Make no mistake – the Coronavirus pandemic is a serious matter.

There is no doubt we will see the ripple effects of COVID-19 for months and years to come. None of us will know the full repercussions of our decisions for quite some time.

In this month's newsletter, I will walk you through the changes I see coming to Virtual-Medicine. I like to use the term “Virtual Medicine” rather than “Telemedicine” because the prospects for the future – given all our digital capabilities – are so much deeper and broader than our current concepts.

Virtual-Medicine

No digital modality has had a greater impact from the pandemic than Virtual-Medicine.

Insurance companies and medical providers alike have quickly pivoted to expand their capabilities and offerings to provide contactless solutions to the diagnosis and treatment of more minor medical conditions. Those with health concerns have been reluctant to visit hospital emergency rooms and doctor's offices for risk of exposure to COVID-19. Emergency rooms have been overcrowded and unless the patient is a minor, family members are not permitted to accompany the patient. Recognizing these obstacles, doctors have made themselves available to treat patients virtually.

Virtual-Medicine provides a faster and safer alternative to the ER or exposure in a doctor's waiting room.

Obstacles In The Way

Potential liability and licensure for healthcare providers involved in Virtual Medicine need to be addressed.

Physicians need to ensure that their professional liability insurance policies cover “tele-medicine”. The good news is that most do so long as the connection is compliant with the requirements of the Federal Health Insurance Protection and Portability Act (“HIPPA”). HIPPA regulations have strict requirements around the protection of personally identifiable patient information. That's another area where cybersecurity issues abound.

The key issue a physician needs to address in Virtual Medicine is whether the condition involved is amenable to remote diagnosis and treatment. Where that's not the case, the physician can protect him – or herself – by directing the patient to the ER or a local physician.
But what about licensure? Physicians are licensed by a State. Licensure in one State is not subject to automatic recognition by other States like a driver's license. It's a professional license and there are State-prescribed standards. But from a practical perspective, the delivery of medical services should have roughly the same standards throughout the United States. The way to treat appendicitis in Seattle, Washington shouldn't differ from the way it's handled in Biloxi, Mississippi.

Fortunately, common sense has prevailed among a number of States. The medical licensure boards of several States came together in 2015 on an agreement among them to recognize medical licensure from consenting States. The Interstate Medical Licensure Compact (the “Compact”) began operations in 2017. It permits physicians in 29 States, the District of Columbia and Guam to participate in telemedicine in member States.

Before the Compact, Virtual Medicine was licensed only for physicians in the same State as the patient. The Compact requires that a State enact legislation to agree to its terms and recognize the qualification of participating physicians to practice medicine in the latter State, with reciprocal privileges for its own physicians.

As of April 2020, New York and New Jersey have introduced the required legislation – and none too soon! You can determine the status of your state by visiting the Interstate Medical Licensure Compact website. From a lawyer's perspective, this voluntary cooperation among the States is a wonderful exercise of Federalism.

Rather than having a “top-down, one-size-fits-all” approach from the Federal government, the States themselves and their medical boards decide how to permit remote medical practice. My prediction is that the current pandemic will induce many of the States yet to participate in the Compact to do so.

This arrangement makes perfect sense – and sometimes we need a crisis to push people to move on ideas that make perfect sense.
I see that the pandemic has also induced States to reach out to greatly augment their healthcare resources. In April 2020, New Jersey and New York have permitted temporary medical licensure for foreign-licensed physicians. When an emergency occurs, even our political establishments are willing to reach out for new resources and permit access to additional healthcare professionals.

No digital modality has had a greater impact from the pandemic than Virtual-Medicine.
Insurance companies and medical providers alike have quickly pivoted to expand their capabilities and offerings to provide contactless solutions to the diagnosis and treatment of more minor medical conditions. Those with health concerns have been reluctant to visit hospital emergency rooms and doctor's offices for risk of exposure to COVID-19. Emergency rooms have been overcrowded and unless the patient is a minor, family members are not permitted to accompany the patient. Recognizing these obstacles, doctors have made themselves available to treat patients virtually.

Virtual-Medicine provides a faster and safer alternative to the ER or exposure in a doctor's waiting room.

Obstacles In The Way

Potential liability and licensure for healthcare providers involved in Virtual Medicine need to be addressed.
Physicians need to ensure that their professional liability insurance policies cover “tele-medicine”. The good news is that most do so long as the connection is compliant with the requirements of the Federal Health Insurance Protection and Portability Act (“HIPPA”). HIPPA regulations have strict requirements around the protection of personally identifiable patient information. That's another area where cybersecurity issues abound.

The key issue a physician needs to address in Virtual Medicine is whether the condition involved is amenable to remote diagnosis and treatment. Where that's not the case, the physician can protect him – or herself – by directing the patient to the ER or a local physician.
But what about licensure? Physicians are licensed by a State. Licensure in one State is not subject to automatic recognition by other States like a driver's license. It's a professional license and there are State-prescribed standards. But from a practical perspective, the delivery of medical services should have roughly the same standards throughout the United States. The way to treat appendicitis in Seattle, Washington shouldn't differ from the way it's handled in Biloxi, Mississippi.

Fortunately, common sense has prevailed among a number of States. The medical licensure boards of several States came together in 2015 on an agreement among them to recognize medical licensure from consenting States. The Interstate Medical Licensure Compact (the “Compact”) began operations in 2017. It permits physicians in 29 States, the District of Columbia and Guam to participate in telemedicine in member States.

Before the Compact, Virtual Medicine was licensed only for physicians in the same State as the patient. The Compact requires that a State enact legislation to agree to its terms and recognize the qualification of participating physicians to practice medicine in the latter State, with reciprocal privileges for its own physicians.

As of April 2020, New York and New Jersey have introduced the required legislation – and none too soon! You can determine the status of your state by visiting the Interstate Medical Licensure Compact website. From a lawyer's perspective, this voluntary cooperation among the States is a wonderful exercise of Federalism.

Rather than having a “top-down, one-size-fits-all” approach from the Federal government, the States themselves and their medical boards decide how to permit remote medical practice. My prediction is that the current pandemic will induce many of the States yet to participate in the Compact to do so.

This arrangement makes perfect sense – and sometimes we need a crisis to push people to move on ideas that make perfect sense.
I see that the pandemic has also induced States to reach out to greatly augment their healthcare resources. In April 2020, New Jersey and New York have permitted temporary medical licensure for foreign-licensed physicians. When an emergency occurs, even our political establishments are willing to reach out for new resources and permit access to additional healthcare professionals.

What The Future May Hold

What about those conditions that require more than what current Virtual Medicine can accommodate? Suppose a patient needs special in-person tests or other treatments? My long experience with med-tech entrepreneurs convinces me they view these problems as opportunities for new and even more cost-effective methods of addressing diagnosis and treatment.

Imagine a set of smartphone apps that could record and transmit to a patient's physician vital signs and biomarkers that would help predict when an acute episode of illness would occur. Imagine further a facility with kiosks equipped with the types of more invasive tests not amenable to apps where a patient could go for quick confirmation of the recommended next steps in treatment – be it prescription medicine or a quick visit to the local ER.

Imagine also that all of this data could be anonymized, collected and analyzed using artificial intelligence to refine treatment protocols generally – as well as providing a customized protocol for the individual patient. At least one health insurer is on track to use data from its patient population more creatively than has been done in the past and has found methods to analyze data to help it better serve its customers while saving costs. I'm sure others will follow.

We don't need to imagine too much here because entrepreneurs are working on many of these ideas. And they will enrich medical practice – as well as reaching out to serve underserved populations – for long after the pandemic has ended.