Inside A Practice

Policy Recommendations to Guide the Use of Telemedicine in Primary Care Settings

Hilary Daniel, BS; Lois Snyder Sulmasy, JD, for the ACP Health and Public Policy Committee**

SEPTEMBER 2015 – Telemedicine—the use of technology to deliver care at a distance—is rapidly growing and can potentially expand access for patients, enhance patient–physician collaboration, improve health outcomes, and reduce medical costs. However, the potential benefits of telemedicine must be measured against the risks and challenges associated with its use, including the absence of the physical examination, variation in state practice and licensing regulations, and issues surrounding the establishment of the patient–physician relationship. This paper offers policy recommendations for the practice and use of telemedicine in primary care and reimbursement policies associated with telemedicine use. The positions put forward by the American College of Physicians highlight a meaningful approach to telemedicine policies and regulations that will have lasting positive effect for patients and physicians.

The use of telemedicine (use of technology to deliver health care services at a distance) and telehealth services (a somewhat broader definition of telemedicine that includes not just delivery of health care services at a distance but patient and health professional education, public health, and public administration [1]) has expanded rapidly to solidify a place in the modern health care conversation. The use of telemedicine technologies began mainly in rural communities and federal health programs but has since been used in various medical specialties and subspecialties across care settings. The term telemedicine comprises different types of technologies with different applicable functions, outlined in the Table.

Table. Types of Telemedicine


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Although telemedicine has been a component of the health care field for decades, only since the broad proliferation of computer and smartphone technology into the everyday lives of the general population has telemedicine taken a foothold in how health care may be delivered to larger groups of patients. Telemedicine holds the promise to improve access to care, improve patient satisfaction, and reduce costs to the health care system. However, various challenges and risks of telemedicine, such as variations in state and federal laws, limited reimbursement, logistic issues, and concerns about the quality and security of the care provided, should not be overlooked.

As telemedicine technologies and applications continue to develop and evolve, the American College of Physicians (ACP) has compiled pragmatic recommendations on the use of telemedicine in the primary care setting, physician considerations for those who use telemedicine in their practices, and policy recommendations on the practice and reimbursement of telemedicine. The statements represent the official policy positions and recommendations of ACP. The rationale for each is provided in the full position paper (see the Appendix).

In 2008, ACP published a position paper, “E-Health and Its Impact on Medical Practice” (2), which discussed how the use of technology (including electronic health records, patient portals, and telemedicine) can augment the practice of medicine in an efficient and secure way. Since that paper’s release—just 1 year after the first iPhone (Apple) was introduced—the use of technology is engrained into the everyday lives of persons across the United States and the world. The use of these technologies has been shown to increase patient satisfaction while delivering care that is similar in quality to, and in some cases more efficient than, in-person care and support. Research shows that telemedicine can potentially reduce costs, improve health outcomes, and increase access to primary and specialty care.

The ACP’s Health and Public Policy Committee, which is charged with addressing issues affecting the health care of the U.S. public and the practice of internal medicine and its subspecialties, developed these positions and recommendations. The committee reviewed studies, reports, and surveys on all applications and uses of telemedicine, patient satisfaction with telemedicine, and quality of telemedicine in addition to the legal landscape surrounding telemedicine, including licensing, prescribing, credentialing, and other legal requirements. Draft recommendations were reviewed by ACP’s Board of Regents, Board of Governors, Council of Early Career Physicians, Council of Resident/Fellow Members, Council of Student Members, and Council of Subspecialty Societies. The position paper and recommendations were reviewed by the ACP Board of Regents.



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