As you know, the NCMB adopted revised position statements related to the practice of telemedicine last fall. The Board’s primary goal at the time was to provide important clarifications to telemedicine companies and the licensees they employ while maintaining a strong stance on patient protection.
I believe the revised versions of the Board’s positons on Telemedicine and Contact with patients before prescribing do just that. Changes to the position statements, adopted in November 2014, include the following:
• The expectation that telemedicine practitioners will engage in practice improvement and outcomes monitoring
• Clarification that telemedicine practitioners are held to the “standard of care” governing their practice specialty and there is no separate (or lower) standard of care for telemedicine practice
• Clarification that the physician-patient relationship need not be established through an in-person encounter so long as a physician may acquire the same or superior information through the use of technology and peripherals
• Additional burdens are placed on the practitioner to ensure he or she verifies identity and location of the patient and provides his or her identity, location and professional credentials to the patient
• A new section clarifies constraints on prescribing
• Telemedicine practitioners are held to the same professional standards concerning communication and transfer of health care records to the primary care physician or medical home
• Contact with patients prior to prescribing need not occur through an in-person encounter, so long as a practitioner has access to the same or superior information through telemedicine technology
So far, the response to the revised position statements has been generally positive. Individuals representing telemedicine companies or the telemedicine industry have indicated that the changes clear up questions raised by the previous versions of these statements, removing apparent obstacles.
For example, prior to the revisions it was widely believed that the NCMB’s positions on telemedicine and prescribing did not support the issuance of prescriptions to patients following a telemedicine consult. Now, it should be clear that prescribing may be appropriate as part of such an encounter, with the important caveat that the prescriber must have sufficient information to make a diagnosis. This is a critical point to resolve, especially as telemedicine steadily expands into primary care. It’s worth noting that the Board’s recent review of telemedicine has largely been focused on this emerging market for telemedicine.
One comment I have heard is that the NCMB could have done more to ease the concerns of telemedicine providers by including lists of treatments or procedures the Board believes can or cannot be handled appropriately via telemedicine. I do not believe this would have been wise, or even possible. New technologies and applications for telemedicine emerge almost daily and it simply not feasible for the Board to maintain a current catalogue of approved or disapproved uses. Such a list would almost certainly be out of date the moment the gavel banged to approve it.
A few licensees have expressed their belief that the NCMB, in developing any policy regarding telemedicine, is needlessly interfering in how medical professionals practice. I suspect anyone who would argue this point lacks a full understanding of the NCMB’s mission. The Board has no desire to control how telemedicine is practiced in the state of North Carolina. This should evolve naturally as patient demand, technological capabilities and provider interests allow.
The NCMB’s interest in telemedicine is the same as its interest in all care provided to North Carolinians: ensuring that medical treatments provided to patients meet at least minimum accepted and prevailing standards established in North Carolina. The recent revisions to the NCMB’s positions on Telemedicine and Contact with patients before prescribing put licensees and the many interests fueling telemedicine’s growth across North Carolina on notice that this is so.
It is my hope, and the Board’s expectation, that any licensee who practices telemedicine will ensure that he or she is able to provide quality care, and meet all related professional obligations to their patients. At the same time, the Board will remain vigilant and will continue to uphold prevailing standards of care in telemedicine as well as face to face care.
