- The American Medical Association doesn’t yet know how to define an appropriate telemedicine practice – and probably won’t take up the issue again until halfway through next year.
The AMA’s House of Delegates this past week sent proposed rules of ethics back to the drawing board, saying there were still too many questions on how to define a valid doctor-patient relationship when applied to phone, video and online services. The recommendations, drafted earlier this year by the AMA’s Council on Ethical and Judicial Affairs, will now be revised and sent to the AMA’s 2016 annual meeting, scheduled for June 11-16 in Chicago.
As proposed, the AMA would define a valid relationship as one that can be conducted “in person or virtually through real-time audio and video technology.” But that definition hasn’t gone over too well with the delegates, and the issue has left state officials and healthcare providers concerned about liability.
At a meeting this past week in Atlanta, delegates raised a number of questions with the proposed recommendations, and said they had problems with requirements that physicians inform their patients of the limitations of telemedicine and provide advice on arranging follow-up care. They also questioned whether different guidelines are needed for specialists, such as pathologists and radiologists.
Other issues discussed included protecting patient privacy and information during a telemedicine visit, ensuring that care is coordinated after the visit, disclosing any financial interest by the provider in the telemedicine platform, and determining whether the platform being used – phone, online or video – is appropriate when prescribing medications.
And in a nod to ongoing deliberations in Texas and Arkansas, among other states, delegates debated whether state medical boards should have the authority to set their own rules. In Texas, for example, state officials are headed to court with telemedicine provider Teladoc over a proposed rule that would prohibit doctors from conducting a first visit and issuing prescriptions via phone.
The AMA’s House of Delegates had tabled the first round of telemedicine ethics rules this past June, following spirited discussion that included references to the Texas-Teladoc battle.
“There is no requirement here of any form of inpatient, face-to-face interaction,” Arlo Weltge, MD, PhD, MPH, an AMA alternate delegate from Texas, was quoted in news reports from that meeting. “For physical diagnosis, there needs to be a physical exam that can be done either with an initial face-to-face, or it can be done with a presenter who is seeing the patient in consultation.”
"The unintended consequence of the way (the AMA's proposed ethical guidelines are) written means that anybody can set up a remote station and prescribe medications and, if you will, become an Internet pill-mill," he added.