With passage of a new law in March, Indiana joined the list of states that have created rules and regulations to manage the growth of telemedicine. Telemedicine, or telehealth, uses technology to allow patients and healthcare providers to interact remotely, and it’s often seen as a way to deliver greater access to care to more patients, especially those in rural areas or those in areas where a needed medical specialist is not available. Indiana approved the creation of a pilot telehealth program in 2014, and patients have been able to use it since last summer (although some Hoosiers have been using unregulated telemedicine programs for years). The pilot would have expired this July if the new law had not passed.
What is Telemedicine?
Telemedicine is a broad term for any technology that allows doctors and patients to interact over long distances without physically getting together. It can be as simple as a patient describing their symptoms to determine if treatment is necessary, and as advanced as a doctor using a remote-controlled robot to perform surgery from hundreds of miles away. Telemedicine is generally seen as a useful advancement in bringing healthcare services to more people while at the same time reducing costs. In Indiana, it’s meant to expand the availability of care, especially to underserved populations; one of the expected critical uses here is the delivery of mental health services.
The potential market for telemedicine is huge – everyone – but actual use is so far very small. Among the general public, estimates range from a few tens of thousands of visits to close to half a million each year. The Department of Veterans Affairs has made great use of it and scheduled more than 2 million visits in 2014. Use overall is expected to grow rapidly.
Building on Existing System
The Indiana law, because of lessons learned from the pilot, covers a great deal of ground. Some aspects of the pilot program have been streamlined, but much has been rolled forward. In Indiana, legitimate telemedicine will be restricted to secure video conferencing, store-and-forward audio (intended for consultations), and remote patient monitoring technology. Simply picking up the phone, using email or an online chat, or using other “remote” technologies will not qualify.
Physicians must meet specific criteria to offer services to a patient, but the pilot requirement to begin with an in-person visit has been dropped. The requirements for documenting each visit, and for patient confidentiality, have been maintained or strengthened. In an important change, prescriptions may now be written for telemedicine patients, although a few key exceptions have been included: controlled substances cannot be prescribed remotely, for instance, and prescriptions for glasses, contact lenses, and other prescription eyewear cannot be issued in this way. To ease the transition and speed adoption, Indiana has followed the majority of states by requiring that insurers treat telemedicine visits the same as traditional visits.
Telemedicine is not a Panacea
Indiana’s telemedicine bill passed with a large majority, but it’s not without critics. It has the potential to do a lot of good, but it’s not a magic remedy that can improve everything about the American healthcare system. Even strong supporters know that it needs to be planned thoughtfully and its implementation needs to be monitored to make sure that quality of care is maintained and abuse is prevented.
The ability to remotely issue prescriptions has also been a sticking point, with the argument made that this could be abused. That concern was met by specific provisions written into the law. Speaking as a representative of the Indiana Academy of Family Physicians, a former state health commissioner was not supportive and expressed concerns over the risk of “perpetually electronic” care with no physical doctor presence. As recently as last October, the full congress of the American Academy of Family Physicians was unable to agree on their position on telemedicine. Most states have programs and regulations in place, but there are still bumps in the road: within weeks of Indiana’s new law, Mississippi rejected one of their own, in part because a state medical association came out strongly against it. The language of that law was viewed as weak compared to Indiana’s.
All Medicine Has Risks, Even Telemedicine
Telemedicine will no doubt bring many good things to Indiana. But the risks that exist in all medicine will still be there: failure to diagnose, misdiagnosis, medication errors, and other examples of malpractice will continue to occur. Despite the best intentions and well-meaning regulations, it’s possible that some of these problems could happen more frequently via telehealth systems. Indiana’s legal community has already been thinking about these issues for some time.
If you’ve been harmed because of a medical error during or in conjunction with a telemedicine session, give us call to discuss the situation. At Wilson Kehoe Winingham, we’re equipped to deal with medical malpractice cases, whether they take place in a hospital, a physician’s exam room, or in cyberspace. We offer a free consultation, and if you choose us to represent you you’ll pay no legal fees unless we’re successful at reaching a settlement. Our phone number is 317-920-6400 or you can contact us online.