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.

New hospital telemedicine services: potential market for a nighttime telehospitalist service.

BACKGROUND: A critical shortage in the supply of physicians in the United States has necessitated innovative approaches to physician service delivery. Telemedicine is a viable service delivery model for a variety of physician and health services. Telemedicine is most effective when applied where physician resources are scarce, patient care is time sensitive, and service volume may be distributed across a network. Shortages in critical care and neurology specialists have led to the use of tele-intensive care unit and telestroke services in hospital settings. These hospital-based telemedicine services have gained acceptance and recommendation. Hospitalist staffing shortages may provide an opportunity to apply similar telemedicine models to hospitalist medicine. This study assesses the potential market for a nighttime telehospitalist service. MATERIALS AND METHODS: An analysis of the Florida state hospital discharge dataset investigated the potential market for a new nighttime telehospitalist service. Admissions were filtered and stratified for common hospitalist metrics, time of day, and age of patients. Admissions were further expressed by hour of day and location. RESULTS: Nineteen percent of common hospitalist admissions occurred between 7:00 p.m. and 7:00 a.m., with a range of 17%-27% or 0.23-10.09 admissions per night per facility. Eighty percent of admissions occurred prior to midnight. Nonrural facilities averaged 6.69 hospitalist admissions per night, whereas rural facilities averaged 1.35 admissions per night. CONCLUSIONS: The low volume of nighttime admissions indicates an opportunity to leverage a telehospitalist physician service to deliver inpatient medical admission services across a network. Lower volumes of nighttime admissions in rural facilities may indicate a market for telehospitalist solutions to address the dilemma of hospitalist staffing shortages.