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The Legal Landscape of Teledermatology
February 01, 2017

The Legal Landscape of Teledermatology

Oluwatobi (Tobi) Ogbechie's interest in healthcare delivery grew from the fascination with the interplay of the socioeconomic and medical implications of disease. She has co-authored articles in peer-reviewed medical and scientific journals and managed health education programs for the underserved. She completed a joint degree in medicine and business administration in 2015 at Harvard Medical and Business Schools respectively. She will complete a residency in Dermatology and continue to use her academic and management foundations to foster her interest in innovative and entrepreneurial models for healthcare delivery.
LICENSURE, CREDENTIALING, AND PRESCRIBING
Each state is responsible for setting individual licensure and credentialing rules for their state. This individualized credentialing process creates an administrative barrier to practicing teledermatology across states. Thus, many nationwide telehealth and credentialing companies have emerged to assist clinicians in this process. Some proponents of teledermatology promote an interstate telehealth licensure compact to facilitate practice across state lines.12 However, opponents argue that the creation of a national licensure would leave patients vulnerable to neglect and create an even greater national credentialing bureaucracy.

In line with the goals of expanding access to underserved populations, some lawmakers have also promoted the ability for non-physicians to practice telehealth, which occurs in 17 states. Furthermore, more states do not require a licensed health professional present during the consultation.

Some states require that a physician have a pre-existing in-person relationship with a patient before a remote prescription can be made. This would limit the use of teledermatology for patient follow-ups, a use-case that is highly promoted by the American Academy of Dermatology.13 The American Telemedicine Association recently put out practice guidelines in 2016 that sets the standard of practice for teledermatology.

LIABILITY
Much hesitation to teledermatology adoption stems from the concern of liability in the setting of clinical ambiguity or inadequate technology. To date, there have been no legislations differentiating telemedicine from in-person practice.14 Therefore, a clinician assumes full liability when performing a telemedicine consultation. Many insurance companies do require physicians to disclose their involvement in telemedicine practices.

A majority of the malpractice cases regarding telemedicine arise from physicians prescribing medicines across states. However, none of these have centered on teledermatology. 

CONCLUSION 
Overall, US national and state policies are rapidly changing to accommodate the demand for teledermatology. Although the regulatory and reimbursement policies are lagging behind the technology, teledermatology still holds much promise. Much is still unknown about the appropriate clinical cases for teledermatology due to the large variability of patient populations, clinician abilities, technology quality, and access gaps. It is prudent for governing bodies to proceed cautiously. However, implemented policies should continue to foster the appropriate use of this promising technology. 

*This article was adapted and updated from a publication in conjunction with SkyMD, a teledermatology company.


REFERNCES   
1. Warshaw EM, Hillman YJ, Greer NL, et al. Teledermatology for diagnosis and management of skin conditions: A systematic review. Journal of the American Academy of Dermatology. 2011;64(4):759-772.e721.
2. Nelson CA, Takeshita J, Wanat KA, et al. Impact of store-and-forward (SAF) teledermatology on outpatient dermatologic care: A prospective study in an underserved urban primary care setting. Journal of the American Academy of Dermatology. Mar 2016;74(3):484-490 e481.
3. Fogel AL, Sarin KY. A survey of direct-to-consumer teledermatology services available to US patients: Explosive growth, opportunities and controversy. J Telemed Telecare. Jan 4 2016.
4. Whited JD. Teledermatology. The Medical clinics of North America. Nov 2015;99(6):1365-1379, xiv.
5. Datta SK, Warshaw EM, Edison KE, et al. Cost and Utility Analysis of a Store-and-Forward Teledermatology Referral System: A Randomized Clinical Trial. JAMA dermatology. Dec 1 2015;151(12):1323-1329.
6. Livingstone J, Solomon J. An assessment of the cost-effectiveness, safety of referral and patient satisfaction of a general practice teledermatology service. London journal of primary care. 2015;7(2):31-35.
7. Armstrong AW, Kwong MW, Chase EP, Ledo L, Nesbitt TS, Shewry SL. Teledermatology operational considerations, challenges, and benefits: the referring providers' perspective. Telemed J E Health. Oct 2012;18(8):580-584.
8. Armstrong AW, Kwong MW, Chase EP, Ledo L, Nesbitt TS, Shewry S. Why some dermatologists do not practice store-and-forward teledermatology. Archives of dermatology. 2012;148(5):649-650.
9. Ogbechie OA, Nambudiri VE, Vleugels RA. Teledermatology perception differences between urban primary care physicians and dermatologists. JAMA dermatology. Mar 2015;151(3):339-340.
10. How to Get Reimbursed for Telehealth. eVisit. 2015.
11. Thomas L, Capistrant G. State Telemedicine Gaps Analysis: Coverage and Reimbursement. 2016.
12. Chaudhry HJ, Robin LA, Fish EM, Polk DH, Gifford JD. Improving access and mobility--the Interstate Medical Licensure Compact. The New England journal of medicine. Apr 23 2015;372(17):1581-1583.
13. Dermatology AAo. AAD Position Statement on Telemedicine. 2013.
14. Natoli C. Summary of Findings Malpractice and Telemedicine. Center for Telehealth & eHealth Law. 2009.


 
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