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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.
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.

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. 

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.

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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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