On July 7, 2015, Delaware became the 29th state to enact a new Telemedicine Act (HB69). Telemedicine is very futuristic and allows patients to communicate with their doctor without actually having to be with the doctor. This Act has unanimous support from both Delaware’s House and Senate. The text of the Act provides this will go into effect immediately, however it may take licensing boards sometime to actually implement regulations called for by the Act.
Telemedicine is described as “a form of telehealth which is the delivery of clinical health care services by means of real time two-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care by a health care provider practicing within his or her scope of practice as would be practiced in-person with a patient, and legally allowed to practice in the state, while such patient is at an originating site and the health care provider is at a distant site.” Telehealth is “the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.”
Establishing a doctor-patient relationship with telemedicine can be established by, but is not limited to: fully verifying and authenticating the location and, to the extent possible, identifying the requesting patient; disclosing and validating the provider’s identity and applicable credential(s); obtaining appropriate consents from requesting patients after disclosures regarding the delivery models and treatment methods or limitations, including informed consents regarding the use of telemedicine technologies; establishing a diagnosis through the use of acceptable medical practices, including patient history, mental status examination, physical examination (unless not warranted by the patient’s mental condition), and appropriate diagnostic and laboratory testing to establish diagnoses, as well as identify underlying conditions or contra-indications, or both, to treatment recommended or provided; discussing with the patient the diagnosis and the evidence for it, the risks and benefits of various treatment options; ensuring the availability of the distant site provider or coverage of the patient for appropriate follow-up care;and providing a written visit summary to the patient.
There are some exceptions, and some services may be provided without a doctor-patient relationship. Those include: informal consultation performed by a physician outside the context of a contractual relationship and on an irregular or infrequent basis without the expectation or exchange of direct or indirect compensation; furnishing of medical assistance by a physician in case of an emergency or disaster if no charge is made for the medical assistance; or episodic consultation by a medical specialist located in another jurisdiction who provides such consultation services on request to a person licensed in this state.
In the instances where the doctors can not diagnose or treat the person with out a face-to-face appointment, they must do at least one of the following: an appropriate examination in-person; have another Delaware-licensed practitioner at the originating site with the patient at the time of the diagnosis; the diagnosis must be based using both audio and visual communication; or, the service meets standards of establishing a patient-physician relationship included as part of evidenced-based clinical practice guidelines in telemedicine developed by major medical specialty societies, such as those of radiology or pathology. Any prescriptions made online are subject to the same standards as traditional prescriptions. Only a doctor who has formed a relationship with a patient may prescribe him or her medicine. A physician is not allowed to prescribe medicine to a person solely an the basis of an internet questioner or phone or internet consult. All medicines may be prescribed to a proper patient via telecommunications, including controlled substances in some cases.
The practice of telemedicine is not just limited to primary care doctors either. Other health care professionals can utilize this service too, including: psychologists, physician assistants, nurses, pharmacists, genetic counselors, chiropractors, respiratory care practitioners, podiatrists, dentists, occupational therapists, optometrists, mental health counselors and chemical dependency professionals, dietitians and nutritionists, and clinical social workers.
Many hospitals around Delaware are already using telemedicine to some extent. The new laws that Delaware are enacting will help guide the practitioners who already use this service and open the doors for many more. Surveys reveal that healthcare executives are optimistic about about the benefits offered by these teleservices.
There are many pros to having teleservices. These include: convenience, cost efficiency, less waiting time, quick transmission of x-rays, etc. to another doctors for a second opinion, and everything is privet because telepractice is subject to the same HIPAA standards as traditional practice. On the down side telemedicine is subject to technological glitches, inadequate assessments, resistance from physicians, and intrusion by hackers. Telemedicine is a great thing, but it should never and could never replace traditional medical services.