HealthJune 25, 2020

4 key factors to consider when getting started in telemedicine

By: Melissa Welby, MD

Getting started in telemedicine and figuring out how to incorporate it into your practice can be a challenge, but the benefits are worth the effort!

This morning I woke to an ice storm and the news that school was canceled. Before adopting telemedicine into my practice, I would have had to reschedule all of my patients. Even if I made it to the office, most of my patients wouldn't come.

Today, I wore slippers all day, didn't risk my life driving on icy roads and saw my entire schedule remotely. I didn't have the stress of rescheduling everyone and doing hours of unbillable phone calls to address the issues that couldn't wait.

Getting started in telemedicine can be intimidating, but it's worth it. Here's how to do it -- but bear in mind that this isn't legal advice. The laws surrounding telehealth requirements are evolving and differ by state, so be sure to consult with an attorney to ensure you're compliant.

4 key telemedicine concepts

Key elements to consider as you think about getting started in telemedicine include standards of care, Health Insurance Portability and Accountability Act (HIPAA) compliance, licensing requirements and regulations on what and who you can prescribe for. This baseline knowledge is essential to accurately envision how to incorporate telehealth into your practice.

1. Standards of care

Simply put, telemedicine standards of care are the same as in-office visits. If an equivalent assessment cannot be done via telehealth technology, then the patient needs to be seen in the office. For example, it would be challenging to evaluate a patient's stomach pain without being able to palpate their abdomen, so an in-person visit may be most appropriate. However, the follow-up discussion and review of imaging and labs could be done in a telemedicine appointment.

Telehealth technology has become increasingly sophisticated, and with the right tools, complex exams can be done from afar. Specialties that previously seemed incompatible with telehealth can now feel more confident about meeting the standard of care and take advantage of the benefits telemedicine has to offer.

2. Federal and state laws

It's not enough to familiarize yourself with federal regulations like the Ryan Haight Act. State laws also need to be followed. To add to the confusion, those state laws vary, according to the Center for Connected Health Policy, and can be more or less restrictive than federal laws.

For example, if your state allows a controlled substance to be prescribed during a telehealth encounter and does not require an initial in-person visit to establish a doctor-patient relationship, you may violate federal law while following your state law. It's confusing!

Depending on how much time you have to research and understand the state and federal telehealth regulations, it may be easier to consult with a lawyer while you're getting your feet under you. This will ensure you know the rules and how they apply to your practice.

3. Patient privacy

Some physicians getting started in telemedicine want to use the technology they already have for their remote appointments. After all, most of us can easily video chat with friends and family from our phones. Why not see patients that same way?

HIPAA requires that you have a Business Associate Agreement (BAA) with the platform you use to see patients remotely. Unfortunately, many of the common teleconferencing and video chat platforms don't allow you to obtain a BAA. When considering which platform will work best for you, avoid the temptation to choose the free option. Often the free version includes all the same features as the paid — except it doesn't provide a BAA. Don't do it! The potential consequences of violating HIPAA standards are just too big.

4. State licensure

Modern technology can bring physicians and patients together regardless of geographic distance; however, medical licensing regulations aren't as freeing. Physicians can only see patients who are located in the states where they're licensed. There are several exceptions to this rule, though. For example, physicians working for the Veterans Administration (VA) can remotely see patients at VAs across the country without getting different licenses.

The Interstate Medical Licensure Compact is making it easier for physicians to be credentialed in multiple states. But note that this is only an option if your state has signed on to the compact.

Getting started in telemedicine

Incorporating telemedicine into my practice benefits both my patients and myself. When a patient is late, I immediately reach out and assess if a telemedicine visit is appropriate. This has cut down on no-shows and wasted time. If a lab result requires discussion and a potential medication change, I can now schedule a telehealth visit instead of explaining everything by telephone or making my patient wait to see me in the office.

Patients are happy because they don't always need to carve out extra time from work to get to an appointment or spend hours traveling by bus for a 15-minute visit. This convenience may make them more willing and able to seek regular care, improve the treatment alliance and ultimately positively influence their health.

Getting started in telemedicine can be initially overwhelming, but I encourage you to take the time to educate yourself and incorporate it into your practice. You and your patients will be glad you did it!

Melissa Welby, MD
Lippincott Medicine
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