The report notes that 22 states have a “supportive policy landscape” for telemedicine adoption and usage; 26 plus the District of Columbia have “room for improvement.” Alabama, Arkansas and Texas create the most stringent clinical practice rules for telemedicine providers compared with in-person practice. Every state, however, makes practicing medicine across state lines difficult, whether the care is delivered via telemedicine or not, according to the report.
Another case making its way through the Texas courts centers on the state Medical Board’s regulations on telemedicine. Teladoc, based in Dallas, offers online access to a consultation with a physician for non-emergency care for such conditions as cold and flu symptoms, urinary tract infection, ear infections, poison ivy, bronchitis, etc. Doctors associated with Teladoc can order a short-term prescription for common medications, such as antibiotics and antihistamines, and can advise patients whether they should see a specialist. The organization works with several employer-sponsored insurance plans across the country.
The Texas Medical Board objected to Teladoc’s operation in that state. The board says that it was adopting a rule that would take effect on June 3 requiring that doctors first meet in person with the patient before writing a prescription, according to an article in the Dallas Morning News.² Teladoc filed a lawsuit against the Board in May, alleging the Board was trying to stifle competition. The Texas Tribune reported recently that although the suit is still in the courts, a U.S. District judge has issued a temporary injunction against the rule taking effect until the lawsuit is settled.³
The American Medical Association adopted a new telemedicine policy at its annual meeting last year.4 The new policy, according to AMA President Robert M. Wah, MD, establishes the foundation for physicians to use telemedicine to “help maintain an ongoing relationship with their patients, and as a means to enhance follow-up care, better coordinate care and manage chronic conditions.”
The policy calls for a physician to be licensed within the state where the patient is receiving services and that a valid patient–physician relationship be established before delivery of telemedicine services. This relationship should be established by a face-to-face examination “if the face-to-face encounter would otherwise be required in the provision of the same service not delivered via telemedicine,” or through a consultation with another physician who has an ongoing patient–physician relationship with the patient.
A Cato Institute report by Simon Lester, published in March, outlines barriers to telemedicine in the U.S., including the requirement for licensing in the state where the doctor practices medicine and in the state where the patient is located.5 “With doctors and nurses providing medical advice online, the idea that their advice can or should be restricted to people within their borders seems arbitrary,” Mr. Lester wrote.