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Licensure Guidelines Could Speed Telemedicine Adoption


Telemedicine and telehealth have the potential to improve healthcare while lowering costs. As the market continues to grow, lawmakers are beginning to look at regulatory changes that could support the technology.

How large is the telemedicine market? That answer differs from analyst to analyst, and depends to a great extent on each analyst’s definition of telemedicine. But one thing they all agree on is that the telemedicine market is growing rapidly.

And, with the recent completion of the drafting process for model legislation to create an Interstate Medical Licensure Compact aimed at speeding the process of issuing medical licenses in multiple states, the telemedicine market is primed for even more rapid growth.

The model legislation, which was crafted by the Federal of State Medical Boards, is aimed at reducing some of the more onerous barriers to physicians acquiring multi-state licensing. But according to Professor Charles Doarn of the University of Cincinnati’s Department of Family and Community Medicine, other barriers still remain.

“If you really think about the use of technology and medicine, this should be a no-brainer,” Doarn says. “The problem is, it is still a problem. And I think sometimes it’s predicated on either misunderstanding, or lack of knowledge, or fear of change.”

No-brainer philosophy

Doarn, who is also special assistant, Office of the Chief Health and Medical Officer, NASA Headquarters, as well as editor-in-chief of the Telemedicine & e-Health Journal, and co-chair of the U.S. Government’s FedTel Working Group, says that where telemedicine and telehealth are concerned, physicians too often adopt the attitude that they need to see a patient face-to-face.

Doarn believes that attitude doesn’t take into account the patient’s expense or inconvenience of traveling to the physician’s office.

“I live in Ohio,” he explains. “Say someone wants to come in from a rural county and it’s a 50-mile drive. They have to take off work, they don’t get paid when they take off from work, they sit in the doctor’s office for an hour and then the doctor comes in and says, ‘Well, your wound looks like it’s healed. I’ll see you again in a week.’ That could have been taken care of with the patient having some type of tool at home.”

Doarn explains that each state has its own licensing approach, for which fees are charged. Shortly after 9-11, and in the aftermath of Hurricane Katrina, there was a push for a national license, because physicians were traveling from one part of the country to another to provide assistance. With national licensing yet to come to fruition, reimbursement across state lines has become the biggest focal point for physicians.

Defining the issue

With the drafting process for model legislation to create an Interstate Medical Licensure Compact completed, state legislatures and medical boards can now begin to consider adoption of this model legislation. But, says Doarn, the problem might not end there.

During the summer of 2014, Doarn was contacted by legislators regarding an upcoming meeting in Denver of state medical boards, and asked to write a letter defining telemedicine and telehealth. The concern by legislators was that the group planned to define telemedicine as face-to-face teleconferencing, which would eliminate remote monitoring and home health care.

Doarn wrote a letter, but in it expressed concern about the language and definition surrounding telemedicine.

“I did see the language that was passed, and my understanding is that they predominantly believe that telemedicine and telehealth must be video based,” Doarn says. “It must be face-to-face, physician to patient.”

Which, according to Doarn, flies in the face of technology dating back to the space program of the 1960s. At that time, the Soviet Union sent a dog into space and monitored its vitals wireless from the ground.

“If you’ve ever had an EKG, those patches they put on you now were originally developed in support of the space program in the 1960s,” Doarn says. “If the Federation of State Medical Boards says that telemedicine must be face-to-face, it refutes everything else.”

Addressing a growing need

Doarn says that there is already a shortage of medical professionals to address patient needs.

“For every 30 surgical residents who finish their training and enter practice every year, do you know how many retire?” Doarn asks, rhetorically. “Seven hundred and fifty. So, the only way to alleviate stress on the system is to integrate telemedicine technologies. And that doesn’t mean they can be used for everything. But they can be used for post surgical wound care, for dermatology, and for congestive heart failure.”

He points out that the capabilities of apps on smart phones continue to grow, and the image quality on phone cameras is equal to that on many digital cameras. Limiting the definition of telemedicine to face-to-face conferencing doesn’t make sense.

“Mobile phones have the capability of being our link to everything; we can unlock our car, we can start our car, and we can check our home because of the cameras. Patients are more intelligent than they were a generation ago. They’re going to demand this stuff.”

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