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Key Points
Telemedicine (or telehealth) is slowly gaining definition as a term describing a variety of approaches to healthcare using communications links.
By removing the requirement for physical presence (of the patient, provider, or educator), telemedicine permits fundamental changes in health care delivery, administration, and education.
Telemedicine has significant ramifications relating to licensure and malpractice that have yet to be fully defined.
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Telemedicine and telehealth are two terms that are slowly creeping into public awareness. The former is a subset of the latter. Telehealth is the delivery of healthcare over a distance using tools such as the telephone, email, video, and computers. Patients who look to the Internet for information about healthcare are engaged in telehealth. Physicians who consult over the Internet are also practicing telehealth. A broad definition is the application of health care services across space, time, social, and cultural barriers. Telehealth ideally involves changes both in technology and the health care environments where it is deployed (Fig. 14-1).
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Telemedicine encompasses a range of specific medical activities including teleconsulting among clinicians, specialty telemedicine applications, telehomecare, remote diagnosis, and remote surgery. Some of the specialty areas in which telemedicine has been employed include emergency medicine, cardiology, dermatology, ophthalmology, neurology, gastroenterology, rehabilitation, and critical care medicine.
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Telemedicine and telehealth are associated with a variety of unique issues that have prompted legal scrutiny and legislative changes. One well-publicized example is the development of online pharmacies. In order to bypass ordinary constraints, consumers and providers have collaborated to form a marketplace for drugs to treat impotence, hair loss, and allergies. For example, “Internet doctors” maintain websites indicating that they “treat” erectile dysfunction. Interested patients describe their symptoms on a form, pay a fee, and are issued a prescription without ever having seen the physician. One company ran ads for physicians who would be willing to conduct “fully automated online medical reviews” in return for stipends of up to $10K per month. An orthopedist “reviewed” these forms and authorized sildanefil prescriptions in return for a stipend. It is hard to draw a clear line between this seemingly problematic interaction and legitimate telehomecare, where a patient enters into a dialogue with an online physician to ask appropriate health care questions and receive care.
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Another area with legal ramifications pertains to state licensure and malpractice in telemedicine. Traditionally medicine is practiced with both the patient and the clinician in the same place at the same time. Telemedicine permits separations in time and location. A clinician with a license in one state may interact with a patient in a different state during a virtual visit. A consultant in one state may collaborate with a clinician in another state or country during the care of ...