Telemedicine And The Law: 7 Things You Should Know

Telemedicine is the treatment of patients through the use of telecommunications in situations where the health professional and the patient are not in the same area. As developments in telecommunication technologies have expanded the capabilities of telemedicine, the use of telemedicine has increased dramatically. And with the wide adoption of this form of health care comes a whole list of laws to consider, both as a medical practitioner and as a patient. So let’s take a look at what you need to know about telemedicine and the law.

As medical practitioners try to keep up with the constant stream of new laws and safely navigate the gray areas in this dynamic, shifting environment, there are some who will be hesitant to give telemedicine a chance for fear of accidentally overstepping legal boundaries. Equally, some patients are likely to be overwhelmed by the changes, and this may make them decide against telemedicine when it very well may be the best option available. However, with time, the undeniable effectiveness and cost-efficiency of this industry will guarantee that its laws accurately represent both doctors and patients. This will leave health practitioners feeling confident working with telemedicine to bring the vast number of benefits it provides to patients across the country.

Knowing your rights allows you to ensure you are kept safe, legally. With that in mind, we’ve created a list of 10 things you should know about telemedicine and the law.

1.  Telemedicine Doesn’t Include…

According to Health Care Law Today, telemedicine doesn’t include “audio only” phone calls, email, or fax correspondence. Images and videos must supplement any form of communication in order for it to be considered telemedical. confirms this.

Divan Medical - laws

It’s important to familiarize yourself with telemedicine and the law to ensure you’re being treated right as a patient, or treating your patients right as a medical practitioner.

2. Telemedicine Is Only Available If…

In order to qualify for telemedicine, you must be located within a Health Professional Shortage Area (HPSA). As well as this, they must be seeking one of the following types of medical health facilities:

  • A physician
  • A hospital
  • Community mental health center
  • Rural health clinic
  • Critical access hospital
  • Skilled nursing facility
  • Federally qualified health center
  • Renal dialysis center

3. Telemedicine Isn’t a Substitute

Telemedicine does not overrule the need for bedside contact or a patient-doctor relationship; nor does it substitute standard medicine. It is supplemental and to be used in times where traditional medicine is not feasible.

4. Telemonitoring is Not Always the Way

Telemonitoring relates to the control of vital signals at a distance, through systems not dependent on any particular doctor and often portable by the patient. These systems send alarm signals to remote control centers. There are many scenarios in which telemonitoring should not be used. For example, if a patient has a disease, illness, or wound that which may require urgent care, then relying on telemonitoring may be considered malpractice.

Divan Medical - doctor in lab

In some cases, in-person treatments or observations are required by law in addition to (or instead of) telemedicine.

5. Telemedicine is Both a Health Care Service and an Information Service

This means that regulations regarding both types of service are applicable to telemedicine and both should be considered as a medical practitioner. For example, information services have their own laws regarding privacy of information.

6. Telemedicine is Still Young

As telemedicine is still in its early development stages, the laws surrounding it have yet to deal with all of the intricacies it brings. This means both patients and health practitioners may be unprotected in certain ways. It also means that already established laws may evolve or be entirely redefined.

7. The Laws In Each State Differ

As the approach taken to telemedicine and the law differs significantly from state to state. It is important not to confuse the telemedicine laws of one state with another. Both the doctor and the patient are expected to uphold the law of the state in which the patient currently resides.

Despite the fact that every state’s laws, regulations, and Medicaid program policies differ, there are certain ideas that are consistent throughout. For example, live video Medicaid reimbursement persistently exceeds reimbursement for remote patient monitoring and store-and-forward (the process by which information is sent and stored in a halfway station to be sent at a later time to the final destination).

So there you have it: the top seven things you should know about telemedicine and the law. Keeping them in mind, you’ll be better able to protect yourself, both as a patient and a health practitioner. As telemedicine is built on telecommunications, the constant and rapid advancement in telecommunication technologies means that the capabilities of telemedicine are developing at an astonishing rate. This is, of course, an incredibly positive thing. It will help improve the physical and mental health of many patients in rural, isolated areas, patients with limited mobility, and patients with anxiety disorders. At the same time, it will also help to reduce health care costs, which can, in turn, be used to fuel even better health care – a positive, upward cycle. However, it is important to realize that with such rapid developments, the laws surrounding telemedicine will likely also change rapidly. With that in mind, if you have any skin in the game, keep yourself informed and your information up-to-date.

