- After three years of discussion and a year of delays, the American Medical Association has signaled its support of telehealth.
The 230,000-member organization “overwhelmingly” approved a set of guidelines for the ethical practice of telemedicine during its annual meeting this week in Chicago, giving physicians across the country a framework from which to launch and develop their own program. Chief among these guidelines is a directive that the clinician understands that technology doesn’t trump medical ethics.
"Telehealth and telemedicine are another stage in the ongoing evolution of new models for the delivery of care and patient-physician interactions," AMA Board Member Jack Resneck, MD, said in a release issued after the June 13 vote. "The new AMA ethical guidance notes that while new technologies and new models of care will continue to emerge, physicians' fundamental ethical responsibilities do not change."
"Physicians who provide clinical services through telemedicine must recognize the limitation of the relevant technologies and take appropriate steps to overcome those limitations," added Resneck, who’d been a keynote speaker at the recent American Telemedicine Association conference and trade show last month in Minneapolis. "What matters is that physicians have access to the relevant information they need to make well-grounded recommendations for each patient."
The guidelines were developed by the AMA’s Council on Ethics and Judicial Affairs, a process that officials say took three years. An earlier draft of those guidelines was presented at last year’s AMA meeting and tabled, then tabled again at a meeting in November.
Both times, AMA members said they were uncomfortable laying out a framework for physicians that emphasized technology over the physician-patient relationship – a contentious issue that has hampered telehealth efforts in states like Arkansas and Texas. The root of that debate is whether a physician can establish a meaningful relationship with a new patient via telemedicine, without first meeting that patient in person.
While not specifically settling the debate, the AMA’s guidelines “permit physicians utilizing telehealth and telemedicine technology to exercise discretion in conducting a diagnostic evaluation and prescribing therapy, within certain safeguards.”
According to the guidelines, physicians using telehealth should:
- inform patients that the technology does have its limitations;
- advise patients how to arrange for follow-up care;
- encourage patients to let their primary care physician know when they’ve used telehealth; and
- support policies and initiatives that promote access to telehealth or telemedicine services “for all patients who could benefit from receiving care electronically.”
The guidelines follow on the heels of a strong opening statement by the AMA’s chief executive on the dangers of new mHealth technology.
In opening comments this past weekend, AMA CEO James Madara, MD, acknowledged the benefits provided by mHealth and telehealth technology, but said the landscape was crowded with inefficient and dangerous players as well – calling them the “snake oil salesmen” of today’s healthcare landscape.
“Today we have really remarkable tools -- robotic surgery, new forms of radiation treatment, targeted biologics; and we live in a time of rapid development in the digital world -- telemedicine as an example,” he told the AMA delegates. “But appearing in disguise among these positive products are other digital so-called advancements that don’t have an appropriate evidence base, or just don’t work that well -- or actually impede care, confuse patients and waste our time. From ineffective electronic health records, to an explosion of direct-to-consumer digital health products, to apps of mixed quality – it’s the digital snake oil of the early 21st century.”
"The future is not about eliminating physicians - it’s about leveraging physicians,” he added. “That means leveraging physicians by providing digital and other tools that work like they do in virtually all other industries – making our environments more supportive, providing the data we actually need in an organized, efficient way, and saving time so we can spend more of it with our patients.”