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Removing State Barriers to Telehealth: Where do we strike the balance?

About two weeks ago, the Governor of Nevada signed into law new legislation that removes a number of barriers to the practice of telehealth within the state of Nevada.  Among the most significant changes, the Nevada legislation allows physicians to establish a physician-patient relationship (which is a precondition for prescribing drugs, rendering diagnoses, and performing other medical services) through a telehealth encounter.  In doing so, Nevada joins only a small number of states that have taken this step.  However the Nevada law is significant not only because it allows a physician to establish a physician-patient relationship through telehealth, but also because it broadly expands the state’s definition of telemedicine to include telephonic communications (in addition to electronic face-to-face).

This means that in Nevada, a physician will not need to see a patient, either in-person or through a video transmission, to prescribe medication or provide other treatment.   A telephone call will be sufficient.  For years, advocates of telehealth have been advocating states to relax their practice of medicine restrictions and allow physicians to establish a doctor-patient relationship through telehealth.  However, to date, most states have resisted, and continue to require that the physician physically examine the patient in-person in order to establish a doctor-patient relationship (for purposes of prescribing drugs, rendering diagnosis, etc.)   It is in the light of this backdrop, that Nevada’s law seems so remarkable.

There are, of course, many good reasons for expanding the range of activities that can be performed through telehealth, which I stand behind.  Telehealth increases access to physicians (who otherwise may not be local), offers individuals with more choices on where to go for care,  makes health care more convenient, and with regard to many telehealth applications, has been shown to improve health outcomes and lower costs of care.    But, as we continue to push for broader adoption of telehealth, and a removal of barriers to prescribing, diagnosing, and performing other forms of treatment through telehealth means, we also need to carefully consider where (and how) the new boundaries should be drawn.

  • Should physicians or advanced practice nurses be allowed to treat patients they have never seen in a face-to-face encounter through the telephone? If so, under what circumstances?
  • Should governments be making decisions regarding the specific ways telehealth can and cannot be practiced, or should medical boards, medical societies or the providers themselves be making these decisions on their own?
  • How do we make sure as an industry that, in our efforts to remove state law barriers to telehealth, we continue to act in the best interest of the patient or the individual?

Right now Nevada is an outlier, and the problem in the vast majority of states is too many restrictions on telehealth practice.   But if we don’t get the balance right, and instead go too far in the other direction, then bigger problems may surface.   There could be more accidents and injuries, and the public may begin to question the safety of telehealth as an alternative to conventional medicine.