Telemedicine, by definition, is medicine at a distance. This raises new issues for physicians and practitioners since licensing is done at a state level.
Licensure Issues in Telemedicine
State licensure requirements are the biggest hurdles for expansion of telemedicine. Most state laws require that medical care be rendered to residents of the state only by physicians licensed in the state, and the Medicare and Medicaid programs provide coverage only where the service meets state law licensure requirements. Illinois, for example, explicitly requires licensure of physicians providing care to Illinois residents via telemedicine, but excludes the following from the definition of telemedicine:
(1) periodic consultations between a physician licensed in Illinois and an out-of-state physician;
(2) a second opinion provided to an Illinois-licensed physician; and
(3) diagnosis or treatment provided to a patient in Illinois following care originally provided to the patient in the state in which the physician is licensed.
A small number of states provide for special purpose licenses for telemedicine.
Regulation of Internet Pharmacies
In recent years, some well-publicized incidents demonstrated the dangers of physicians prescribing for patients without personal contact. In 2009, a Colorado physician was sentenced to nine months in jail for practicing medicine in California without a license. The physician had prescribed an antidepressant over the internet to a college student, who later committed suicide. A similar incident (involving a student who overdosed on prescription painkillers obtained via the internet) led to enactment of the Ryan Haight Online Pharmacy Consumer Protection Act of 2008. The law requires registration of online pharmacies, and at least one face-to-face medical evaluation prior to issuance of a controlled substance prescription via an internet pharmacy. The law contains an exception for the practice of telemedicine, as authorized under state or federal law.
With the expansion of health information technology and the continuing search for means to extend access to health care and control costs, telemedicine initiatives are likely to increase. We have a long way to go in developing a regulatory framework for standards of telemedicine practice.
Ref. 1 225 ILCS 60/49.5(c).
Ref. 2 A listing is available at http://www.telehealthlawcenter.org/loadattachment.php?attachmentid=174_1744_327
Ref. 3 Pub. L. 110-425.
About the Author
Patricia King is a health care attorney in Illinois, and principal of the web-based business Digital Age Healthcare LLC (http://www.digitalagemd.com/).