A family practice physician in eastern Oklahoma was disciplined by the state medical board for using Skype on initial mental health consults. Skype is not approved by the board for telemedicine; other factors were that the patients were not physically seen at any point and that they were prescribed controlled substances (including narcotics). Three of the patients died while under care but the deaths were not attributable to Dr. Trow. It is easy to score the doctor for what could be seen as bad practice in telemedicine, but a mitigating factor is his practice in a remote area of the state and the distance of the patients. Joseph Kvedar, MD of the Center for Connected Health/Partners HealthCare reviews the situation and contrasts their generally positive experiences and patient benefits of virtual visits/house calls in immediacy and lowering of stress. He adds these caveats: patients should sign consent, Skype’s claims they are encrypted (but the TeleMental Health Institute disagrees in Psychiatric News–TTA 11 May, and there are many other HIPAA-compliant video providers), and that visits should be follow up only. News OK, the CHealthBlog.
A better example was highlighted at the Epic EHR User Conference last week with Stanford (University) Hospital and Clinics. Epic has developed a software add-in for video consults which integrates three ways: 1) with the patient’s EHR, 2) with scheduling and keeping the appointments into the physician workflow and 3) with third-party identity verification services. The ease of use demonstrated in the Epic video is a real pointer to the future. An earlier telemedicine test was done with Stanford Dermatology and the Cisco HealthPresence platform. InformationWeek, ScienceRoll.