It goes without saying that telemedicine proponents are displeased with the Texas Medical Board’s recent decision to restrict the practice of telemedicine in the state to physicians who have a pre-existing, in-person relationship with patients they want to treat remotely.
This was evident Tuesday during a plenary session at the American Telemedicine Association’s annual meeting in Los Angeles, where a panel discussed the safety of telemedicine diagnosis and treatment.
“That was bad policy,” said Dr. Ateev Mehrotra, a hospitalist at Beth Israel Deaconess Medical Center in Boston. “It was a mechanism to protect the turf of some physicians.”
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There is a perception that telemedicine providers are held to a higher standard than the rest of the healthcare industry. But, as it is, in-person care is fraught with risk. “We have 30 years of evidence” that face-to-face visits don’t follow guidelines and are prone to errors, Mehrotra said. “Why should we think telemedicine should be any different?” he wondered.
“This idea that telemedicine works or doesn’t work isn’t a reality,” Mehrotra continued. Efficacy often depends on the condition of the patient. “It’s going to vary by patient.”
He said that policy should only prohibit telemedicine when there is evidence that this kind of care would be harmful.
Even an American Medical Association board member, University of California, San Francisco, dermatologist Dr. Jack Resneck, said that it is unfair to stigmatize telehealth as unsafe — though it’s a good bet that the ATA would not have invited him to speak if he were anti-telemedicine. “There is great promise in telemedicine that maintains standards of care and patient protections,” Resneck said.
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While the normally conservative AMA does recommend that physicians practicing telemedicine have existing “face-to-face” relationships with patients, video meets that criterion, according to Resneck, and the organization largely defers to medical specialties. “The AMA policy really looks to specialty societies to establish policies for telemedicine,” he said.
An audience member drew applause during the Q&A portion of the session by asserting that telemedicine should be focused on the patient and grounded in data, not physician-centric and based on historical roles. “I think we need to reframe the discussion,” this commenter said. “We have to stop being paternalistic.”
Curtailing telehealth has the unintended effect of limiting access to care. “It’s not geography, it’s access,” he said. And one mistake should not be grounds to terminate remote practice of medicine. “When a CEO embezzles money, we don’t do away with all CEOs,” he said.
Judging by the Twitter stream, this was a popular idea.
Docs assume we want “relationship” – Most people want access, convenience, low cost, accurate care even more #ATA2015
— Sherry Reynolds (@Cascadia) May 5, 2015
[Image from Twitter user @StevenChanMD]