It is no secret that telemedicine has experienced a dramatic rise in popularity since the birth of the Digital Revolution. With a few simple clicks on a computer and an internet connection, a patient can instantly communicate with a physician anywhere in the world by videoconferencing.

Teleradiology, as a subset of telemedicine, has won widespread acceptance as a way for health care providers to transmit radiological images, such as X-rays, CT scans, and MRIs, from one location to another for diagnostic or consulting purposes.  The increased expansion and utilization of telemedicine has particularly benefited patients in rural and medically underserved areas who lack access to high-quality care, small healthcare providers which cannot afford to employ a diagnostic radiologist or nuclear medicine physician on a 24-hour basis to send their films for immediate interpretation, and radiologists who want a better work-life balance. In fact, it is estimated that more than half of all radiology practices outsource their call coverage.

While there are a variety of factors that have led to the high degree of success of teleradiology, many questions and challenges still exist.  One the biggest issues facing radiologists is where to obtain and maintain a license to practice teleradiology if a patient image is produced in one state, but is interpreted in another state. For example, suppose a cardiology practice located in Pennsylvania would like hire a radiologist who resides in Colorado to perform radiological diagnostic evaluations or interpretations for its patients from the radiologist’s home in Colorado. Does the radiologist have to be licensed to practice telemedicine in Pennsylvania, Colorado, or both?  While the current requirements to practice telemedicine in Pennsylvania are murky, I believe the answer is both for two reasons.

First, both Pennsylvania [through the State Board of Medicine] and Colorado [through its Board of Medical Examiners] require physicians who practice interstate telemedicine, teleradiology, or telehealth to acquire a “full, unrestricted medical license to practice medicine” in the respective state. While the Pennsylvania Board does not currently have specific regulations addressing the parameters of how to engage in the practice of medicine over the internet, Colorado has specifically added “the delivery of telemedicine”, which includes “the delivery of medical services, diagnosis, consultation, treatment, … using interactive audio, video or data communication” to its definition of “the practice of medicine” under C.R.S. § 12-36-106(1)(g).  Colorado is only one example of a state that has codified a definition of “telemedicine” and/or has specifically set forth the requirements to obtain a “special purpose telemedicine license”. Thus, it is important for radiologists and employers to check the laws of the production state and the interpretation state.

Second, both the American College of Radiology (ACR) and the American Board of Radiology (ABR), are actively pushing for legislation that would require out-of-state physicians to obtain and maintain a license to practice teleradiology within a particular jurisdiction.  The ACR and ABR work with state medical boards to ensure high quality medical care and professional integrity in the practice of radiology by establishing guidelines for standards of care governing outsourcing of radiologists’ services.  The ACR already requires that those who interpret images in a state other than the one in which they reside be licensed in both states – the one where the image was produced and the one in which the interpretation takes place.

In March 2019, State Rep. Harry Readshaw introduced legislation (H.B. 15), titled the “Telemedicine Act”, which would define telemedicine as “the delivery of health care services provided through telemedicine technologies to a patient by a health care provider who is at a different location (but does not include a provider-to-provider consultation).”  H.B. 15 would also require the state licensure board to promulgate regulations that would provide for and regulate telemedicine within the scope of practice and standard of care regulated by the board.

For these reasons, it is recommended that the radiologist in the hypothetical obtain a full, unrestricted medical license to practice radiology in both Pennsylvania and Colorado.

As telemedicine grows, it will become more important than ever to ensure compliance with the medical licensure laws in the state in which the patient is “being seen” and in the state where the physician is physically located. This is a dynamic and changing area of health care law.

Rachel E. Lusk, Esq. is an associate in Lamb McErlane’s health law and litigation departments.  She represents physicians, dentists, group practices, and other health care professionals and health-related entities in transactional, regulatory, and compliance matters. 610.701.4416 / rlusk@lambmcerlane.com.

 This publication is for general information and should not be construed as legal advice on any subject matter.