NASA Astronauts Use Telemedicine: Now You Can Too

Telemedicine has played a major role in the care of our astronauts at the International Space Station (ISS) since 2001, but the first pioneering telemedicine initiatives relating to space travel actually occurred in the 60s and 70s with the Mercury missions. The technology existed even back then to communicate an astronaut’s medical status, X-rays, and ECGs to a crew of professionals at the home base, ensuring that their health could be checked and monitored remotely.

2001 saw the first lengthy stay on the ISS and, since then, a new team of astronauts and cosmonauts has been dispatched to the Station four times a year. The duration of their stay can be anything from six months to a year, during which time they are required to perform engineering tasks, maintenance and upgrades, and so on. Access to medical care would be important for any group of people not within easy reach of physicians and specialists, but with astronauts in space, it’s even more vital that they are monitored regularly. The weightlessness that a lack of gravity causes can have demobilizing effects on the astronauts’ bodies – affecting in particular their immune system, fluid distribution, and the condition of their bones and muscles. The advancement of telemedicine technology means that the crew can be monitored and cared for throughout their stay. To help maximize the resources, a degree of training for medical emergencies and simple procedures is undergone by one or more of the astronauts during their pre-launch instruction period.

Divan Medical - International Space Station

Advances in telemedicine mean that astronauts hundreds of miles into space can receive medical monitoring and treatment.

One thing that the Mission Control staff have learned over the years is that good communication is crucial during situations involving telemedicine. All professionals involved in ISS expeditions – medical personnel, the astronauts, and Mission Control staff – undergo training in order to acquire excellent communication skills. In an emergency situation, the astronaut needs to convey clear and precise information on what is taking place, and the medical professional needs to be able to give definitive and speedy instructions on how to proceed.

There’s a story relating to an astronaut who had a history of a knee injury prior to his launch to the ISS. He’d been symptom-free throughout the training period before the launch, but, during his time at the station, his knee started to present with some problems. Spacecrafts are equipped with ultrasound imaging – a form of technology which is radiation-free, cost-effective, and reliable, and which requires less expertise from the operator than some other forms of technology. Perfect for use in space! An ultrasound NASA specialist on the ground guided the nominated crew member through the procedure of taking some X-rays of the offending knee. They were joined by a remotely located radiologist who was able to view the images and diagnose the problem. Treatment was prescribed and the astronaut went on to continue his stint in space without a further hitch. A perfect example of telemedicine working to its full potential.

It’s been proven that a lot of planning and training is required prior to any NASA launch and also, as previously mentioned, that good communication – along with the ability to learn essentials quickly – is vital in the use of telemedicine. This has had a positive impact on the potential for telemedicine’s role in care and treatment in other remote or extreme environments. And some of those remote and extreme environments exist on terra firma! It’s possible to be connected quickly and cheaply with health care providers without the need for travel. You save time and money – as does the health service, as they are able to treat more patients – and you’re in the hands of someone who not only has the necessary medical expertise but also appropriate communication skills. Just one more example of how you could benefit from telemedicine.

Divan Medical - knee X-ray

X-ray images can be taken on-board the International Space Station and transferred to Earth for examination.

Another clear result that has come from the NASA ventures is that shared knowledge and shared input work well in the diagnosing and treatment of conditions. Videoconferencing is used between an astronaut and a physician, either for a specific problem or for the general monitoring of health, and often a specialist will be called in to join the conference when further expertise is required. This communal meeting is beneficial to all concerned as it brings the top brains together simultaneously, thus saving time and money and giving the best odds for a positive outcome. It’s easy to see how this translates into everyday telemedicine, which can benefit us all.

A further vital point learned from NASA’s use of telemedicine is that a strong and secure communication link is essential. You wouldn’t want to lose connectivity in the middle of a consultation or the briefing of a minor procedure. The provision of better broadband facilities in rural areas is currently under discussion, thanks to a representation that has been made to the House Energy and Commerce Committee on behalf of a coalition of health care providers, schools, libraries, and health centers.

Ultrasound, as detailed above in the example of the astronaut’s knee problem, is currently still the most used and the most developed telemedicine procedure, but other “guidable” procedures – minor surgery being one of them – are in the process of being developed. Imagine how this will not only help people in remote areas, but will also reduce waiting times for minor operations anywhere in the States, thereby cutting down on time taken off work and the use of pain relief while waiting for the procedure. Health costs will be slashed and so too will insurance premiums. Ultimately, we will all be beneficiaries of the continued advancement and development of telemedicine, and NASA is playing an important role in showcasing exactly what can be achieved via telemedicine.

