The Texas Medical Board (TMB) on April 10, 2015, voted to accept a proposed rule change that would prohibit physicians licensed in Texas from prescribing medicine over the phone or by video conference to a patient they have never seen before in person. This change will undoubtedly affect the use of telemedicine as we know it today as a tool to care for patients in their homes, retirement communities, nursing homes, and even in rural hospitals.
It is clear that the use of telemedicine for the diagnosis of geographically distant patients has been effective. Physical examinations of people via video conferencing by the appropriate specialists have helped their primary physicians to make appropriate diagnosis and treatment plans. In such cases, the primary care physician who is with the patient can then order the appropriate diagnostic studies and prescribe necessary medication. These telemedicine programs have been utilized most frequently for potential stroke victims, and those with complex neurological symptoms and dermatological conditions. Best known, however, is the use of experienced critical care physicians distantly to provide care recommendations for ICU patients in a network of small or rural hospitals.
But, as technologies have permitted more and more care to be rendered in ambulatory settings and the healthier portion of the aging population desires the ability to live as independently as possible, distant physicians using telemedicine tools have been providing both sick and well care to their homes, or retirement communities at the independent, assisted living, or skilled nursing levels. In addition, in rural communities where the 24 hour-a-day availability of a physician is often difficult or impossible, distant physicians via the phone or video conferencing can provide much needed care in a timely fashion.
Teledoc, a telemedicine provider company, issued a statement saying that TMB”S decision “takes away Texans’ access to safe, affordable and convenient care options that many have depended upon for a decade”. It is important to note that TMB’s position is supported by several states, including Utah, and the American Medical Association has adopted a similar national policy for their members. So, as is often the case, some physicians are driving and supporting this change in the way telemedicine can be delivered. Hopefully this is because they truly believe that quality and safe care cannot be rendered to a person the physician has never seen face-to-face.
Could it be that some of these physicians have sought this change so as to prevent companies like Teledoc from potentially taking patients from their population base and reducing their revenue potential? To assure that the correct directional change is supported by data, clinical outcomes measurements of people being treated by telemedicine methodologies must be collected and studied to determine if prescribing medicine to a patient the physician has never seen in-person is resulting in acceptable or non-acceptable care. Rushing to judgement and enacting policy changes without supporting data, which often occurs in politically charged circumstances, will obviously cause the patient to lose out on what has been clinically helpful, service-oriented, readily available and cost-saving care.