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Reasons Federal Regulation of Telemedicine is Needed

There is no question that telemedicine has been able to save lives in many ways. It’s been used in remote areas where medical staff has been scarce to help people ward of illnesses, it has proved to be both a money and time saver for many in need of medical treatment all over the world. As more people are embracing the idea of using telemedicine as an alternative to the traditional means of getting treatment, concerns about how to monitor this growing industry begin to increase.


Evidence has made it clear that there are times when medical professionals will make entirely different decisions when dealing with a telemedicine patient than they would for an in-person visit. While this may work out better for the patient, there is also the risk of problems as a result of this inconsistency. According to a point raised in a recent article in JAMA in the case of prescription medications. It appears that, “The antibiotics prescribed during telemedicine visits raised some specific quality concerns that require further attention. … While the rates of prescribing were similar, the adjusted prescribing rate for broad spectrum antibiotics such as azithromycin, amoxicillin and levofloxacin was 86 percent for Teledoc versus 56% at physician offices.”


This evidence clearly shows some inconsistencies between the different types of medical treatments and the higher risks some patients may be exposed to when getting prescriptions online through telemedicine.


Causes for Concern


The disparity between the two has raised some major causes for concern. Without monitoring telemedicine more closely the issue of overuse can naturally become a problem. The ease in which a patient can reach medical help means they are more likely to take liberties in getting treatment, which could lead to higher costs.


In addition, people may find themselves taking medication more frequently than before causing patients to develop higher tolerance levels to certain drugs, and as a result decreasing their effectiveness in treatment.


It could also be an indication that telemedicine providers take a more conservative approach when it comes to providing prescriptions as opposed to the in-person patient. To cover their bases, they may be more apt to prescribe broader treatments simply because they are unable to put their hands on the patient directly.


And, the concern that medical professionals may not be able to properly diagnose a patient without a face-to-face contact is a major one. Many believe that they lack the needed insight in raising alarm bells across the medical community.


The Need for More Research


Many regulatory agencies are raising alarm bells and at the very least are opening the door to the need for more study in this area. As explained at the Center for Connected Health, “There must be a patient-provider relationship, presumed to be established in an in-person encounter, before a prescription can be written. By having all interaction occur online, questions are raised regarding whether the provider has enough information to make an informed decision regarding treatment.”


These concerns stem from whether the provider has enough information on the patient’s true health condition and medical history are foremost on many people’s minds. And they wonder how a physician will be able to confirm that the patient is honestly relating his true condition in any given situation. This is why some states have taken the step to prohibit any means of issuing or receiving prescriptions online without at least one in-person doctor-patient interaction first.


State Control


In the past, all that was needed for a prescription to be considered valid was a bona fide medical need that was verified by a physician during the course of his practice. However, in 2008, Congress prohibited the issuing of any controlled substances over the Internet without having a “valid prescription” with the passing of the Ryan Haight Online Pharmacy Consumer Protection Act.


Today, control of Internet prescriptions is regulated by each individual state, which adds to even more complications. There is no consistency across the board in regards to prescriptions online. It is up to each state to determine if the patient-provider interaction is adequate through telemedicine or if an in person visit is necessary. This leads to varying complications across the country as the chances can be quite high that the patient and the physician may not always be in the same state and therefore will fall under completely different guidelines when it comes to issuing or receiving prescriptions.


An example of this controversy is a case of an Idaho doctor that issued a prescription over the telephone. The State Licensing Board did not approve and issued sanctions against the doctor. As stated in Modern Healthcare, “But Idaho’s medical licensing board doesn’t approve and earlier this year punished a doctor for prescribing a common antibiotic over the phone. The sanctions against Dr. An DeJong are so severe that her board certification is threatened.”


The controversy has raised many issues that the largest telemedicine provider has chosen to pull out of Idaho because of these stringent regulatory issues. It is clear that there is strong promise in the future of telemedicine but the system has yet to be perfected. As long as there remains disparity between the states regulatory system, there will always be confusion as to the best way to proceed with telemedicine in the future.


It seems that there is a division on where this growing industry will go next. Those who live in remote areas where medical treatment may be far away are watching the transition with anticipation. They are the ones that look forward to getting the treatment they want without having to make a major journey from a remote location when they are already in poor health. Those on the opposite end feel just as strongly about their position.


Everyone is now in anticipation of the decisions that will be made at this coming conference on consistent regulation of telemedicine across the nation.

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