Printed in the Legal Intelligencer 10/4/16
By: Vasilios J. Kalogredis, Esquire*

“Telehealth” or “Telemedicine” encompasses a broad variety of technologies and tactics which deliver virtual medical, health, and education services. Telehealth is not a specific service, but a collection of means to enhance care and education delivery. Telehealth is most commonly used in areas of healthcare such as: dentistry, counseling, physical and occupational therapy, home health, chronic disease monitoring and management, disaster management, radiology, dermatology and consumer and professional education.

Telehealth allows long distance patient/clinician contact and care, advice, reminders, education, intervention, monitoring and remote admissions. It also allows for provider distance-learning, meetings, supervision, presentations among practitioners, and online information, health data management, and healthcare system integration. For example, Telehealth could include two clinicians discussing a case over video conference; a robotic surgery occurring through remote access; physical therapy done via digital monitoring instruments, live feed and application combinations; tests being forwarded between facilities for interpretation by a higher specialist; home monitoring through continuous sending of patient health data; client to practitioner online conference; or even videophone interpretation during a consult.

Telehealth encompasses four distinct domains of application:

1. Live video (synchronous): This is live, two-way interaction between a person (patient, caregiver, or provider) and a provider using audiovisual telecommunications technology.  This type of service is also referred to as “real-time” and may serve as a substitute for an in-person encounter when it is not feasible or available.
2. Store-and-forward (asynchronous): This is transmission of recorded health history (for example, pre-recorded videos and digital images such as x-rays and photos) through a secure electronic communications system to a practitioner, usually a specialist, who uses the information to evaluate the case or render a service outside of a real-time or live interaction. As compared to a real-time visit, this service provides access to data after it has been collected, and involves communication tools such as secure email.
3. Remote patient monitoring (RPM): Personal health and medical data collection from an individual in one location via electronic communication technologies, which is transmitted to a provider (sometimes via a data processing service) in a different location for use in care and related support is what this relates to. This type of service allows a provider to continue to track healthcare data for a patient once released to home or a care facility, reducing readmission rates.
4. Mobile health (mHealth): Health care and public health practice and education supported by mobile communication devices such as cell phones, tablet computers, and PDAs is what this relates to. Applications can range from targeted text messages that promote healthy behavior to wide-scale alerts about disease outbreaks.

State and federal agencies differ in how they define Telehealth. For example, the California Business & Professions Code Section 2290.5 defines Telehealth as “the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at a distant site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.” The Pennsylvania Department of Public Welfare defines Telehealth as “the use of real-time interactive telecommunications technology that includes, at a minimum, audio and video equipment as a mode of delivering consultation services.” The Delaware General Assembly defines Telehealth as “the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.”

By contrast, the Federal Health Resources and Services Administration (HRSA) defines Telehealth as “the use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.” These varying definitions influence the policies and regulations surrounding how Telehealth is allowed to be used within the several states and through regulation by the federal government.

The Delaware Board of Dietetics/Nutrition proposed a regulation in 2015 which would require in-person initial evaluations of patients, and then allow licensed dietitians and nutritionists to determine whether the use of Telehealth going forward is in the patient’s best interest. The Federal Trade Commission (FTC), in a letter dated August 16, 2016 to the Administrator of the Delaware Board of Dietetics/ Nutrition, raised concern and filed comments with the state board expressing its disproval of the proposed regulation. The FTC argues that the regulatory proposal could unnecessarily discourage the use of Telehealth and impede upon patient choice. The FTC comments submitted to the Delaware Board of Dietetics/Nutrition stated, “While supporting the proposed regulation’s flexibility in generally allowing licensees to determine whether to use Telehealth, we urge the Board to consider whether legitimate health and safety justifications support the restriction, or whether allowing licensees to decide whether to use Telehealth during all phases of care would better promote competition and access to safe and affordable care.”

Over the past few years, Telehealth has been growing at a rapid pace because of four fundamental benefits appreciated by patients: improved access, cost efficiency, improved quality, and patient demand. First, Telehealth brings healthcare services to patients who are located in distant or rural regions. Not only does telemedicine improve access to patients but it also allows physicians and health facilities to expand their reach, beyond their own offices. Second, Telehealth provides for reduced costs for both patients and medical providers. Telemedicine has been shown to reduce the cost of healthcare and increase efficiency through better management of chronic diseases, shared health professional staffing, reduced travel times, and fewer or shorter hospital stays. Third, studies have consistently shown that the quality of healthcare services delivered via Telemedicine are as good those given in traditional in-person consultations. In some specialties, particularly in mental health and ICU care, telemedicine delivers a superior product, with greater outcomes and patient satisfaction. And finally, patients view Telehealth services very favorably.

The greatest impact of Telehealth is on the patient, her family, and her community. Using Telehealth technologies reduces travel time and related stresses for the patient. Over the past 15 years, study after study has documented patient satisfaction and support for Telemedical services. Such services offer patients the access to providers that might not be available otherwise, as well as medical services without the need to travel long distances.

For additional information on Telehealth, visit http://www.telehealthresourcecenter.org/.

Vasilios (“Bill”) J. Kalogredis is Chairman of the Health Law Department at Lamb McErlane PC.  Bill has been practicing health law for over 40 years, representing exclusively physicians, dentists, group practices, other health care professionals and health care-related entities.

*Katherine E. LaDow, Esquire, an associate with Lamb McErlane P.C., contributed to this article.

Katherine (Katie) is an associate in the litigation department. She concentrates her practice in the areas of state civil litigation and family law.