American College of Physicians recommends direct patient-doc contact before telehealth consult

Benefits offered by telemedicine "must be measured against the risks and challenges associated with its use," the American College of Physicians states in a position paper published in the Annals of Internal Medicine.

The paper is a follow-up to one written in 2008 titled "E-Health and Its Impact on Medical Practice," in which the ACP addressed the use of technology including electronic health records, patient portals and telemedicine.

The ACP, in its most recent paper, said it supports the expanded role of telemedicine as a way to increase access to care and reduce costs; however, it also calls upon physicians to use their judgment in determining when remote care is appropriate. To that end, it recommends that telemedicine be used when a patient and a physician have an established, ongoing relationship, and then "only as an intermittent alternative to a patient's primary care physician when necessary to meet the patient's immediate acute care needs."

A physician using telemedicine who has no direct previous contact with the patient must attempt to establish the same sort of relationship required for an in-person visit, the ACP says, or consult with another physician who does have a history with that patient.

The paper also calls for:

  • Developing evidence-based guidelines and clinical guidance on appropriate use of telemedicine to improve patient outcomes
  • That streamlined processes be established for obtaining licensure in multiple states while allowing states to retain individual licensing and regulatory authority
  • Lifting Medicare's geographic restrictions on reimbursement, and providing reimbursement for telemedicine communications, whether synchronous or asynchronous, provided by text, voice, video or device feeds

The debate of whether a patient-provider relationship in necessary before use of telemedicine is ongoing in the industry. In on case, the Texas Medical Board and telemedicine provider Teladoc are wrangling in court over the board's requirement of an in-person visit first. It follows the Federation of State Medical Boards' policy on appropriate use of telemedicine, which calls for doctors to establish a "credible patient-physician relationship." However, the rule created problems between physicians who were on call for their colleagues, issues the board is still trying to settle.

Meanwhile, the Colorado Medical Board has paved the way for more flexible and expanded use of the technology in the state, with guidelines that allow for greater use of telehealth for people living in cities, not requiring an in-person visit first and not requiring that patients have to be in a certain facility in order to conduct the visits.

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