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Is Telehealth Redefining the ‘Doctor-Patient Relationship’?

A Pennsylvania bill that would define what telehealth platforms a physician can and can't use might cause other states to take another look at their telemedicine guidelines.

By Eric Wicklund

- Pennsylvania lawmakers are considering telehealth legislation that would clearly define what technology a physician can use – and clamp down on vendors offering such services.

Senate Bill 1342, sponsored by State Sen Elder Vogel, focuses on an online platform that favors video and store-and-forward services, and mandates that insurers reimburse telehealth as they would for in in-person encounter. The proposed legislation would also permit remote patient monitoring services and enable physicians to establish a relationship with new patients through telehealth and prescribe medications once that relationship has been established.

More important, the bill specifically excludes from its definition of telemedicine “the use of audio-only telephone conversation, facsimile, e-mail, instant messaging, phone text, answers to an online questionnaire or any combination thereof.” This would exclude several vendors who base their platform on phone or SMS messages.

“Telemedicine is the remote delivery of healthcare services and medical information using telecommunications technology,” Elder write in a March 10 memo outlining his proposed bill, which was introduced on August 5. “Telemedicine is a significant and rapidly growing component of healthcare. Through the use of telemedicine, specialists and other healthcare providers are able to expand their reach, helping rural patients stay in their communities and avoid traveling long distances for specialized care.”

The bill places the state in the middle of a growing national effort to reconcile telehealth with medical boards and physician organizations who fear the technology will harm the traditional physician-patient relationship. In states like Texas and Arkansas, some have argued that such a relationship can only be established in person.

Even the American Medical Association wrestled with that question. The board twice delayed a vote on ethical guidelines for telemedicine before approving new standards in June.

"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 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," he added. "What matters is that physicians have access to the relevant information they need to make well-grounded recommendations for each patient."

Earlier this month, Arkansas’ medical board approved a new rule allowing healthcare providers to establish a relationship with new patients through telehealth technology, though they failed to act on separate legislation that severely curtails where a patient can be located to use telehealth and what tools a physician can use.

In Texas, meanwhile, the state’s Medical Board is facing a court trial over its efforts (currently suspended) to prohibit physicians from using phone-based telehealth to dispense prescriptions to new patients. According to recent news reports, state officials and telehealth advocates are meeting behind closed doors to work on new legislation that would ease those barriers.

In Pennsylvania, Vogel’s bill, now in the hands of the Senate’s Banking and Insurance Committee, will be watched closely. Alongside the hotly debated effort to create a national licensure compact to help providers wishing to set up telehealth programs across state lines, this move to define the physician-patient relationship might prompt other states to take a closer look at their rules and definitions.

Dig Deeper:

Is There a Difference between Telemedicine and Telehealth?

Telehealth Terminology: ‘Store-and-Forward’ Has its Fans - And Critics


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