It was to say the least startling to watch the Utube video of Rep. Michele Bachmann holding forth in another otherworldly tirade against “Obamacare” in Webster City, Iowa. It was even more scary to see the audience sitting their calmly, politely and acceptingly as if “chewing the cud” while her fantasies poured fourth. This is no joke. She told her audience that a seven foot plus doctor told her that he waited on the phone for 2 hours and 15 minutes with the IRS awaiting for approvals of care for “a little lady in my office,” while patients stacked up in his waiting room.
The often contentious California legislature passed the Telehealth Advancement Act of 2011 without opposition achieving broad advances in the expansion of medical services in rural areas of the state. It expands the Telehealth Development Act of 1996 to all licensed health care providers and proscribes insurance plan requirements for an in person relationship to obtain consent. Consent can be verbal and must be recorded. Failure to obtain consent is deemed "unprofessional conduct."
The new Act provides for advancing hospital credential approval of distant consultants and specifies that insurance companies may not place limits on settings where telehealth services may be provided. The Act does state that it is not to be used to mandate telehealth service in settings that insurance companies deem inappropriate.
The Legislature in enacting the law sought to dispel any doubt about the future of telemedicine in California.
It is the intent of the Legislature to recognize the practice of telehealth as a legitimate means by which an individual may receive health care services from a health care provider without in-person contact with the healthcare provider.
Smart Medicine: How the Changing Role of Doctors Will Revolutionize Health Care is a book soon to be published by Palgrave Macmillan is an entertaining mix of the history of medicine and promise of medical technology in the future. The history takes us through the early colonial feuds of Drs. John Morgan and William Shippen, Jr.in Philadelphia to an interesting chapter about how George Washington was killed by his doctors. Lincoln’s physicians do not show well either, but he probably would have died anyway. There are of course other candidates for this presidential distinction such as Zachary Taylor, but enough said.
The rise of the internet, telemedicine and on-line communication technology have led to a greater federal government interest in improving the cost and quality of medicine by promoting the cost-effective patient access to consulting or even treating physicians across state lines. Earlier many states had loose regulations permitting limited consultation by in-state physicians with out of state physicians. With the proliferation of communications technology many, if not most, states have tightened up their vigilance and regulatory requirements for out of state physicians consulting on or treating patients located in the state. Most states have adopted standards to deal with and in varying degrees permit telemedicine. They provide various forms of limited licensure and of course require the payment of fees and the submission of the physician to the jurisdiction and authority of the state medical board which regulates and imposes discipline on the practice of medicine.