Which Areas of Health Care Use Telemedicine?

Telemedicine might seem like a relatively recent phenomenon in health care, but in actual fact, the idea has been around since the 1950s. Back in those days, of course, digital technology didn’t exist; the only mode that existed for housebound or rural patients to access continued health care resources was the telephone, hence the name. When it was first introduced, telemedicine was regarded as a fringe service for the next few decades, albeit one with huge benefits for patients living in remote areas. However, in 2018, telemedicine is being regarded as the next progressive enhancement to sweep through the American health care system.

The reason of this is all down to digital technology. Telemedicine, though it retains the analog name, is no longer an archaic technology benefitting only a few remote patients. With the advent and continued prevalence of the smartphone, it’s becoming so much more than that, and experts forecast that the telemedicine revolution will grow exponentially in 2018 and beyond. It’s no longer just beneficial to patients who have trouble getting to their doctor, either; while it still remains that, it’s so much more simultaneously. Telemedicine is making health care cheaper and faster for everyone involved, including patients, doctors, and specialists. The former can see a medical professional on their own terms, when and where they need to, while the latter can get through more patients in a day and provide better quality care for less cost.

Divan Medical - doctor

Patients can experience many benefits from telemedicine, and it can help doctors do their job more efficiently too.

So which areas of health care actually use telemedicine? A better way to phrase the question might be, which areas of health care don’t use telemedicine? The prevalence of smartphones and digital technology means that many areas of the expansive network that is the American health care system can benefit from the positives of telemedicine, regardless of whether they adopted telemedicine before. Here are a few of the areas that are receiving major boosts from telemedicine.

1. Mental health

According to statistics, a quarter of adults will battle a mental disorder of some type or another during their life, yet only fifty percent of these people will seek treatment. The reason for these low figures has a lot to do with the stigma surrounding mental health, and how some people who suffer from it spend their time in denial without ever actually acknowledging their issue. Mental illness is also more prevalent in isolated areas, which makes it harder for people to seek out proper care. Another barrier is the cost of mental health treatment, which usually involves a committed treatment program that some potential patients might be scared of committing to for whatever reason.

Telemedicine provides a remedy to many of these barriers, with the practice already having a successful track record in the mental health field over the last twenty years. As telemedicine becomes more widespread, mental health care is set to benefit even further, with the potential to be completely revolutionized by the nationwide adoption of telemedicine. Patients in remote areas will have the constant access to specialists that they require, while sufferers who feel shame and anxiety about stepping foot in a real-life doctor’s office can be eased into treatment from the comfort and security of their own home.

Divan Medical - doctor with medicine

Getting medication and treatments has been made a lot easier for some people through the advent of telemedicine.

2. Prescription services

Going to retrieve a prescription has always been a bit of a drag for most people, but for some, it’s a relative impossibility. Those who are disabled or housebound can’t always make it to a doctor to receive the prescriptions they need. Telemedicine makes it possible for any patient to easily avail of their required prescriptions, as well as making the whole process easier for everyone who takes medication. All you need to do in most cases is download a relative app that you use to keep in touch with your doctor or order your medicine, or alternatively you can order up your prescription from the internet.

“And when talking about “prescriptions,” don’t just think pills, either; prescriptions come in all shapes and sizes, and cover many different varieties of illnesses or conditions. Telemedicine can help with all of them. If you require medical marijuana, you can sign up for an MMJ card at MMJ Recs. If you suffer from a mental condition and think you’d benefit from an emotional support animal, you can get yourself verified at Moosh. Or if you’re disabled or handicapped in any way, and unable to reach a doctor, you can retrieve a disabled parking permit at Dr Handicap.

3. Specialists

Everyone knows that for any condition causing serious worry, your family doctor is merely a gateway to a specialist. Previously, if you lived in a rural or remote area, you’d have to be referred to the nearest specialist to your local area, who might not always be your preferred choice, or even the best option for your condition. With telemedicine, you can choose from a wide range of specialists and not get tied down to one just because they’re convenient. Telemedicine also reduces waiting times, which were previously inordinate, and helps patients see the specialist they require and want in much shorter order.

The History of Telemedicine

Over recent years, the service known as telemedicine has grown exponentially and it is now very much an accepted part of modern-day medicine. For some folk, it’s probably crept up on you and perhaps taken you by surprise; for others, telemedicine may have been part of your life for some time now. But what is the history of telemedicine?

