While the Federal Court Supports Teladoc in Ongoing Saga Against Texas Medical Board in a decision about the appropriateness of video contacts, the Federation of State Medical Boards (FSMB) has been examining the appropriateness of video vs. telephone contact. FSMB approved the “Model Policy on the Appropriate Use of Telemedicine Technologies in the Practice of Medicine” at the recent American Medical Association’s yearly meeting in Denver. While accepting the adequacy of telehealth contact for establishing a professional relationship in first visits, the document says:
Generally, telemedicine is not an audio-only, telephone conversation, e-mail/instant messaging conversation or fax. It typically involves the application of secure video conferencing 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. (p. 4)
This decision comes on the heels of a decision in Idaho this past spring, where the Idaho Medical Board censored a physician for prescribing a common antibiotic by telephone. Nonetheless, Idaho clinicians using video-based care have not been deterred from telehealth. In fact, this week’s news brought the announcement that telepsychiatry is expanding significantly in Idaho to treat the state’s mentally ill. 1
Relevance of the FSMB decision for behavioral health?
Allied behavioral professionals often question the relevance of medical decisions to behavioral care. The reader is encouraged to think about the overall significance of the above debates from two perspectives:
- The international discussion about telehealth has shifted from whether telehealth itself is appropriate to question the telepractitioner’s choice of technologies. This shift is indicative of the broad-based acceptance now enjoyed by telehealth after decades of work to establish its legitimacy when using established treatment protocols. For mental health professionals, those protocols have not been as clearly delineated as in medicine, and have been shrouded by seriously questionable practices used by untrained practitioners. Nonetheless, for many first generation pioneers who fought the battle to establish legitimacy of telehealth, this shift is not to be overlooked.2
- In behavioral and mental health care, the controversy about technologies is presenting itself with yet a wider range of options consider by some as being reasonable, including such controversial approaches to treating behavioral problems with Text Messaging for Counseling, Therapy & Crisis Intervention. Until we hear from our regulatory boards and professional associations, we can expect a continued range of technologies that push the therapeutic window through which licensed professionals are engaged to serve the Internet public.
What’s the take-away message for behavioral professionals of all types?
Stay tuned. We’re likely to see much more controversy take shape in the upcoming months as professional associations, regulatory boards, technology companies, practitioners and consumers struggle to find a reasonable balance between responsibility and the increased access now afforded by various technologies.
1 Some of you will also recall that I was invited to speak at the Idaho Counseling Association’s annual convention as their keynote speaker. Interest was quite strong. The conference sold out.
2 For a list of more than 1000 searchable telehealth references, see the TeleMental Health Institute’s Bibliography. The Institute’s training courses organize and distill more than 3,500 such references for telemental health trainees.