In a world where change is often reactionary rather than anticipatory, many forward-thinking professionals are dismayed that telehealth is taking so long to be accepted. After all, the evidence base supporting telehealth started building in 1959, and at this point, contains more than 4,000 primary source references establishing its effectiveness at reducing healthcare costs, improving outcomes and receiving high satisfaction ratings among patients.
Why then, do so many barriers still exist?
1. Regulations and restrictions by state boards
Most regulatory boards have decided that licensees in most healthcare disciplines can legally and ethically offer services across state and national borders, but typically must be licensed in the state and/or country of the patient at the time of the contact with the patient. That is, a resident of New York may fly to another state to care for an ailing parent, for example, but is not allowed to have his regular Thursday afternoon appointment with an established clinician in New York by telephone or video teleconferencing.
Also prohibitive is the administrative burden of fees, forms and processing delays when obtaining and maintaining licensure in multiple states. Such rules are considered antiquated by many, who point to today’s mobile society and patient expectations regarding access.
Another factor making it difficult for clinicians to understand state regulations regarding telehealth is lax terms directly referencing telehealth. A recent study found that no fewer than 27 terms are being used across state boards to refer to telehealth. The lack of agreement regarding nomenclature all too often leaves the practitioner wondering or assuming that telehealth is unregulated.
The fact is that telehealth is heavily regulated, and arguably, too regulated. A notable example of a behavioral state board that is setting the pace with regard to clarity is Georgia’s Composite Board, which enacted a ruling October 1, 2015, that requires all licensees and supervisors to take up to nine hours of continuing education for telemental health. Its definition of telehealth includes all clinical service that uses telephones, video, email, text messaging and apps for client/patient contact.
A number of states are imposing more restrictive laws in an effort to curb the irresponsible prescribing of controlled substances, much to the dismay of many telepsychiatrists. Federally, the Ryan Haight Act requires at least one in-person medical evaluation of a patient before prescribing any controlled substances remotely. While some states allow the remote prescribing of controlled substances, the federal act pre-empts those laws. Although the act contains specific exceptions for telemedicine, those exceptions were drafted in 2008, before telehealth's recent refinements. Therefore, they do not cover the models most widely used in telemedicine, such as in telepsychiatry, where medical management of medications for patients has been shown both safe and effective.