Telehealth Guidelines and Recommendations 2017

Information adapted from Policy Recommendations to Guide the Use of Telemedicine in Primary Care Settings: An American College of Physicians Position Paper.

Telehealth Guidelines and Recommendations 2017

The American College of Physicians has outlined best practices in using telehealth or E-health in your office or practice. These below guidelines suggest use-cases for implementation of telehealth.

Telemedicine v. Telehealth

Telemedicine, as defined by the Institute of Medicine, is “the use of electronic information and communications technologies to provide and support health care when distance separates participants."

Telemedicine is often used interchangeably with the term telehealth, which is more broadly defined as the use of technology in general health–related services.

Klara (distinctly not a telemedicine platform) is a telehealth (technology used in healthcare) tool for providers and healthcare professionals on a patient-centered conversation. Think: secure, instant messaging.

Below are the American College of Physicians (ACP) 'best use' guidelines for medical practices.

ACP Guidelines

1. ACP supports the expanded role of telemedicine as a method of health care delivery that may enhance patient–physician collaborations, improve health outcomes, increase access to care and members of a patient's health care team, and reduce medical costs when used as a component of a patient's longitudinal care.
   a. ACP believes that telemedicine can be most efficient and beneficial between a patient and physician with an established, ongoing relationship.
   b. ACP believes that telemedicine is a reasonable alternative for patients who lack regular access to relevant medical expertise in their geographic area.
   c. ACP believes that episodic, direct-to-patient telemedicine services should be used only as an intermittent alternative to a patient's primary care physician when necessary to meet the patient's immediate acute care needs.
2. ACP believes that a valid patient–physician relationship must be established for a professionally responsible telemedicine service to take place. A telemedicine encounter itself can establish a patient–physician relationship through real-time audiovisual technology. A physician using telemedicine who has no direct previous contact or existing relationship with a patient must do the following:
   a. Take appropriate steps to establish a relationship based on the standard of care required for an in-person visit, or
   b. Consult with another physician who does have a relationship with the patient and oversees his or her care.
3. ACP recommends that telehealth activities address the needs of all patients without disenfranchising financially disadvantaged populations or those with low literacy or low technologic literacy. In particular, telehealth activities need to consider the following:
   a. The literacy level of all materials (including written, printed, and spoken words) provided to patients or families.
   b. Affordability and availability of hardware and Internet access.
   c. Ease of use, which includes accessible interface design and language.
4. ACP supports the ongoing commitment of federal funds to support the broadband infrastructure needed to support telehealth activities.
5. ACP believes that physicians should use their professional judgment about whether the use of telemedicine is appropriate for a patient. Physicians should not compromise their ethical obligation to deliver clinically appropriate care for the sake of new technology adoption.
   a. If an in-person physical examination or other direct face-to-face encounter is essential to privacy or maintaining the continuity of care between the patient's physician or medical home, telemedicine may not be appropriate.
6. ACP recommends that physicians ensure that their use of telemedicine is secure and compliant with federal and state security and privacy regulations.
7. ACP recommends that telemedicine be held to the same standards of practice as if the physician were seeing the patient in person.
   a. ACP believes that there is a need to develop evidence-based guidelines and clinical guidance for physicians and other clinicians on appropriate use of telemedicine to improve patient outcomes.
8. ACP recommends that physicians who use telemedicine should be proactive in protecting themselves against liabilities and ensure that their medical liability coverage includes provision of telemedicine services.
9. ACP supports the ongoing commitment of federal funds to establish an evidence base on the safety, efficacy, and cost of telemedicine technologies.
10. ACP supports a streamlined process to obtaining several medical licenses that would facilitate the ability of physicians and other clinicians to provide telemedicine services across state lines while allowing states to retain individual licensing and regulatory authority.
11. ACP supports the ability of hospitals and critical access hospitals to “privilege by proxy” in accordance with the 2011 Centers for Medicare & Medicaid Services final rule allowing a hospital receiving telemedicine services (distant site) to rely on information from hospitals facilitating telemedicine services (originating site) in providing medical credentialing and privileging to medical professionals providing those services.
12. ACP supports lifting geographic site restrictions that limit reimbursement of telemedicine and telehealth services by Medicare to those that originate outside of metropolitan statistical areas or for patients who live in or receive service in health professional shortage areas.
13. ACP supports reimbursement for appropriately structured telemedicine communications, whether synchronous or asynchronous and whether solely text-based or supplemented with voice, video, or device feeds in public and private health plans, because this form of communication may be a clinically appropriate service similar to a face-to-face encounter.
14. Get Modern with Klara

Klara core values align with the ACP guidelines of using technology to provide a better quality of care by facilitating collaboration, supplementing (while not replacing) in-office visits, and providing transparency.