private health plans for appropriately structured telemedicine communications, whether synchronous or asynchronous, text-based, or supplemented with voice, video, or device feeds.
“Telemedicine shows promise not just in the United States but across the globe as third-world and developed nations embrace technology as a way to provide citizens access to health care,” Ms. Daniel and her colleagues wrote in the policy statement. “The legal, regulatory, technical, and cultural barriers to widespread adoption in the United States should be addressed to fully realize the potential of telemedicine for the benefit of physicians, patients, and the health care system.”
In an accompanying editorial, Dr. David A. Asch executive director of the University of Pennsylvania’s Center for Health Care Innovation, adds telemedicine can mean significant savings for physicians and patients in the form of time, money, and administrative burdens.
“The scalable gains from telemedicine will come from delivering care to populations – sometimes highly specialized care, in totally different ways – often with less physical infrastructure and less of the baggage that accompanies conventional practice,” Dr. Asch wrote. “Although the ACP position paper urges parity between telemedicine and face-to-face medicine in how physicians practice and get paid, arguing for parity is a trap if it merely carries forward practice styles and reimbursement requirements from one context to the other. The innovation that telemedicine promises is not just doing the same thing remotely that used to be done face-to-face but awakening us to the many things that we thought required face-to-face contact but actually do not.”
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