A survey and review of telemedicine license portability.

BACKGROUND: One of the major barriers to the practice of telemedicine is the state-to-state inconsistency and variability of requirements for physicians to obtain a medical license. MATERIALS AND METHODS: Invitations were extended to 61 individuals, representing 21 companies and healthcare systems. The participants had to meet strict inclusion criteria. Health professionals who process well over 1,000 applicants a year were provided a 30-question survey asking about state medical boards and their assessment, including ease of obtaining a license as well as difficulties. RESULTS: Responses were received from 40 of 61 (66%) individuals. Responders ranked their expectations of state medical boards for the following qualities: responsiveness to questions, cooperation, willingness to expedite the application, and knowledge. Although 46% of respondents perceived the state medical board licensing to be reasonable, 54% reported a prolonged application process owing to variable requirements and a deficiency of board office assistance. When respondents were asked about difficulty in dealing with the state medical boards, the reasons listed included the following: failure to respond to e-mails or calls, failure to provide updates on missing content, lack of cooperation, lack of uniform process/consistency, provision of erroneous information, and failure to use the Federation Credentials Verification Service. Lost documents was a problem in that 79% had to resubmit documents that were lost. CONCLUSIONS: The rapid growth of telemedicine is consistently meeting resistance because of the timely, costly, and variable process of medical license portability. A survey of professionals who, combined, annually process over 1,000 applications revealed major disparities among states. The survey demonstrated delayed responsiveness by the medical board, lost documents, and lack of access online as to the current applicant's status. Many of the respondents felt a standardized process or even a national license was a viable solution. Several models for a solution are presented.

Critical care telemedicine: evolution and state of the art.

OBJECTIVES: To review the growth and current penetration of ICU telemedicine programs, association with outcomes, studies of their impact on medical education, associations with medicolegal risks, identify program revenue sources and costs, regulatory aspects, and the ICU telemedicine research agenda. DATA SOURCES: Review of the published medical literature, governmental documents, and opinions of experts from the Society of Critical Care Medicine ICU Telemedicine Committee. DATA SYNTHESIS: Formal ICU telemedicine programs now support 11% of nonfederal hospital critically ill adult patients. There is increasingly robust evidence of association with lower ICU (0.79; 95% CI, 0.65-0.96) and hospital mortality (0.83; 95% CI, 0.73-0.94) and shorter ICU (-0.62 d; 95% CI, -1.21 to -0.04 d) and hospital (-1.26 d; 95% CI, -2.49 to -0.03 d) length of stay. Physicians in training report experiences with telemedicine intensivists that are positive and increased patient safety. Early studies suggest that implementation of ICU telemedicine programs has been associated with lower numbers of malpractice claims and costs. The requirements for Medicare reimbursement and states with legislation addressing providing professional services by telemedicine are detailed. CONCLUSIONS: The inclusion of an ICU telemedicine program as a major part of their critical care delivery paradigm has been implemented for 11% of critically ill U.S. adults as a solution for the problem of access to adult critical care services. Implementation of an ICU telemedicine program is one practical way to increase access and reduce mortality as well as length of stay. ICU telemedicine research including comparative effectiveness studies is urgently needed.

Barriers to telemedicine: survey of current users in acute care units.

CONTEXT: The present study of current telemedicine users is a unique attempt to understand the barriers and motivational factors related to the utilization of telemedicine. OBJECTIVE: A survey of emergency and critical care remote presence telemedicine users was conducted to determine the factors that motivate and the barriers that impede the acceptance and maintenance of a robotic telemedicine (RTM) program. SETTING: The majority of the survey users were in the Emergency Department or in the Intensive Care Unit. METHODS: E-mail invitations were sent to 483 individuals representing 63 healthcare institutions and groups in North America and Europe. Respondents were directed to a Web-based survey. The survey consisted of 96 separate questions, addressing user familiarity and 5-point Likert scales, addressing issues spanning the conceptual and practical issues surrounding adoption of telemedicine. RESULTS: A total of 106 surveys were completed, representing an individual response rate of 21.9% but an institutional response rate of 60.3%. More than two-thirds of the respondents were physicians who participated in active RTM programs. Across seven different topics related to barriers to implementing RTM, the majority of all respondents indicated that cultural issues did not constitute meaningful hurdles, technological matters were generally favorable, and that most personnel were agreeable to both achieving the buy-in to start an RTM program and to maintaining RTM once started. However, respondents proclaimed that RTM's success was still hampered by licensing, credentialing, and malpractice protection, as well as costs, billing, and reimbursement issues. Achieving immediate patient access, overcoming service gaps, improving quality, providing clinical support, maintaining patient satisfaction, and adhering to practice guidelines were viewed as significant motives for RTM implementation. CONCLUSIONS: The leading applications of RTM included emergency response and consultation. The patients, physicians, nurses, nor hospital executives served as barriers to implementation. However, licensing, costs for technology, and reimbursement for RTM continue to impede progress.