Since 2014, there has been a dramatic increase in the utilization of telemedicine, resulting in the advancement of telemedicine technologies and new challenges to the safety of patients. The rapid expansion of telemedicine generated by the public health emergency of the COVID-19 pandemic has caused concerns regarding fraud and abuse and access inequity. To address these concerns, the FSMB appointed a workgroup tasked with establishing an updated policy regarding telemedicine. The workgroup created the new policy by addressing the challenges and evolving use of telemedicine, analyzing the effect of waiving licensing requirements and practice across state lines, reviewing current state and federal legislation and comparing the use of telemedicine during the public health emergency with times of nonurgency.
Regarding licensure, the requirements are stringent. In order to practice medicine, physicians who use telehealth service sites to diagnose, treat, or prescribe must be duly licensed in each jurisdiction where the patient receives care. However, there are exceptions when physicians are not required to obtain a license in the state where the patient is located:
- When a physician is requesting consultancy from another physician from outside the state.
- When a physician is providing speciality assessments or consultations in order to screen a patient for acceptance of a referral.
- When a patient is temporarily outside the physician’s jurisdiction, provided the physician has sufficient knowledge to meet the standards of care.
- When a patient has chosen to travel outside their state for care, a doctor may use telemedicine technologies to provide follow-up care.
- When the physician is using patients from outside their jurisdiction to improve the likelihood of success in their clinical trial.
A physician must adhere to the standards of care and code of ethics in order to ensure patient safety and avoid disciplinary action. The FSMB adapted these standards and codes of ethics to the advancements of telemedicine technologies.Under the new policy, physicians must:
- Ensure that the services provided using telemedicine technologies are within the practitioner’s scope of practice.
- Establish a comprehensive relationship with a patient where a mutual understanding of the shared responsibility of the patient’s care is developed.
- Ensure that treatments and evaluations made using telemedicine technologies adhere to the same standards as an in-person visit would.
- Document all suitable patient informed consent for the use of telehealth and ensure all online services have clear and correct information regarding the services operator.
- Ensure that patients have easy access to contact the physician if required for follow-up care or for information.
- Ensure copies of all patient-related electronic communication are in all medical records.
- Ensure full compliance with the requirements of the Health Insurance Portability and Accountability Act.
The second section regards the equity of healthcare access. Telemedicine can be incredibly useful increasing access and reducing inequalities in the provision of healthcare when properly used and deployed as an integrated component of healthcare delivery. For telemedicine to be effective for everyone, obstacles must be removed or minimized, including those relating to literacy gaps, access to broadband internet, and the availability of and payment for telemedicine services.
Telemedicine is one component of the delivery of healthcare, and it can vary in quality, appropriateness and usefulness. It is important that as telemedicine continues to be utilized, healthecare providers adhere to the guidelines of the HHS in order to ensure public health and safety.