Telemedicine as a way of delivering healthcare is more advanced and widespread than many people understand, says attorney Dale Van Demark, a partner in the McDermott Will & Emery law firm.

A good example is telestroke programs that are in many hospitals across the nation and across all sizes of facilities, giving care in a critical time period where if diagnosed quickly enough can significantly mitigate damage, he notes. Telemedicine for behavioral health also is widespread, particularly with prison populations, and the Veterans Administration has been experimenting with telemedicine for some time.

The problems with telemedicine have been insurance reimbursement—which is getting better—and the patchwork of state licensure laws that make it more difficult to practice telemedicine across state lines. But there are changing attitudes among state legislators and medical boards, and a broader acceptance of telemedicine is being seen that could aid in reducing barriers. Nearly half of the states, Van Demark notes, have telemedicine reimbursement laws to some degree with about 10 more considering, according to the American Telemedicine Association.

Also See: Unprecedented Number of Telemedicine Bills Awaiting Congressional Action

And after several attempts, the Federation of State Medical Boards has put together a multi-state compact on licensure, which includes telemedicine. There is a small but growing movement by states to make it easier for physicians to have privileges in neighboring states.

But not all states are ready. The medical board in Texas adopted a rule requiring that a doctor and patient must first have an in-person consultation. That presents a significant barrier to providing telemedicine because first the physician and the patient have to find each other and could need to travel significant distances in Texas to do so, Van Demark says. Overall, however, more states are coming to terms with telemedicine and coming up with rules that regulate but do not prohibit the practice, he adds.

Insurers, who always consider issues of efficacy, efficiency and safety when determining coverage also increasingly finding telemedicine a treatment service acceptable for reimbursement, Van Demark says.

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