New Ethical Guidelines

On June 13, the American Medical Association (AMA) adopted a new ethical guidance policy governing the practice of telemedicine that will be published in the coming months. The policy is based on a report from the AMA Council on Ethical and Judicial Affairs and builds upon the AMA’s 2014 telemedicine guidance.

Consistent with past guidance from AMA and other professional organizations, the AMA notes that the ethical responsibilities of physicians are the same – regardless of whether the physician communicates with a patient in-person or remotely – and encourages providers to recognize the potential uses and limitations of technology when delivering care. “Telehealth and telemedicine are another stage in the ongoing evolution of new models for the delivery of care and patient-physician interactions,” said AMA Board Member Jack Resneck, MD. “The new AMA ethical guidance notes that while new technologies and new models of care will continue to emerge, physicians’ fundamental ethical responsibilities do not change.”

The 2016 policy recommends that once a patient-physician relationship is established, physicians who engage in telemedicine by responding to individual health queries electronically or providing clinical services through telemedicine:

  • Must disclose financial or other interests in certain telemedicine applications or services
  • Must protect patient privacy and confidentiality
  • Should inform patients of the limitations of the telemedicine encounter
  • Should encourage patients to inform their primary care doctor about the encounter
  • Should advise patients how to arrange follow-up care
  • Should, when necessary, recommend the use of a telepresenter or other health care professional at the originating site (e., the patient’s physical location)

Notably, the 2014 guidance required that a patient-physician relationship be established prior to the provision of telemedicine services. The relationship could be established during a face-to-face examination, through a consultation with another physician, or by meeting the evidence-based practice guidelines developed by major medical specialty societies. While the 2014 guidance did not specify whether the face-to-face examination must occur in-person, rather than digitally, many interpreted this requirement to be satisfied via an interactive telemedicine encounter.

In addition, the 2016 policy formally recognizes the importance of a “coordinated effort across the profession,” which includes clarifying standards and promoting access to technology. That said, the 2016 policy still requires the licensure of physicians in the state in which the patient is located. (As a general rule, physicians that practice telemedicine are subject to the licensure rules of both the state in which their patient is physically located and the state in which the provider is practicing.) One potential avenue for facilitating multi-state licensure is the Federation of State Medical Boards’ Interstate Medical Licensure Compact, which offers a streamlined licensure process in each Compact state. The Compact has been adopted by 17 states thus far and more are expected to join this year and in 2017.

In sum, the AMA’s new ethical guidance should help physicians to better understand how their fundamental ethical responsibilities may play out differently when patient interactions occur through technology, and how this technology can be used to deliver more accessible, efficient and effective care.

Telemedicine Training for Students and Residents

Two days after adopting the ethical guidelines above, the AMA adopted a second telemedicine policy encouraging the inclusion of telemedicine training into undergraduate and graduate medical programs.

Since the vast majority of medical students are not learning about the potential benefits and appropriate uses of telemedicine technologies during medical school and residency, they are learning about telemedicine “on the job,” which may create missed opportunities for its use. “As innovation in care delivery and technology continue to transform health care, we must ensure that our current and future physicians have the tools and resources they need to provide the best possible care for their patients,” said AMA immediate past president Robert M. Wah, MD “In particular, exposure to and evidence-based instruction in telemedicine’s capabilities and limitations at all levels of physician education will be essential to harnessing its potential.”

In sum, the hope is that integrating formal telemedicine training into medical education programs will better prepare future physicians to appropriately and effectively integrate telemedicine into their clinical practices.

MaryKathryn Hurd, summer associate in McDermott’s Chicago office, co-authored this post.