On June 13, 2016, the American Medical Association (AMA) at its annual meeting approved new ethical guidelines for physicians providing telemedicine services, which will be incorporated in the full publication of the AMA Code of Medical Ethics this fall. Although the ethical guidelines do not place legal limitations on the provision of telemedicine for any individual physician or State, they are designed to guide a physician in his or her practice. Allegations of any violations of the Code of Medical Ethics, after a disciplinary hearing, could ultimately result in suspension or revocation of a physician’s AMA membership. Individual State agencies are responsible for issuing licenses and enforcing State law governing the practice of medicine, including ramifications of unethical behavior.
Although not publicly released, the reference committee’s recommendations seem to present a dichotomy between “promoting initiatives that will help make needed technology more readily available to all patients who want to use telemedicine services,” as the AMA states in its official release, and ensuring that “physicians have access to the relevant information they need to make well-grounded recommendations for each patient,” as described by Jack Resneck, M.D., an AMA Board Member.
Importantly, the AMA’s ethical guidelines provide that a physician providing clinical services through telemedicine should:
Recognize the limitations of the relevant technologies and take appropriate steps to overcome those limitations. Physicians must ensure that they have the information they need to make well-grounded clinical recommendations when they cannot personally conduct a physician examination, such as by having another health care professional at the patient’s site conduct the exam or obtaining vital information through remote technologies. CEJA Rep.1-A-16, Page 2, Lines 27-32.
The AMA ethical guidelines generally mirror the requirements published by CMS and The Joint Commission. The guidelines advise physicians to:
- Inform users of the limitations of the telemedicine relationship;
- Arrange for follow-up care;
- Encourage those patients with primary care physicians to inform their primary care physician of the telehealth consultation;
- Be proficient in the use of the relevant technologies;
- Be prudent in carrying out a diagnostic evaluation of prescribing medication (establish the patient’s identity, confirm telemedicine is appropriate for the situation, evaluate the indication, appropriateness, and safety of any prescription, and document the evaluation and prescription, if applicable);
- Tailor the informed consent to ensure patients understand how telemedicine technologies will be used, limitations of the technology, credentials of health care professionals, and patient expectations during the evaluation;
- Inform patients of any conflicts with regard to ownership or investment in a given telemedicine company or technology; and
- Take steps to promote continuity of care and provide information to a primary care provider, if applicable.