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.