TV-6 Investigates Telemedicine: Regulatory Challenges - News and Weather For The Quad Cities -

TV-6 Investigates Telemedicine: Regulatory Challenges


Iowa faces a shortage of doctors in rural areas.

One solution is telemedicine, a technology that connects patients to doctors over the Internet.

The technology has many benefits, but it also poses a challenge for those writing new rules to address it.

Iowa has had only one position on telemedicine since 1996, it's ok to use, but doctors providing care to patients in Iowa, must be licensed in Iowa.

The state's board of medicine issued a new rule earlier this year regulating abortion providers.

The rule says a doctor must physically examine a patient before prescribing a chemical abortion pill.

That rule has been challenged by Planned Parenthood of the Greater Heartland.

It built a telemedicine system to deliver this specific abortion service to its clinics in parts of the state without timely abortion access.

If a judge lets the rule stand, Planned Parenthood will only be able to provide this abortion service at four facilities with doctors, leaving out 11 clinics spread across the state.

The Board of Medicine says the rule is not about telemedicine at all.

However, not everyone in the Iowa medical community agrees.

"We should be the ones that really help to draft these guidelines," says Doctor Pat Brophy.

He helps run the e-health program at the University of Iowa. He says telemedicine, like all new technology, challenges those coming up with rules for how to use it. He says telemedicine still has some big hurdles to clear.

"Patient safety first, is the most important thing, and patient safety and privacy are the biggest issues we have to deal with," says Brophy.

He says those issues are tough but not impossible to solve. He points to technology already being used outside of medicine.

"Most of us pay our bills with our phones, we can do banking, we can do a lot of the private services we have, I think there's a real opportunity to take and apply some of these same business practices to healthcare," says Brophy.

It's a future he sees coming, but a future the Iowa Medical Society fears may be limited by the Board of Medicine's new rule. It commented on it twice, once at a board hearing, and again to an Iowa legislative committee. The Society said "... Physicians are concerned about the potential impact of this rule upon medical care delivery in other telemedicine contexts. The criteria adopted here essentially eliminate telemedicine as a mechanism for the delivery of this medical service..."

"That new rule certainly affected a telemedicine practice, but it was not the first rule that said initially, the physician and patient need to be in the same room to establish that relationship," says Board of Medicine Executive Director Mark Bowden.

He says the board wants to ensure there is a good link between patients and their doctors. Not every telemedicine system includes a web chat like our Skype interview.

"Technology puts the physician and the patient together very quickly but there are many parts of this system that presumes that everything is on the up and up," says Bowden.

That's why he says the Board disagrees with the Medical Society's stance that the abortion rule limits telemedicine. He says the board has three worries surrounding this technology. Is it being used appropriately, does the patient know what is going on, and what are the expectations for security and privacy?

"It's one thing to call a doctor and say I don't feel well," says Bowden. "It's another thing for the doctor to say well I don't know you I'm going to write you all these prescriptions."

Bowden says the board's job is to ensure Iowa doctors practice medicine safely. He says telemedicine is only a tool to do that. It doesn't deserve special treatment.

"(We're) trying to look at every situation and determine if it's appropriate or not."

"I worry about the effect it may have on patients, that patient may be less hesitant to engage in treatment if they think telemedicine is some evil entity," says Iowa City based child psychiatrist Jennifer McWilliams.

She worries the abortion rule could create a stigma on all telemedicine systems if it survives the legal challenge. She says it's already difficult for mental health patients to overcome the stigma attached to their disorders.

"There are definitely areas in telemedicine where we can greatly improve health not just in rural communities, but across the board," says McWilliams.

She's seen patients using telemedicine for the last three years. She believes doctors should define what's acceptable for treating patients. Her practice has rules requiring some patients to meet in person. For example, diagnosing Autism disorders is impractical using telemedicine.

"Patients who have Autism have a very difficult time with social reciprocity anyway, and they're very interested in inanimate objects, like TV screens, so whereas I may not be that interesting to a patient who has Autism in person, I'm fascinating when I'm on TV" says McWilliams.

For other cases, McWilliams says telemedicine is just fine. She just believes patients need to use it in a controlled environment like a local clinic.

"As long as I have my staff at the other sites, the important thing for me at each visit, are to get vital signs, blood pressure, height, weight, that's something that a nurse can very easily do for me."

She does not believe patients should be consulted at home. Dr. Brophy says drawing that line may not be that simple. Telemedicine keeps growing, and with new phone applications and ways to communicate, doctors and lawyers need time to figure out the best ways to use this technology.

"At the end of the day, these are our patients, that we're looking after, we want to provide the best care that we possibly can," says Brophy.

Care he believes telemedicine can improve, as long as the rules don't get in the way.

An Iowa judge has not yet issued a ruling on the new abortion rule.

The Federation of State Medical Boards expects to issue new guidance to state medical boards on telemedicine.

The Iowa Medical Board says telemedicine is on its regulatory agenda for 2014.

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