After ratification on Saturday, the Federation of State Medical Boards (FSMB) and its State Medical Boards Appropriate Regulation of Telemedicine (SMART) Workgroup released their model state policy for the utilization of telemedicine in the delivery of healthcare. Named the, “Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine,” the policy was developed through a collaborative process to provide states with definitions and principles to use for guidance when developing their individual policies to regulate telehealth. A work group of the non-regulatory FSMB developed the policy to provide a non-binding guide to its 70 member boards on a consistent, national approach to using telehealth technology in medicine. The far-reaching model act represents the biggest change in medical licensing in decades, and opens the door to greater use of telehealth across disciplines because of the example it sets for other professions. The FSMB draft legislation proposes a legally binding agreement among states to share an agreement on many key issues to address the changing needs of american healthcare.
Individual state medical boards have discretion as to if they adopt the guidelines contained in the FSMB guideline. The next challenge, then, is for states to react. Besieged by a patchwork of conflicting and outdated laws that unduly restrict practice, many states have been awaiting the Federation’s Model Act to revise their own regulations.
Several key guidelines are beginning to raise eyebrows. The primary principles advanced by the Act include:
Establishing a Treatment Relationship Online. A physician-patient relationship can be established using technology and related processes known in medical circles as “telemedicine”, so long as the standard of care is met. It also says such a relationship can be created “whether or not there has been an encounter in person between the physician (or other appropriately supervised healthcare practitioner) and patient.” The policy also says that to establish the essential patient-physician relationship on a first visit, “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.”
Evaluation and Treatment. Treatment made online should be held to the same standard of appropriate practice as those in traditional settings. (This aspect is nothing new).
Online Prescribing Safeguards. Prescribing in a telehealth encounter should be at the discretion of the physician. (This guideline is in direct opposition to the Oklahoma Board’s recent decision to discipline a physician for).
Ensuring Privacy, Security, Documentation, and Continuity. Telehealth encounters should be HIPAA compliant, include informed consent, the generation of a medical record, and support the continuity of care. A number of related issues are surfacing. In Oklahoma, a physician was disciplined for failure to establish proper doctor-patient relationship, for not obtaining proper informed consent, for using Skype, and other related infractions. See our webinar for details.) In Idaho, a physician was sanctioned for prescribing an antibiotic based on a telephone assessment of a patient.
Licensure Portability. The model act calls for states to allow physicians to practice across state lines.
State-wide controversies have existed for years, despite the promise of astounding telehealth growth predictions. Idaho, for example, sanctioned a physician for prescribing an antibiotic based on a telephone assessment. Oklahoma disciplined a physician for failing to establish a proper doctor-patient relationship, failing to use an appropriate consent form and for using skype, a non-HIPAA compliant technology.
What do you think?
Should your state follow such a guideline for your discipline? How does this FSMB Model Act apply to your practice? Your thoughts are invited below.