The American Medical Association this week put proposed ethical guidelines for telemedicine use on the backburner, amid questions about whether an initial meeting between a physician and a new patient can be established through telemedicine.
The AMA's House of Delegates, in fact, delayed action on guidelines prepared by the organization's Council on Ethical and Judicial Affairs, which defines a "valid patient-physician relationship" that a physician must establish in treating new patients. The CEJA guidelines say this relationship can be accomplished "in person or virtually through real-time audio and video technology."
Hanging over the discussion, however, was a bitter legal battle being fought in Texas.
The Texas Medical Board is seeking to enforce more rigid definition of that relationship. Earlier this year, the board voted to amend its guidelines to mandate that physicians first meet face-to-face with a new patient before being able to make certain diagnoses or issue prescriptions. That initial encounter, the board said, should be in person, but could be done through a video consult if another healthcare provider is in the room with the patient.
That interpretation is on hold. Teladoc, a Dallas-based telemedicine provider that does a majority of its business via telephone, recently won a court injunction blocking the new rule, amid charges that it interfered with the company's business. That issue will now head to the courts.
In its discussions this week, AMA delegates worried that their ethical guidelines, if approved, would put Texas physicians in a bind. One delegate urged the AMA to back the Texas Medical Board's line of thinking.
“There is no requirement here of any form of inpatient, face-to-face interaction,” Arlo Weltge, MD, PhD, MPH, an AMA alternate delegate from Texas, said of the AMA's proposed guidelines. “For physical diagnosis, there needs to be a physical exam that can be done either with an initial face-to-face, or it can be done with a presenter who is seeing the patient in consultation.”
"The unintended consequence of the way (the AMA's proposed ethical guidelines are) written means that anybody can set up a remote station and prescribe medications and, if you will, become an Internet pill-mill," Weltge said in a story in MedPage Today.
Other delegates supported the guidelines, according to MedPage.
"CEJA has done a tremendous job ... trying to not be too prescriptive and too restrictive ... this is a field of evaluation," said Gamini S. Soori, MD, MBA, a delegate from the American Society of Hematology who spoke on his own behalf.
Another delegate added that "telemedicine is here – it's not the future, it's here. We need ethical guidelines, and we need them now."
The proposed guidelines, which cover a wide range of issue relating to physicians using telemedicine – including patient privacy and education on the limits of telehealth technology – have been sent back to the CEJA for review. The earliest they could come back to the AMA's House of Delegates is next November.
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