Most readers will be aware of the TSA Telecare & Telehealth Integrated Code of Practice which has developed over time from the TSA’s original telecare code, and many will be aware of the recent arrival of the Telehealth Services Code of Practice for Europe (TeleSCoPE). Now the ATA in the US has produced revised draft telemedicine core guidelines for comment that provides an interesting comparison with these two.
Before I go further, a word on definitions. The definition of ‘telehealth’ in TeleSCoPE includes telecare so it covers the same areas as the TSA code. This ATA draft does not cover telecare, and includes telehealth into the definition of ‘telemedicine’. However by also explicitly covering clinician to patient communications where the patient is attending a location away from their home and where care is provided professionally, it also covers a wider range of services than the normal UK understanding that telehealth is primarily aimed at the patient in their own home, or, via their mobile device, their own private setting. The comparison across the codes is not therefore exact.
The TSA code is of course accessible to members and those seeking accreditation only. Those who have read the many sections of it will be aware that it is extremely detailed and comprehensive in its intended coverage. The TeleSCoPE code, which is freely accessible, is far shorter, requiring significantly greater interpretation by local users and assessors to ensure compliance. As a result though, it is far more flexible, so more suited to wider geographic coverage. (Disclosure: I was recently asked by both the TSA & Coventry University, on behalf of TeleSCoPE, to review the coverage of both codes.)
The draft ATA code dispenses with some issues already covered briefly in TeleSCoPE, in an even briefer manner. So, for example Governance Structure, elements of which happen to be shared across two TSA modules, and which is a single section in TeleSCoPE (C1) is essentially covered in two lines under ‘Administrative Guidelines – Organisations’ in the ATA draft.
In other areas though, the reverse is the case. As might be expected given the fear of litigation in the US, there is much about competence, including for example the requirement that “…the telehealth provider shall provide the patient (or legal representative) with his or her qualifications, licensure information, and, when applicable, registration number. The health professional shall also provide a location for verifying this information.” The ATA draft goes into significant detail too on ensuring that clinicians are familiar with the patient’s medical history, current medication, rescue medication and available local caring resource.
Requirements for equipment are even more detailed, for example: “Healthcare processes that provide one-way or two-way live video services through consumer devices that use internet-based video conferencing software programs should provide such services at a bandwidth of at least 500 Kbps in each of the downlink and uplink directions. Such services should provide a minimum of 640 x 480 resolution at 30 frames per second.”, an issue that is covered in significantly less detail by both the TSA & TeleSCoPE codes.
Differences of emphasis are therefore perhaps understandable. Looking at the ATA draft as a whole, it is hard to see that any major area has been left out or is greatly at odds with the TSA & TeleSCoPE codes. There appear to be some omissions, such as anonymisation of information, providing for the support and well-being of staff and whistle-blowing policy (to use TeleSCoPE headings) although one suspects those are a reflection of cultural differences, not genuine errors.