Telehealth: Is this a legitimate way to provide treatment?

My first article on telehealth services in mental health was in February 2009. Since that time, I have written about this subject on multiple occasions. It has seemed natural to many of us that some mental health services could be appropriately provided using services like Skype.

This area is very much open for debate, but in Oklahoma, a doctor has been sanctioned for mental health services he provided remotely. Investigative Reporter Andrew Knittle reported on NewsOK that Dr. Thomas Trow was disciplined because he prescribed controlled substances for a patient he had never met face-to-face (his nurse was with the patient and present during the remote session), the patient overdosed multiple times, and the patient ultimately died. Joseph Kvedar, M.D. re-reported this story and his comments in the cHealth Blog after he was invited to comment in WBUR’s Common Health blog. Dr. Kvedar wrote the following as part of his contribution:

The Medical Board of the state of Oklahoma recently sanctioned a physician for using Skype to conduct patient visits. A number of other factors add color to the board’s action, including that the physician was prescribing controlled substances as a result of these visits and that one of his patients died. This situation brings up several challenges of telehealth — that is, using technology to care for patients when doctor and patient are not face-to-face.

• Legal/regulatory: On the legal side, physicians are bound by medical regulations set by each state. It appears that the use of Skype is not permitted for patient care in Oklahoma.

• Privacy/security: Skype says its technology is encrypted, which means that you should not be able to eavesdrop on a Skype call. That would seem to protect patient privacy.

At Partners HealthCare, we ask patients to sign consent before participating in a ‘virtual video’ visit. Because this is a new way of providing care, we feel it’s best to inform our patients of the very small risk that their video-based call could be intercepted. I don’t know if the Oklahoma physician was using informed consent or not.

But the most interesting aspects of this case involve the question of quality of care. Can a Skype call substitute for an in-person visit? Under what circumstances?

While Dr. Kvedar brings up additional interesting points in his discussion, I think the three listed above are crucial.

1. What is the state law where you are working? If the patient is in another state, what is the law in that state? Which state’s laws govern the interaction?
2. Is the method you are using for your session secure? Does the patient understand that it might not be so?
3. Can you provide quality care remotely? Is this a new patient you have never met face-to-face or is this follow-up care with an already established patient?

Has your organization begun using remote sessions to provide behavioral health services? How do you do this? How do you handle the privacy/security issues? How do you assure that the quality of the patient’s care remains high?

Please share your comments below.