Last month, ACP released a position paper on telemedicine in primary care settings. The use of telemedicine is growing rapidly, so the policy recommendations are timely. In the paper, four types of telemedicine are described: 1) asynchronous, which consists of sending information to be used at a later time – the example given is a radiograph of a broken bone being sent to an orthopedist who will see the patient subsequently; 2) synchronous, in which real-time interaction between physicians and patients occurs, such as a physician conducting “e-visits” or a rural community health center connecting remotely with a physician; 3) remote patient monitoring, where data is accumulated and then forwarded to the physician for interpretation and action – for example, blood pressure measurements, which are electronically forwarded to the primary physician; and 4) mobile health care services, such as the use of mobile technology to send texts to promote healthy behaviors or track conditions.
The paper outlines 13 specific recommendations, several with sub-recommendations. Most particularly there is a clear call for the existence of a valid patient-physician relationship. If there is not an existing, ongoing relationship, several steps should be taken to establish such a relationship, including consulting with a physician who currently oversees the patient’s care. There are also recommendations for public policy including guidelines for data security, licensing and reimbursement. I encourage you to review the Position Paper.
Coincidentally (or not), the Cochrane Collaboration published their review “Interactive telemedicine: effects on professional practice and healthcare outcomes” the same week. Their findings in the end were not so robust: use in the management of heart failure is no better than face-to-face or telephone delivery of care; there is some evidence for improved glycemic control in diabetes; cost and acceptability are not clear due to limited data reported for these outcomes. Not much to go on. Unfortunately, though, many studies that have come out in the past 18 months were not included because of the time and effort required for such a rigorous review from the time it was initiated, highlighting the difficulty in trying to conduct systematic reviews when a topic is rapidly evolving.
In Connecticut, Governor Malloy signed into law Public Act 15-88, which took effect October 1. The act requires that the provider communicate through real time using two-way technology; has access to or knowledge of the patient’s medical history; give the patient his/her license number and contact information; and conform to the standard of care expected for in-person care. Prescription of controlled substances in prohibited, as is charging of a facility fee. The act also sets requirements for insurers.
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