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Should Telemedicine Implementation Compel Prior In-Person Care?

The state of Arkansas is considering to include legislation allowing doctors to treat patients virtually that they haven’t examined in-person ahead of time.

By Vera Gruessner

- Telemedicine implementation is taking place around the country as more physicians continue to communicate with their patient base by phone and video consultations. The state of Arkansas is another one that’s attempting to pass new legislation regarding telemedicine implementation across clinics, hospitals, and physician practices.

Telehealth Adoption Regulations

The Arkansas Democrat-Gazette reports that the state is considering to include legislation allowing doctors to treat patients virtually that they haven’t examined in-person ahead of time. It seems that employers support this type of regulation around telemedicine implementation, but legislators are worried that this type of virtual care could negatively impact patient safety.

The Arkansas Medical Board's Telemedicine Advisory Committee held a hearing regarding a draft of the telehealth legislation. The current proposal states that doctors would be able to provide diagnoses on a patient’s illness and prescribe medicine while also advising follow-up care at their primary care physician’s office.

Currently, the telehealth legislation within the state requires that doctors examine a patient in-person before offering telemedicine services, have an on-going professional relationship with the consumer, or have a referral from another physician.

The new proposed legislation for telehealth implementation practices supported by Rep. Dan Sullivan, R-Jonesboro, suggests that doctors can establish a relationship with a person using audio-visual technology instead of the in-person visit.

Additionally, the new proposed ruling would allow the Medical Board to establish a patient-doctor relationship in other ways. Some legislators such as Sen. Cecile Bledsoe, R-Rogers, are concerned that doctors would be unable to find some physical ills and symptoms during an audio and video consultation that they would have discovered during an in-person examination.

“They [ Arkansas Medical Society’s board of trustees] latched on to that very quickly and were very concerned that we not move too quickly, that we slow down and think about what we're doing and make sure that the interests of the patients and safety come before everything else,” David Wroten, executive vice president of the Arkansas Medical Society, told the news source.

Other employers have found that telehealth implementation may not be suitable for their particular needs because their employees do not have primary care providers and would be unable to complete follow-up care.

"Most of the commercially available telemedicine programs would be gutted if that requirement were in place," Henry DePhillips, chief medical officer for Dallas-based Teladoc, told the source about the stipulation for follow-up primary care.

Arkansas is not the only state to have complications and multiple viewpoints when passing telehealth legislation and working toward improving telemedicine implementation around the region. For example, recently North Dakota passed new telehealth regulations, as reported by mHealthIntelligence.com.

In North Dakota, providers of telemedicine are required to be licensed physicians within the state. This may, however, restrict the spread of telehealth throughout the country by prohibiting doctors to communicate with patients across state borders. Those on the other side of the debate claim that state licensing requirements are vital for patient safety.

The rulings in North Dakota also aim to ensure that the patient-physician relationship is established when providing virtual care while at the same time, offering more remote monitoring solutions.

“North Dakota’s definition of telemedicine includes direct interactive patient encounters as well as asynchronous store-and-forward technologies and remote monitoring,” The National Law Review reported.

“Certain types of telemedicine utilizing asynchronous store-and-forward technology or electronic monitoring, such as tele-radiology or ICU monitoring, do not necessarily require an independent examination of the patient to be performed. However, an examination or evaluation that consists only of a static online questionnaire or an audio conversation will not be considered to meet the standard of care.”

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