Telemedicine in the Healthcare Delivery System
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The document discusses the growing role of telemedicine in healthcare, driven by factors such as physician shortages and consumer demand for convenient services. It outlines the definitions, requirements, and limitations of telemedicine practices, including necessary provider-patient relationships and conditions under which care can be delivered. It also explores the potential benefits of telemedicine in addressing healthcare disparities, while emphasizing the need for appropriate regulations and standards to ensure quality care.
Telemedicine in the Healthcare Delivery System
- 1. TELEMEDICINE IN THE HEALTHCARE DELIVERY SYSTEM Nancy W Dickey, MD, FAAFP Executive Director, Rural & Community Health Institute, Texas A&M University College of Medicine January 24, 2017
- 2. TECHNOLOGY IS A GROWING PART OF HEALTHCARE – DIAGNOSIS, TREATMENT, FOLLOW- UP And telemedicine is a growing part of technology.
- 3. WHAT IS DRIVING THE GROWTH? Physicians having difficulty getting appropriate call coverage Most powerful driver is consumer demand – if the internet can be used for banking, shopping, communication, why not healthcare? Demonstrated success at treatment in the face of reduced time to acquire care, enhanced patient convenience, meet current shortages
- 4. DEFINITIONS 1. Telemedicine involves a health care providers medical care delivered to patients physically located at sites other than where the provider is located This entails use of technology that allows the provider to communicate with (see and hear) patients in real time 2. The provider (MD, DO, PA, APN) must be licensed in Texas 3. Telemedicine, telehealth, and telemonitoring are all subsets of telemedicine
- 5. WHERE CAN IT BE PROVIDED? 1. IF patient is being seen for the first time by a distant site provider OR is presenting with a new condition May only be used at a qualified staff present and sufficient technology and medical equipment to allow the distant provider to conduct an adequate physical exam (the TMB call this an established medical site) 2. IF NOT at an established medical site, a distant provider can provide care IF It is follow up care for an established patient’s previously diagnosed condition OR It is a referral by a physician who completed a proper evaluation 3. An established patient with a new condition must be advised to seek appropriate follow-up care Within 72 hours if symptoms do not resolve Distant provider cannot provide additional care for such symptoms IF the patient is not seen by such a physician 4. Sites must also provide patient privacy and enable presentation of the patient to the distant provider
- 6. REQUIREMENTS 1. There must be a physician-patient relationship To establish that the patient is who he/she claims to be To discuss the diagnosis, evidence supporting diagnosis, and risks and benefits of recommended intervention 2. The distant site must include the presence of qualified staff to assist in the evaluation of the patient Diagnosis should be established using acceptable medical practices, documentation, performance of physical exam, diagnostic and lab testing as appropriate 3. Treatment and consultation are held to the same standards of acceptable practice as traditional in-person care
- 7. VS Does a distant site provider HAVE to see a patient in- person prior to providing telemedicine? BUT…. Either the provider must conduct a face to face evaluation at an established medical site OR Provide a treatment for a patient referred by another physician who completed a face-to-face evaluation via telemedicine at an established medical site
- 8. PENDING ISSUES/NEXT STEPS Using telemedicine as call coverage TMB has created an entity called “nonreciprocal” call coverage Agreement in writing Establish physician’s responsibility to meet the standard of care Include a list of all physician who may provide call coverage Covering physician must have access to patient medical records Covering physician must provide information within 3-7 days for covered physician’s records Teledoc vs Texas Medical Board: Originated over the right of telemedicine providers to treat a patient without an initial in-person visit Has grown to an anti-trust issue and currently sits at the US District Court – Fifth District IF the court invalidates the rules from TMB it will raise questions about the medical board’s rulemaking authority in general and the future of the board’s ovesight
- 9. TELEMEDICINE MAY PROVIDE SOLUTIONS TO A VARIETY OF CHALLENGES 1. Health Professions Shortage Areas Population growth outpacing growth of providers 2. Primary Care and Specialty Care shortages Majority of specialty care physicians are in/around large urban areas Telemedicine could extend reach into underserved rural areas 3. Creating a solution to a conservative legislature and growing Medicaid population 4. Transportation Challenges 5. Over-utilization of high-cost care
- 10. WHAT YOUR LEGISLATORS ARE HEARING: 1. Consider using telemedicine to cover shortages in state psychiatric hospitals 2. Use telemedicine to triage fragile children entering foster care Consider creating a certification/education process for CPS case workers to qualify as telepresenters 3. Expand the use of telemedicine to ensure timely access to trauma services 4. Work with the DEA to allow psychiatrists to prescribe controlled substances via telemedicine BUT – any expansion should fall within the standard of care
- 11. SUMMARY Without provider demand, appropriate licensure requirements, fair reimbursements, and supportive regulations, the full benefits of telemedicine will struggle to be fully realized. Fortunately, there is agreement that telemedicine has a place in health care, but it must be done safely, fairly, and with no loss of care quality. Future applications should be designed by healthcare professionals not policy writers Telemedicine should be utilized to support and strengthen existing doctor-patient relationships, not to supplant them.