AcuteCare Telemedicine Blog


Telemedicine and the Medical Licensing Debate

The number of patients served by telemedicine has grown from a few thousand in the mid-1980s to an estimated 10 million people today. The majority of the growth occurred in the last decade, according to the American Telemedicine Association. Despite the rapid adoption of telemedicine practices by healthcare institutions, practitioners must meet individual state medical licensing requirements.

Some states argue that easing licensing requirements could jeopardize patient safety. If doctors practice without obtaining a license in that state, regulators maintain that they have no power to conduct an investigation or explore a consumer complaint. In addition, doctors would not benefit from any legal protections the state may have against malpractice lawsuits. Advocates of telemedicine argue that because doctors take standardized national exams, with many requirements set by federal agencies such as the U.S. Department of Health and Human Services, states should recognize other state licenses. The debate is not without merit, on either side of the issue.

In a time past, interstate commerce experienced similar obstructions to improving the nationwide consumer product and service delivery model. Implemented in an era before advanced transportation technology and the interstate highway system carriers of goods and services across state lines were required to have individual state licenses, adhere to 50 different sets of roadway regulations and pay transportation taxes and fees in every state where transportation service was provided. The very formidable barriers to streamlining interstate commerce were successfully circumvented by a new national regulatory and licensing system. The move successfully addressed the individual state concerns and resulted in massive improvements to the nationwide delivery of good and services to all consumers, no matter where they resided.

Today, as major telecommunications and health care firms look to create nationwide telemedicine businesses, state medical licensing boards are set to consider an “interstate medical licensure compact” that would give doctors and patients legal protections in any state that signs on. The proposal, to be considered at the annual meeting of the Federation of State Medical Boards (FSMB) this month, would expedite the licensing process for doctors who want to practice across state borders. The compact, which was developed by a task force of 22 state medical boards, may represent the first step in resolving the issue. Lisa Robin, chief advocacy officer for the federation, expects there will be some early adopters. “I believe there will be some proliferation.”

The medical industry is facing significant challenges in the coming decades, such as physician shortages, spiraling costs of care, specialist accessibility and the entry of millions of new patients to the market as the Affordable Care Act (ACA) is fully implemented. In order to implement a long-term solution, technology standards and medical licensing requirements share equal importance in the debate.



Breaking the Rules

The Georgia Composite Medical Board recently voted against implementing a rule requiring that any patient must be seen by a physician before receiving care from nurses or PAs via telemedicine technologies, a requirement that realistically cannot be met in most non-telemedicine encounters. It was a small but important victory for practitioners and patients alike.

Prior to being voted down, the proposed rule was drawing widespread criticism from proponents of telemedicine, and for good reason. The motivation for suggesting the rule was to ensure that all mid-level providers caring for patients via telemedicine were being properly supervised by doctors who are more familiar with the technologies. Certainly, taking steps to guarantee the quality of care and safety of patients, especially when dealing with new tools and methods, is of utmost importance to everyone involved in the care process. However, the rule would have been damaging to the improved access to care that is a hallmark of telemedicine, placing an additional an unnecessary step between patients who need immediate attention and the care they require.

With the increasing shortage of physicians, not just in Georgia, but nationwide, telemedicine has opened avenues for the delivery of quality care to individuals living in rural and underserved locales where providers simply are not available. As more practitioners educate themselves on the virtues of telehealth, the reach of doctors, nurses, and other healthcare professionals will extend further than ever before.

Telemedicine will ultimately enter our vernacular and be known simply as ‘medicine.’ In the meantime, as our technology and methodology continue to evolve, we must be careful to steer clear of implementing laws such as the redundant rule proposed in Georgia to avoid setting precedents that will preclude telemedicine from playing its role in assisting our healthcare system reach new heights.



Long Distance Learning

Along with other massive changes brought on by the increasing power and reach of the internet, the past decade has seen a drastic increase in the number of undergraduate and graduate degrees attained online. Today, more than 12,000 different “digital degrees” can be obtained from accredited U.S. universities, a figure that has grown by double digits annually for the last five years.

While the growth of the internet has enabled a plethora of such ‘distance learning’ opportunities for collegiate education, new technologies and practices in telemedicine are simultaneously reinventing the approach to professional education in hospitals and healthcare facilities around the world.

The educational aspects of telehealth programs demand the least effort and level of investment of any implementation of the discipline, but the benefits of adoption are immense, and can serve as the building blocks for increased engagement down the road.

