The American Telemedicine Association has serious concerns with new guidelines for state medical boards on regulation of telemedicine technologies.

While ATA CEO Jonathan Linkous fears the guidelines from the Federation of State Medical Boards were created in a vacuum, Humayun Chaudhry, president and CEO of the federation, says the organization received input from stakeholders and some of the guidance is being misunderstood.

Linkous contends the federation did not respond to or adopt any of seven suggestions from the telemedicine association before finalizing a draft policy without changes. Chaudhry responds that a draft document was sent to stakeholders including the ATA with modifications made based on comments, and then a federation “reference committee” took more testimony and approved the revised guidelines without change. “There was ample testimony received, both in writing and verbally,” he adds.

However, the ATA contends the new model policy, which replaces a 12-year-old policy, does not appear to reflect current regular uses of telemedicine and raises significant barriers to its use. Chaudhry notes that the new policy reflects changes in the past dozen years, for instance, by deleting previous guidance that an inpatient encounter should first occur before a telemedicine consultation is conducted.

Nonetheless, ATA’s Linkous worries that the federation’s definition of telemedicine appears to leave out such common technologies as the telephone, email/messaging and faxes.

The federation’s new model definition for states is: “Telemedicine means the practice of medicine using electronic communications, information technology or other means between a licensee in one location and a patient in another location with or without an intervening healthcare provider. Generally, telemedicine is not an audio-only telephone conversation, email/instant messaging conversation, or fax. It typically involves the application of secure videoconferencing or store and forward technology to provide or support healthcare delivery by replicating the interaction of a traditional encounter in person between a provider and a patient.”

Linkous counters, “All these types of vehicles are well-accepted by government agencies, health plans, provider organizations and the international community.”  Other guidelines in the federation’s model policy, such as prohibiting use of telemedicine across state lines, appear to lock the telemedicine business in the 20th Century, he adds.

That’s a misunderstanding of the federation’s intents, Chaudhry says. The new policy does not prohibit consultations via telephone, email, messaging or faxes, but does call for these types of consultations to meet specific standards of care. And in most cases, but not all, an audio-only telephone conversation would not meet the standards, he believes. “The bottom line is the policy does not prohibit use of the telephone in the practice of medicine.”

On the issue of licensure and conducting telemedicine consultations across state lines, the new model policy is: “A physician must be licensed by, or under the jurisdiction of, the medical board of the state where the patient is located. The practice of medicine occurs where the patient is located at the time telemedicine technologies are used. Physicians who treat or prescribe through online services sites are practicing medicine and must possess appropriate licensure in all jurisdictions where patients receive care.”

ATA in its comment letter contested the licensure language. “This statement would prohibit a state medical board from entering into a reciprocal relationship with neighboring states or regions regarding state licensure whereby a license to practice medicine in one state is recognized by other states. It is also in conflict with federal policy regarding physicians providing medical care for the nation’s military.”

Not so, retorts federation leader Chaudhry. The policy does not prohibit reciprocal licensing agreements among states and the federation supports development of interstate medical license compacts under which states can agree on a standardized and streamlined approach to recognizing the licenses of physicians in other states if those physicians wish to apply for licensure elsewhere.

ATA also questions why the issue of telemedicine-supported physician-to-physician consultations was not addressed. Chaudhry says more study is needed on the issue before a model policy is created.

The federation’s model policy is here and the ATA’s comment letter is here.

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