The Medical Commission of my State of Washington conducted a virtual workshop recently to create rules in response to legislation. My thoughts:
We should define telemedicine as the provision of medical assessment and/or recommendations via electronic media, including "store and forward" technologies like email, texting and electronic fax. It should not include use of such technologies for setting appointments, requesting refills, and other purely administrative communications.
In crafting rules, we must keep in mind that the provider cannot tell what device the patient uses. The provider could use a desktop computer to conduct an audio-only encounter with a patient using a cell phone. Telemedicine includes store and forward, audio-only, and teleconference technologies. Keep in mind that an encounter that starts out as a videoconference could easily lose video while preserving audio. Also, with both patients and providers wearing masks, some quality of communication is lost, even with in-person encounters.
Standard of Care
Standard of care includes use of the present medium to determine the best setting. For example, a text message combined with a photograph might indicate a need for a visit to an urgent care clinic or emergency room. Telemedicine helps get the patient to the appropriate location or level of care.
Berry Edwards, MD