Friday, June 6, 2008

North Carolina Medical Board gives ACT permission to practice 'telemedicine'
Triangle Business Journal - by Adam Linker http://www.bizjournals.com/triangle/stories/2008/06/09/story10.html?t=printable

RALEIGH - A Wilmington psychiatrists' group has been given the green light by state regulators to write prescriptions after consulting with patients via Internet connections instead of seeing them in person.
ACT Medical Group, which offers its services through what's called telemedicine or telepsychiatry, received permission after asking the North Carolina Medical Board for an exemption from guidelines that prohibit physicians from writing prescriptions without first physically examining a patient.
The medical board's opinion applies only to ACT, says Todd Brosius, an attorney at the NCMB. He says the board's policy committee felt it was too early to issue a broad ruling on telemedicine because the practice is still young.
Instead, he says, the ACT decision can serve as a test case in helping to make future decisions regarding the field of telemedicine. "The board will be interested to see how things go with ACT," he says.
Influencing the NCMB's decision, Brosius says, was the fact that psychiatry does not require physical patient contact. A medical exam via the Internet probably would not get the same exemption for prescribing medicine.
"Underlying the request," Brosius adds, "is that there is a shortage of psychiatric care in North Carolina, and this could help alleviate those shortages."
When telemedicine is practiced in places with a lack of mental health treatment centers - rural North Carolina, for example - Medicare and Medicaid will reimburse psychiatrists for visits through Web connections, says Dove Avylla, marketing manager for ACT Medical Group.
The company works mostly through nursing homes and community agencies, Avylla says. In most North Carolina cities, ACT sends psychiatrists in person, but it was not tenable to treat patients in rural parts of the state.
So ACT began using Web cameras and headphones in early 2007 to consult with clients and prescribe treatments, Avylla says. The practice expanded quickly, she says, and the company now treats about 1,500 people using telepsychiatry.
David Henderson, executive director of the NCMB, says that unlike psychiatric exams, most medical exams require establishing a medical history, conducting a physical exam and giving tests. "It's hard to do a physical exam over the Internet," he says.
There is also a problem with patients getting drugs after completing e-mail questionnaires, he says. The NCMB has disciplined doctors involved in such practices.
That is why the NCMB issued its original guidelines - called a position statement - against Internet prescribing.
A position statement, Henderson says, is not a rule or a law but is meant as a clarification of NCMB policies. But the NCMB can grant exceptions to the general guidelines, he says.
Sara Schneidmiller, vice president of clinical services for ACT Medical Group, says her company would like the NCMB to go further and issue more concrete guidelines to define which practices related to telemedicine are acceptable.
Psychiatry is different than from other medical practices, she says, because it requires a less "hands on" assessment. Also, Schneidmiller says, ACT Medical Group uses a true telehealth approach with live video feeds and direct contact between provider and patient.
It would help to have more guidance from the NCMB, she says, because telehealth and telemedicine are no longer experimental. "Medicare does not fund experimental procedures," she says.