Once upon a time, heart patients traveled to a cardiologist’s office for routine pacemaker checks. Now they have a small monitor at home that connects to a phone line. It collects all the same information that would be gathered during an in-person visit to the clinic and transmits it to the doctor.
Technology has advanced. So has medicine.
Today a surgeon in New York can oversee a procedure in California using real-time videoconferencing. Psychiatrists also use videoconferencing to evaluate, diagnose and decide which drugs to prescribe to patients hundreds of miles away. Radiologists read test results. Burn specialists evaluate victims remotely. So-called telemedicine allows physicians to treat more patients. It saves health care money. Perhaps most important, it provides Iowans access to services they may not otherwise have.
Then along came the Iowa Board of Medicine.
The state board has not crafted administrative rules setting guidelines for telemedicine. Its policy statement on the practice was adopted in 1996 — about the same time many of us were getting our first email accounts.
But the board decided to wade into this 21st-Century method of delivering health care last month by focusing on the use of telemedicine for a single health service: doctors using a videoconferencing system to dispense abortion-inducing drugs to Iowa women.
The board approved an administrative rule requiring physicians to perform exams on these women. A nurse can’t do the exam. Or a physician’s assistant. Or another doctor. The rule states that the same physician dispensing the drug must perform the exam. The board also required the doctor to be in the same room with the woman when she swallows the pill and must schedule a follow-up visit at the exact same location 12 to 18 days later.
The requirements obviously eliminate the telemedicine system that has been used to deliver a health service to Iowa women for five years. Of course, that is exactly what board members appointed by Gov. Terry Branstad wanted to do.
But the board did something else, too: The members’ attitude toward videoconferencing calls into question the use of this technology by countless Iowa physicians. The concerns the board cited in the abortion case jeopardize numerous other health services used by thousands of Iowans, from children to seniors.
The board argues that the remote system for dispensing abortion-inducing drugs puts women at risk. It insists that a physician “must establish an appropriate physician-patient relationship” and that an “in-person medical interview and physical examination for the patient are essential to establishing that relationship.”
A doctor and patient must be in same room to establish a relationship before an elective medical service?
That could pose a problem for University of Iowa psychiatrists in Iowa City who evaluate, diagnose and treat children with mental health problems at five locations around the state using real-time videoconferencing.
“I talk to the child and their parents and we do a full evaluation just like they were here in the clinic. Then we decide if the kids need medication, talk to the family about risks and benefits and prescribe over the phone,” said Dr. Jennifer McWilliams, one of the U of I psychiatrists. “We used to have doctors who would go to the clinics, but I can see three kids for the time it would take me to drive there and back.”
McWilliams treats hundreds of young Iowans. She never meets most of them in person. She is not required to personally perform a physical examination. Does the medical board object to this in a state with a severe shortage of psychiatrists?
And how can the board do nothing while U of I doctors evaluate and treat stroke victims 85 miles away?
“We’re in Iowa City and they’re in Clinton,” said Dr. Harold Adams, a U of I neurologist. Using a robot with monitors, cameras and microphones, a physician in Iowa City watches an emergency room patient move his arms and legs, checks vision and evaluates speech and language. “We can basically do almost the entire neurological exam,” he said. “Iowa is a rural state with many small communities and few neurologists.”
Perhaps the Board of Medicine would prefer that Iowans at rural hospitals not have immediate access to specialists who can save their lives.
Also, if visiting a physician in person is so critical, will the board place limits on an electronic system being used to evaluate nursing home residents? A rolling cart with a computer, moveable arm and videoconferencing system contains an electronic stethoscope, otoscope, dentalscope and EKG. A medical provider at another location can access the health information collected.
What about inmates in Iowa prisons? Spine, shoulder and urology clinics at the
U of I use telemedicine to treat prisoners. Videoconferencing was used for 11,000 inmate appointments with mental health professionals in 2012. Perhaps the medical board would rather the state drive the prisoners to another location 11,000 times.
In trying to limit access to abortion, the Iowa Board of Medicine employed a rationale that jeopardizes the future of all telemedicine in this state. Because if this board thinks a doctor needs to stand next to a woman to watch her swallow a pill that poses little risk to her health, imagine what it might dictate for a neurologist remotely treating a stroke victim facing death.
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Quelle/Source: DesMoinesRegister, 06.10.2013
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