Telemedicine actually allows hospitals to bring the education directly into the facility, offering professional training directly from the experts on the newest procedures and protocols, as well as serving as a 24/7 resource always available for consultation.  Bringing this type of program into a hospital not only helps administrators, physicians, nurses, and staff better perform their jobs and offer patients a better standard of care, but also creates champions of the telemedicine services, opening the door to a healthcare ecosystem that is far more responsive to innovation.

Introducing telemedicine to healthcare facilities through educational initiatives is also a great way to align the goals of the hospital and the provider to foster stronger relationships for the future. The facility wants to offer top quality care within the confines of a tightening budget, and the provider wants to help its client hospital save lives while reducing spending in the process to demonstrate its competitive advantage. The educational process is a great way to interface with the effective and efficient solutions that telehealth can offer. It is a major step towards a future where all hospitals have access to the resources they need to operate equally efficiently; a win for patient and provider alike.



Good Things Come in Small Packages

As the fall approaches and we reach the third anniversary of AcuteCare Telemedicine, we have spent some time reflecting on our company and personal growth over the last three years. From simple beginnings, serving one health care facility in the metro Atlanta area, ACT has expanded to include facilities in rural communities of both Georgia and Tennessee. We have developed alliances with Emory University Hospital and the Georgia Partnership for Teleheath, two partners who enable us to provide the highest quality of acute neurologic care where it may otherwise be lacking. Turning our attention forward, ACT continues to push to ensure that every emergency department is staffed with adequate 24/7 neurology coverage, whether in person or via remote presence.

ACT has always believed that our successes are primarily due to the quality of services we offer. Despite our expansion over the past three years, ACT has remained a small, intimate company, still owned and operated by its four founding physicians. We find unique value in our size; it allows for outstanding continuity of care, frequent “meetings of the minds,” and quick, effective identification of problems and subsequent solutions.

Weekly meetings with all four physicians cultivate innovative ideas, enable problem identification, and facilitate the creation of solutions in a timely and efficient manner, advantages rarely possible in larger corporations. Thanks to the size of the company, each physician of ACT has a specific role, but can be flexible and share duties when needed, strengthening the consistency of the quality care we provide.

Being smaller has other rewards. In the world of acute neurological emergencies, there is little time for complex communication and red tape. When problems or concerns arise at any of our serviced facilities, an ACT physician can immediately make contact remotely and work directly with a facility member on issue resolution. Try calling up the CEO of your car’s manufacturer when your check engine light comes on.

The four physician-owners of ACT continue to practice neurology in a group that has been caring for patients for more than 65 years combined. We are highly trusted neurologists in our own community, and we are committed to bringing our expertise to other communities in need. Our small size ensures that we will stay focused on keeping our standards high and our integrity intact along the way.



Privacy Issues Come to Light

Last month, the Veterans E-Health and Telemedicine Support (VETS) Act was introduced to Congress. The bill would “allow health professionals at the Department of Veterans Affairs (VA), as well as outside VA contractors, to practice telemedicine across state borders if they are qualified and practice within the scope of their authorized federal duties.” Unsurprisingly, the bill is casting a new light on issues of privacy and security in the growing telemedicine field.

Currently, different states have their own regulations around privacy rules that range from less to more severe than federal HIPAA laws. The VETS act has raised the question of what rules, state or federal, would apply in cases of doctor and patient being in different states and consulting via telemedicine.

Outside of the discussion on Capitol Hill, organizations like the American Telemedicine Association (ATA) have been working to override laws in those states inhibiting the growth of telemedicine across state lines. Most cases of doctors attempting to provide telemedicine services to other states serve to fill a need in areas where specialists like radiologists or neurologists are in short supply. Limiting the reach of these practitioners is manifestly detrimental to healthcare access. Doctors currently must obtain licensure in other states in order to provide telemedicine care to patients who reside outside their own state. The ATA approximates that only 20-25 percent of U.S. doctors have licenses in more than one state – national medical licensing is one proposed solution that would also cover the complications of the VETS bill.

Regardless of whether these issues of state vs. federal regulation are addressed sooner or later, more legal questions about the privacy of data in the practice of telemedicine are inevitably becoming part of the conversation. Everyone, not just regulators, but also practicing physicians and their patients must educate themselves about the potential for rubbing up against HIPAA as eHealth services continue to grow in popularity.