Telemedicine: Creates Efficiencies, Requires Caution

The adoption of telemedicine is growing as physicians seek innovative ways to provide clinical healthcare to patients who are at a distance, have a disability, or face other barriers that can impede access to quality care. Telemedicine can improve efficiencies, but security and confidentiality must be addressed.

The Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services, has identified Health Professional Shortage Areas (HPSAs)—geographic regions with an inadequate number of primary care physicians. Physicians who practice in these areas can meet the rising demand for care from a vast patient population by taking advantage of affordable technology, the convenience of webcams and web-based portals like Skype, secure Internet connections, and high-speed links via satellite. Physicians who are not located in HPSAs are incorporating this technology into their practices to help manage increasing patient volume.

The Centers for Medicare & Medicaid Services (CMS) reimburses physicians and hospitals that offer telemedicine to patients in HPSAs, remote sites, and rural areas. Recently, CMS also amended the Medicare Conditions of Participation for hospitals and critical access hospitals, updating the process that facilities can use for credentialing and granting privileges to practitioners who deliver care through telemedicine. In addition, many payers are reimbursing physicians who offer virtual consultations.

While the benefits of telemedicine are vast, its use and adoption must be tempered with caution. Physicians must be aware of the risks associated with access, such as patient and staff privacy, inaccuracies in self-reporting, and symptoms that may only be caught in person. Additional legal considerations for online interactions, such as licensure compliance and professional liability coverage for out-of-state interactions, must be addressed for the protection of the physician and the patient. According to the Federation of State Medical Boards, only 12 states have provided special-purpose licenses to allow for cross-border telemedicine, while most states require complete licensing if the patient is in their jurisdiction

Additional considerations include:

  • Employing secure computer network systems with approved security codes designated under HIPAA compliance.
  • Clearly defining proper protocols for webcams and web-based portals.
  • Using mechanisms to protect the privacy of individuals who do not want to be seen on camera (including staff members, other patients, or patients’ families).
  • Understanding how web-based portals send encryption keys so that hackers can’t access the stream and decrypt the conversation.
  • Developing a method to ensure that the person you are communicating with is not an impersonator.
  • Considering the effects that telemedicine may have on your relationship with your patients and developing strategies to ensure they feel valued. 

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.


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