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    How to balance telemedicine advances with ethics

    An increased number of clinicians are delivering medical care via the Internet, a shift away from traditional office visits that brings both opportunities as well as concerns. The trend has also prompted the American Medical Association and others to develop new guidelines governing how doctors should conduct these virtual exams.

    More than half of all U.S. hospitals use some form of telemedicine, according to the American Telemedicine Association. Meanwhile, IHS Technology predicts that the global telehealth market will grow more than tenfold from 2013 to 2018, with the number of patients using telehealth services jumping to 7 million in 2018 from fewer than 350,000 in 2013.

    Consider the situation in Wyoming. It’s the 10th largest state in the country in area, but with fewer than 600,000 residents, it’s also one of the most sparsely populated.

    That makes accessing doctors a challenge for the many patients who live hundreds of miles away from major medical centers and face long drives even to see primary care physicians, says James F. Bush, MD, FACP, an internist now serving as the Wyoming Medicaid medical director and chairman of the Wyoming Telehealth Consortium.

    There’s no question, Bush says, that telemedicine increases access to care and decreases burdens on these patients. But he adds that telemedicine introduces new challenges to ensuring quality care with the same safeguards that exist for in-person healthcare visits.

    For example, he says a patient who visits an emergency department can be assured that the doctors there are licensed in the state where the ED is located. But that assurance doesn’t exist if the patient connects with a doctor via telemedicine. In fact, Bush says, the virtual doctor may not even be based in the United States.

    “Telehealth is a huge step forward—if it’s done correctly,” he says. “We feel very strongly that there should be a single standard of care, so you don’t have a separate standard of care for telehealth than you would for in-person doctor visits.”

    Aligning standards of care

    Such concerns have prompted various professional associations to act, with the latest coming from the American Medical Association (AMA). The AMA in June adopted a new policy outlining ethical rules for physicians who see patients using telemedicine technologies (see sidebar for details).


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