Docs: It's Time to Certify Specialists in Telemedicine

Virtual medicine practice is more than technological competence. A doctor who proposed the idea of telemedicine certification advocates why this is so.

As medicine sees advancements in technology and expansion of knowledge in care delivery, specialties and their commensurate board certifications continue to proliferate.

With telemedicine use and applications growing, a premier candidate for this process may be a specialty representing the "medical virtualist," proposed two physicians at New York-Presbyterian (NYP) in a recent JAMA Viewpoint.

Paper coauthor Michael Nochomovitz, MD, chief clinical integration and network development officer at NYP, offers his insights on this topic.

The following transcript has been lightly edited.

HealthLeaders Media: What motivated you to share this idea?

Michael Nochomovitz, MD: Telemedicine started out with coughs, colds, rashes—easy things. But now with the technology improving and remote monitoring expanding, the need for a more sophisticated approach has become apparent.

A telemedicine visit isn't the same as FaceTiming your cousin. It involves a true medical interaction that needs to be defined and categorized, and there are a number of people around the country who have set standards of their own, but they haven't made any consensus because it's too early.

Related: The Adolescence of Telehealth

Having said that, there are going to be people who do this for a living. There will be a career where you don't touch a patient, and there will have to be a set of core competencies that will need to be codified.

HLM: Were you surprised by the level of reaction to your article?

Nochomovitz, MD: I don't know. This is the first time the idea of a new specialty has actually gone public. We coined the phrase "medical virtualist," and now people are chewing on the concept.

I think one of the reasons JAMA published it is that the idea is new and somewhat disruptive, and it's unclear where it goes from here and how it will impact the rest of healthcare.

We're excited by the response because the discussion is so needed.

There isn't a major healthcare organization in the United States that doesn't have telemedicine and telehealth as a priority. Now there almost needs to be a pause—a timeout—and ask what we are going to expect from the doctors who do this.

HLM: What is your response to those who say that a telemedicine certification and specialty are unnecessary?

Nochomovitz, MD: Those who say it's not necessary just haven't done enough of it, and they haven't been exposed enough to the complexity of doing telemedicine with complicated patients.

HLM: What are some of the core competencies needed for medical virtualists?

Nochomovitz, MD: One important idea is that of "webside manner." Doctors that see patients in an office each have a different personality. Some doctors are engaging; some are not. That will be exaggerated in a remote visit.

There are techniques that need to be taught on how people speak, where they look, how they engage, what they look for, how they reassure patients, how they address technical glitches, and how they recognize that a particular issue is not within the scope of the telehealth visit without making the patient nervous.

Keep in mind that with increased use of remote monitoring, doctors are going to have much more information at their disposal, and the physicians have to use some skill to put together the patient's complaint, the patient's appearance, and all of this additional information about the patient's prior or current activity. It's a different way of looking at the doctor-patient interaction.

HLM: If a certification were to become a reality, do you think it would deter physicians from pursuing telemedicine?

Nochomovitz, MD: Provided that the process is not overly onerous, I think that certainly the new generation will embrace it because technology is so engaging. And we're so used to using it in our daily lives that we have a blurring of the edges between lifestyle technology commodities and applications in healthcare.

I don't think there's going to be a problem with adoption. Doctors will want to do it right.