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KBIA’s Health & Wealth Desk covers the economy and health of rural and underserved communities in Missouri and beyond. The team produces a weekly radio segment, as well as in-depth features and regular blog posts. The reporting desk is funded by a grant from the University of Missouri, and the Missouri Foundation for Health.Contact the Health & Wealth desk.

Telehealth expert calls for consistency across states

Intel Free Press / flickr
A doctor consults with a patient using telemedicine.

As the use of telemedicine expands it is also growing the footprints of medical professionals, and when doctors licensed in one state begin consulting in another, it presents a problem for state medical boards. KBIA’s Hope Kirwan spoke with Jonathan Linkous, CEO of the American Telemedicine Association, about how states are regulating telemedicine.

Credit American Telemedicine Association
Jonathan Linkous, CEO of the American Telemedicine Association.

This interview has been condensed and edited for content and clarity. 
State medical boards issue licenses as a way to regulate who can practice medicine in their state. But how do these licensing laws apply to doctors who practice medicine online?

“If you're a provider, you have to be licensed in the state where you practice and in the state where the patient is located where you're providing services. The problem is if you're in Missouri and your patient happens to be in Kansas and you're seeing that patient by telemedicine, you'd have to be licensed both in Kansas and Missouri at the same time. This creates a bit of a burden because all of a sudden they're having to pay a separate state medical board, go through the separate regulations through that state, and that's an enormous cost and not to mention a burden and a barrier to the provision of care and the expansion of commerce. We would encourage states to enter into reciprocity, where a medical board in one state would accept the license of another state, because the medical board in Missouri is a great medical board and they've done a lot of good things and they have very high standards of care, and so is the medical board in Kansas. And if you have a physician licensed in Kansas, they're just as qualified as a physician licensed in Missouri.”

In addition to the general laws for practicing medicine, several states have passed specific regulations for telemedicine. But it seems like everyone has a different idea about how to address the issue. Is this inconsistency across states harmful to telemedicine?

“It just doesn't work. It's like the highways, if they were regulated differently, one state than the other, then they wouldn't meet up together or wouldn't have the same pavement standards or whatever. It just makes sense that we start getting some uniformity in this and allowing the practice to continue across the states. I know there's been a few attempts to fix this system but I don't think anything will work until we really have reciprocity where states will agree to recognize the license in another state and we work out a mechanism so we can share information if there are bad doctors or bad nurses, we can bring them to task and make sure that information is shared so that they don't skip out to other states. All of that can be put into place, but we just need a commitment to get it done.”

Is it necessary for states to define how this technology can and can’t be used?

“Telemedicine is a tool. It is not a separate practice of care, it is not a separate specialty, it's a tool just like the use of a stethoscope or an ultrasound. When a doctor uses a stethoscope, you don't regulate the way that he uses the stethoscope. You assume that he has his training or her training, that they know the basic instruments and the same thing with telemedicine. If you're providing care from a distance, you need to be trained, you need to be licensed, you need to follow the laws of the state, but it doesn't mean you have to jump through extra hoops which are sometimes done out of concern for the patient but sometimes they're done just because there's fear of the unknown or even fear of competition.”

Hope Kirwan left KBIA in September 2015.
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