Troubleshooting Complications in OB Telemedicine

Troubleshooting Complications in OB Telemedicine

From the outside looking in, the concept of telemedicine seems like a clear no-brainer. We have the technology to treat rural and underserved patients remotely, and it’s improving every day. So why isn’t telemedicine used more often in the practice of OB/GYN care when 49% of U.S. counties do not have a single OB/GYN physician? Turns out that multiple regulatory and infrastructure barriers make it difficult for telemedicine to flourish despite its enormous potential.

One of the earliest applications of telemedicine in the delivery of OB/GYN care came in 1998, when the University Federico II of Naples commenced a telecardiotocography (TOCOMAT) program to facilitate the transmission of prenatal electronic fetal monitoring data of high-risk pregnant women in remote areas over computerized networks to consulting physicians.

That successful program inspired others to launch similar initiatives.

The Antenatal and Neonatal Guidelines, Education, and Learning System (ANGELS) program in Arkansas has delivered OB care to women in rural Arkansas via telemedicine since 2002. And a 2009 pilot project in Tennessee, the Solutions to Obstetrics in Rural Counties (STORC) program, successfully used videoconferencing to connect rural patients with OB/GYN clinicians.

Connectivity and Regulatory Issues Inadequate telecommunications infrastructure in rural areas is one barrier to robust telemedicine initiatives. An estimated 59 million Americans live in Health Professional Shortage Areas, many of which lack strong broadband connections.

Furthermore, the price of broadband services can be up to three times higher in rural areas than elsewhere, so cost is a considerable impediment.

By its very nature, telemedicine presents myriad legal considerations. Patient information is more vulnerable when transmitted over internet connections, and physicians shoulder additional risk treating patients they don’t see in person.

HIPAA requirements must be top of mind, and patient information must be transmitted securely through accepted methods of encryption and authentication.

Perhaps the most daunting barrier to telemedicine growth is licensing, credentialing, and privileging of physicians across multiple states. In addition to being licensed to practice in their home state, telemedicine providers also must be licensed in each state where a patient receives their care. They also must be credentialed and privileged at each of the recipient institutions. So if a telemedicine provider serves patients at 50 different healthcare facilities in multiple states, that provider must be credentialed and privileged at each of the 50 locations as well.

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With the goal of expediting licensure for physicians seeking to practice in multiple states, the Federation of State Medical Boards in 2013 drafted the Interstate Medical Licensure Compact (the Compact) to allow participating states to share physician licensing information. According to the Compact, eligible physicians would designate a state of principal licensure.

That state would verify the physician’s eligibility and provide credential information to a panel that would collect applicable fees and transmit the physician’s information and fees to the states where the physician wishes to practice. These states each then would grant the physician a license.

Participating states must enact model Compact language into state law. To date, 17 states have done so. Compact opponents contend that it allows state boards to restrict telemedicine practices to protect their own physicians from competition. In addition, some assert that any complaints (founded or unfounded) waged in one Compact state would be shared with all states, requiring physicians to defend themselves in multiple states against potentially false claims. The Compact is scheduled to go into effect once 26 states have joined — or by December 31, 2018 — whichever occurs first.

The Compact has many prominent supporters, including the American Medical Association and the American Congress of Obstetricians and Gynecologists, which stated that it “supports a streamlined process to obtaining several medical licenses that would facilitate the ability of physicians and other clinicians to provide telemedicine services across state lines.”

Proposals to accomplish the same thing are already before Congress, including the TELE-MED Act of 2015 and the VETS Act of 2015. In addition, more than 200 telemedicine bills were introduced in 42 states in 2015 alone. Some states have arrangements that grant temporary telemedicine-specific licenses, and others have licensure reciprocity agreements with other states.

An Option with Staying Power More than half of U.S. hospitals utilize some form of telemedicine, and telemedicine use is expected to increase from 250,000 patients in 2013 to 3.2 million patients in 2018.

Healthcare consumers are warming to the concept of telemedicine. An estimated 64% of Americans surveyed would be willing to see a physician via video link. Accordingly, telemedicine must be a consideration in regional and national strategies to deliver perinatal care in underserved communities. As acceptance of telemedicine grows, healthcare providers should take steps to prepare with investments in connectivity, equipment, and training.

For more information, visit www.OBHG.com, contact Programs@OBHG.com, or call 800.967.2289.

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Ob Hospitalist Group 10 Centimeters Drive • Mauldin, SC 29662 • P: 864.908.3530 • F: 864.627.9920 • www.OBHG.com