Other obstacles include questions about licensing and credentialing requirements, who is responsible for maintaining patient records, how to get reliable and accurate access to patient histories, and how to deal with differing state regulations for ordering prescriptions.
Before a physician can practice in a state or get privileges at a specific hospital, he or she must go through a rigorous process of licensing, background checks, credentialing, continuing education, and periodic recredentialing. The process is pretty straightforward. But telemedicine has blurred these legal and regulatory lines now that physicians can physically be in one state and simultaneously administer care to a patient in another state, according to CTeL.
Several professional organizations are currently working on reciprocity agreements between states, for example. One possible solution is to grant physicians a limited license to practice remote care or to offer multistate licenses at reduced fees. In May 2010, CMS proposed regulations designed to make it easier for hospitals to credential physicians who provide telehealth services at their facilities.
The present credentialing and privileging process requirements for telemedicine providers is “duplicative and burdensome for physicians, practitioners, and hospitals,” the agency said in its announcement of the proposed rule in the Federal Register. “It is particularly burdensome for small hospitals, which often lack the resources to fully carry out the traditional credentialing and privileging process for all of the physicians and practitioners that may be able to provide telemedicine services.”
Another regulatory issue that crops up is whether the remote physician can (or should) prescribe medication for the patient, especially across geographic boundaries. If the physician doesn’t have a complete patient history, the answer to this question is simple: Don’t do it, says David. Physicians should also be aware of country-by-country and state-by-state prescribing and e-prescribing rules.
There is also the question of who is responsible for updating and maintaining medical records. It actually doesn’t matter, so long as you have a signed policy in place with an agreement as to who will update the patient’s medical record with information about the remote visit, David says. As with traditional visits, the referring organization or primary care physician would keep the full patient record, while the specialist would keep records pertinent to the consult. Alternately, a third party can coordinate. Just make sure you come to an agreement up front, he says.
It’s generally true that, over time, the quality and functionality of technology tends to improve while costs tend to drop. Early telemedicine adopters may have paid $200,000 for an in-hospital studio 15 years ago. Today, a similarly equipped setup might cost $30,000, says David. And it will have better equipment and capabilities.