In a recent paper published in the Annals of Internal Medicine, the American College of Physicians (ACP) has outlined several recommendations for the use of telemedicine in primary care settings.
As telemedicine technologies and applications continue to develop and evolve, ACP has compiled pragmatic recommendations on the use of telemedicine in the primary care setting, physician considerations for those who use telemedicine in their practices, and policy recommendations on the practice and reimbursement of telemedicine.
This paper is a follow up to ACP’s 2008 position paper, “E-Health and Its Impact on Medical Practice” which discussed how the use of technology (including electronic health records, patient portals, and telemedicine) can augment the practice of medicine in an efficient and secure way. The use of these technologies has been shown to increase patient satisfaction while delivering care that is similar in quality to, and in some cases more efficient than, in-person care and support. Research shows that telemedicine can potentially reduce costs, improve health outcomes, and increase access to primary and specialty care, the authors wrote.
In summary, ACP believes that telemedicine can potentially be a beneficial and important part of the future of healthcare delivery. However, it is also important, especially as policymakers and stakeholders shape the landscape for telemedicine going forward, to balance the benefits of telemedicine against the risks for patients. By establishing a balanced and thoughtful framework for the practice, use, and reimbursement of telemedicine in primary care, patients, physicians, and the healthcare system will realize the full potential of telemedicine, ACP writes.
Specifically, ACP recommends:
- That episodic, direct-to-patient telemedicine services should be used only as an intermittent alternative to a patient's primary care physician when necessary to meet the patient's immediate acute care needs.
- That a valid patient–physician relationship must be established for a professionally responsible telemedicine service to take place. A telemedicine encounter itself can establish a patient–physician relationship through real-time audiovisual technology. A physician using telemedicine who has no direct previous contact or existing relationship with a patient must do the following: take appropriate steps to establish a relationship based on the standard of care required for an in-person visit, or consult with another physician who does have a relationship with the patient and oversees his or her care.
- That telehealth activities address the needs of all patients without disenfranchising financially disadvantaged populations or those with low literacy or low technologic literacy. In particular, telehealth activities need to consider the following: the literacy level of all materials (including written, printed, and spoken words) provided to patients or families; affordability and availability of hardware and Internet access; ease of use, which includes accessible interface design and language
ACP additionally supports:
- A streamlined process to obtaining several medical licenses that would facilitate the ability of physicians and other clinicians to provide telemedicine services across state lines while allowing states to retain individual licensing and regulatory authority.
- Lifting geographic site restrictions that limit reimbursement of telemedicine and telehealth services by Medicare to those that originate outside of metropolitan statistical areas or for patients who live in, or receive, service in health professional shortage areas.
- Reimbursement for appropriately structured telemedicine communications, whether synchronous or asynchronous and whether solely text-based or supplemented with voice, video, or device feeds in public and private health plans, because this form of communication may be a clinically appropriate service similar to a face-to-face encounter.
