The Federation of State Medical Boards Adopts Guidelines to Govern the Safety of Telemedicine

The Model Policy emphasizes the maintenance of appropriate standards of care for all patients, regardless of whether the care is delivered in-person or through a telemedicine link. This includes, for example, appropriately establishing the physician-patient relationship; providing and documenting an appropriate medical evaluation; obtaining informed consent; providing for the continuity of care; having a plan for emergency service referrals; maintaining appropriate medical records; meeting or exceeding state and federal patient privacy requirements; disclosing to patients information about their rights; and implementing appropriate safety measures when prescribing medications. The Model Policy also includes requirements for the disclosure of information that is specific to providing telemedicine services, such as the use and response times for electronic messages.

Notably, the Model Policy does not address one of the more significant barriers to the provision of telehealth: the requirement of many states that a practitioner be licensed in the state where the patient is located, regardless of whether the service is provided in-person or through telemedicine technology. In June 2013, the Federation published its Telemedicine Overview: Board-by-Board Approach, examining each state’s approach to telemedicine licensure. In its overview, the Federation identified 57 state licensing boards, plus the Washington, DC board, that require physicians who engage in telemedicine to be licensed in the state in which the patient is located (as opposed to having some sort of parity or mutual registration requirement). The Federation did not make any recommendations in its 2013 overview or in the Model Policy regarding whether states should ease these requirements and adopt a more cooperative approach to licensing across state lines for telemedicine services.

There are, of course, legitimate arguments in favor of requiring physicians to be licensed by the state in which the patient is located, regardless of the manner in which care is provided. First and foremost, states may perceive direct oversight of physicians as more protective of the health and safety of the states’ residents, especially when physicians may be prescribing drugs to patients they have not physically seen. Additionally, the state licensure requirement generally is not a barrier when a practitioner’s practice model makes it worth the effort of becoming licensed in multiple states in order to provide telemedicine services — for example, for radiologists who regularly use telemedicine technology to provide services remotely throughout the country. However, for areas of significant subspecialization, the requirement of multiple state licenses remains an obstacle in the expansion of telemedicine. Specialists who receive only a few requests to provide medical care to patients outside of their home state via telemedicine link will have little incentive to seek licensure in more than one jurisdiction. Therefore, until state legislatures and licensing boards adopt processes to permit telemedicine practice without standard licensure, the licensing requirements will remain an obstacle to the expansion of specialist care through telemedicine technology.