Telemedicine in Ophthalmology: Promise and Pitfalls

Abstract

An ophthalmologist in Iowa receives a phone call from a physician in Illinois about a case and provides treatment suggestions. Is the Iowa physician practicingmedicine in Illinois? Was his contact sufficient to establish a physicianepatient relationship with the Illinois patient? Does it matter if he receives an electronic copy of the patient’s record or if the physician seeking the consult is an internist? What if the Illinois patient joins in the phone call to answer some questions? These issues arise frequently and have existed since the advent of the telephone and the origins of medical licensure. Telemedicine uses electronic communications between a physician in “one location and a patient in another with or without an intervening health care provider” to provide expert opinion and care in a confidential patient-specific electronic exchange. Cybermedicine and e-medicine are more inclusive terms that address all aspects of physicians’ electronic communications; however, most laws and regulations apply only to telecommunications that are patient-specific, that is, telemedicine. Ohio’s statutory definition is typical: Telemedicine is “the practice ofmedicine. by a physician located outside. (the) state.” The linchpin for state regulation is the definition ofmedical practice; the laws of the state inwhich the physician is located and the laws of the state in which the patient is located are both relevant. The Federation of State Medical Boards maintains a listing of licensure requirements for telemedicine in each state. In addition, as of September 9, 2013, there were 146 bills pending in state legislatures addressing telemedicine and telehealth, clear recognition of their emergence as essential for medical care. The rush to regulate and the plethora of regulations create a morass for physicians practicing across state boundaries and impede widespread access to healthcare via telemedicine. Ophthalmology relies heavily on visual images for screening, diagnosis, treatment, and monitoring of disease, which frequently can be accomplished through digital imaging and telemedicine. It is not surprising that ophthalmologists have adapted quickly to the changing cyberlandscape and employ telemedicine to expand patient access to advanced care. Telemedicine has been particularly effective in the diagnosis and monitoring of retinopathy of prematurity (ROP) and diabetic retinopathy.