US Behind the World in Telemedicine

NEW YORK – The American College of Physicians (ACP) has issued a baker’s dozen of recommendations intended to guide the effective use of telemedicine in primary care settings.

“The recommendations balance the potential benefits and expanded use of telemedicine with the importance of maintaining the patient-physician relationship and patient safety,” Hilary Daniel from American College of Physicians, Washington, DC, said by email.

Telemedicine, the use of technology to deliver health care services at a distance, began mainly in rural communities and federal health programs, but now is used in a variety of medical specialties and subspecialties.

Daniel and colleagues on the ACP Health and Public Policy Committee detail pragmatic recommendations on the use of telemedicine in the primary care setting, physician considerations for those who use telemedicine in their practices, and policy recommendations on the practice and reimbursement of telemedicine in their September 8 Annals of Internal Medicine online position paper.

While ACP “supports the expanded role of telemedicine as a method of health care delivery that may enhance patient-physician collaborations,” it also recommends that direct-to-patient telemedicine services should be used only as an intermittent alternative to a patient’s primary care physician when necessary to meet the patient’s immediate care
needs.

These services should take place within the context of a valid patient-physician relationship. Physicians who use telemedicine have an obligation to establish such a relationship based on the standard of care required for an in-person visit or consult with another physician who has such a relationship with the patient.

Physicians should take care to see that financially disadvantaged populations also have access to telemedicine services, where appropriate, as well as ensure that these services comply with federal and state security and privacy regulations while meeting the same standards of practice as if the physician were seeing the patient in person.

ACP supports efforts to reimburse telemedicine communications and telehealth services and supports processes to obtain medical licenses and hospital privileges necessary to support telemedicine across state lines.

The committee also endorses the use of federal funds to support the broadband infrastructure and to establish an evidence base on the safety, efficacy, and cost of telemedicine technologies.

“Telemedicine can be an effective and beneficial tool for physicians and patients to enhance a patient’s care,” Daniel concluded. “Physicians can take away from this report a greater understanding of the regulatory and payment issues surrounding telemedicine and evaluate how telemedicine may be useful for their patients and practice and augment the care they already provide.”

In a related editorial, Dr. David A. Asch, from the University of Pennsylvania’s Center for Health Care Innovation, Philadelphia, addressed the hidden economics of telemedicine. He said by email, “I think it is a trap to think that the only promise of telemedicine is the opportunity to do something remotely that used to happen face to face. The real opportunities will come from doing health care in a different way because of this remote technology.”

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