Let’s look at the definition of telemedicine first up. Succinctly put, it’s the remote diagnosis and treatment of patients via telecommunication technology. So we know that telemedicine delivers healthcare services remotely via telecommunications. But what are these services exactly, and what is the purpose? They include assessments, consultations, scans, results, etc. and allow healthcare professionals to evaluate, diagnose, and treat patients without actually seeing them in person.

Telecommunication, also known as telecom, simply means the exchange of information by electronic means. These electronic means – or information transmitting technologies – include telephones, fiber optics, satellites, microwave communications, radio, TV, the internet, and telegraphs.

Quite a lot to digest and understand if you’re not familiar with telemedicine! So let’s now take a look at the full history of telemedicine that has led to these fascinating developments.

Divan Medical - Stethoscope

The history of telemedicine has encompassed many advancements in technology, communications and medicine.

In the early 1900s, a little invention known as the radio was gaining prominence in many different fields, ranging from the obvious one – entertainment – to the perhaps less self-evident one of national defense. In 1924, a Radio News magazine published a sketch showing a doctor speaking with a patient via a video call, under the headline “The Radio Doctor – Maybe!” An incredible vision from a journalist about future technology, which would take another 90 years to be realized!

The world’s first use of electronic transfer for medical purposes took place in Pennsylvania in the 1940s. Radiology images were sent 24 miles from one town to another via the telephone line. A Canadian doctor took this a step further in the 1950s, building what was known as a teleradiology system, which was used in and around Montreal.

With the advent of motion pictures and the advancement of film technology, it wasn’t long before people started talking about introducing video medicine. It came about in 1959, at the University of Nebraska, where a two-way television was set up so that information could be transmitted to medical students around the campus. A short five years later, they actually linked with a hospital and carried out video consultations.

As you might imagine, telemedicine was initially considered important mainly for rural communities without any direct access to local medics. But by the early 1960s, it was being used in urban communities also, and to great effect. In 1967, in a pioneering move, The University of Miami School of Medicine partnered with their local fire department and set up a system where they could transmit electrocardiographic rhythms via radio to the Jackson Memorial Hospital so that they were able to give and receive advice during rescue situations. This innovation paved the way for further research into the possibilities of telemedicine.

One lot of professionals who were surprisingly able to benefit from these advances in telemedicine were astronauts! Yep – the technology even reached outer space as far back as the 60s/70s! X-rays, ECGs, and other medical information could be transmitted to a hospital for analysis, meaning the astronauts had access to medical care while in orbit.

Projects like this spawned an even bigger interest in telemedicine, resulting in further research and development over the following decades.

Divan Medical - woman using phone

These days, many medical services are just a phone call, message or teleconference away.

It’s interesting to note that the world and history of telemedicine encompasses a large spectrum. On the obvious, and least technological, end of this spectrum is the familiar telephone consultation between a patient and a medic. You could include here also the basic radio communication between emergency medical professionals and hospitals. At the far end of the spectrum, then, you have amazing things such as telesurgery, where a surgeon is able to guide robotic instruments in the performance of surgery at a remote site. Sounds pretty mind-blowing, doesn’t it? It’s still largely experimental at this stage, but surely not that far off becoming commonplace.

In between these two extremes of telemedicine, you have a bundle of other functions, such as video conferencing for diagnostic purposes and a whole array of data transmission possibilities between medical professionals and hospitals.

Two things propelling the ongoing research and advancement of telemedicine are concerns about access to health care and advice in remote locations, and the ever-increasing cost of medicine. Currently, many of our medical centers are looking at reduced revenues, coupled with exclusion from locally managed care networks, so they are very keen to explore the multi-faceted world of telemedicine to see how it might reduce their costs at the same time as advancing their services.

Telemedicine is becoming widely accepted by patients and professionals alike. Today, more than half of all U.S. hospitals have a telemedicine program, and research shows that most patients are happy to use it. Insurance companies, too, are coming on board with the concept. Over the last few years, more companies have started to offer telemedicine as an option on health plans, and people are beginning to use this service in their droves.

So although telemedicine appears to be a relatively new concept, it has actually been around for nearly 100 years now, albeit in a very basic form initially. There’s a way to go with it yet, as the potential is huge, but it’s obvious that telemedicine already has many uses, is here to stay, and could be the answer to many a problem.

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