Page 9 Unlocking The Potential of Physician to Patient Telehealth Services The Information Technology & Innovation Foundation

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percent. These trends help explain projected increases in U.S. health care costs, which are
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expected to reach almost 20 percent of GDP in the United States by 2022. Needless to
say, greater efficiency and lower health care costs are needed or else the United States could
find itself making large sacrifices to care for elderly patients. Using telehealth to provide
care for individuals with chronic diseases is a potent solution for reducing health care costs.

WHAT ARE THE BARRIERS TO TELEHEALTH?
Progress in implementing telehealth has so far been disappointingly slow. Despite the
widespread availability of the necessary technologies and significant interest among
patients, most individuals in the United States do not have routine access to telehealth
services because of states and federal laws prohibiting or curtailing its use. In particular, to
overcome existing barriers to telehealth, changes are needed in state and federal policies
about when and how telehealth services can be provided, how out-of-state providers are
licensed, and how telehealth services are reimbursed.

Standards of Care
Each state medical board defines the standard of care that physicians must provide to
patients. These state medical boards can decide whether physicians can provide telehealth
services and the conditions under which they can provide it. If state medical boards do not
properly outline what is allowed, physicians may be reluctant to provide telehealth services
since they may be exposing themselves to potential malpractice lawsuits. For example,
physicians may insist on seeing their patients in-person to avoid any potential liability
arising from the differences in care provided from an electronic encounter versus an in-
person one.

Some states have in fact created laws and regulations that impede the adoption of telehealth
services. In particular, a number of states insist on a physical encounter to establish a
physician-patient relationship. If this relationship is not established, physicians are not
permitted to treat patients or prescribe them drugs thereby severely limiting what they can
do. Patients may be able to see physicians who they have a pre-existing relationship with,
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but they cannot see a physician who they have never seen before, is only seeing patients
online, or is not local. These restrictions severely limit a patient’s choices in telehealth
providers thereby negating many of the benefits of telehealth. They also limit the viability
of physicians providing telehealth services on a large geographic scale.

There are some exceptions to these policies. Some states, such as West Virginia,
affirmatively allow providers to establish a physician-patient relationship using telehealth.
In Texas, physicians can treat patients so long as they adhere to the same standards
required for in-person clinical visits. This flexibility allows physicians to determine for
themselves whether they have sufficient information to diagnose and treat a patient using
telehealth. Other states allow online prescribing if certain conditions are met. Louisiana,
Mississippi and New Mexico, for example, allow physicians to prescribe drugs online if
they have verified the identity of the patient, conducted an appropriate exam, and
established a proper diagnosis and treatment plan, among other requirements, but they do
not specify that any of these activities must be done in person.

THE INFORMATION TECHNOLOGY & INNOVATION FOUNDATION | MAY 2014 PAGE 9