Telemedicine Licensure in the United States: The Need for a Cooperative Regional Approach

Abstract

The extraordinary successes and refinement of modern telemedicine applications in recent years have been diminished somewhat by the anachronistic licensure laws of the 50 state jurisdictions that limit the practice of medicine to specific state geographic boundaries. This approach is deficient when applied to telemedicine because, with the advent of the Internet and modern technological advances, differences in space and time are rendered nearly meaningless. It is recommended in this paper that the practice of telemedicine be handled differently than the practice of face-to-face medicine, as related to licensure. Although it may be argued persuasively that a national licensure model for telemedicine should be advanced, the political and constitutional hurdles may be too great to overcome. It is therefore recommended that a voluntary, regional geographic approach be instituted by jurisdictions already demonstrating a commonality of interests, such as through the Southern Governors' Association or the Western Governors' Association. The benefits to be derived from this approach would include improving access to healthcare and medical specialists, enhancing the quality and timeliness of care, cutting medical costs by moving information instead of people, securing patients' access to medical records and information, and facilitating commercial export of American telemedicine services.

Social Work, Technology, and Ethical Practices: A Review and Evaluation of the National Association of Social Workers’ Technology Standards

“…While there are laws and policies that provide some guidance about mental health treatment and social work services in general, there are no specific federal laws directly related to the provision of online treatment services (Cwiek, Rafiq, Qamar, Tobey, & Merrell, 2007). Although bills have been introduced requesting both funding and corroboration of states regarding licensing rules, there is not currently a statute that addresses national or international provision of medical or mental health services online (U.S. Department of Health and Human Services, Health Services and Resource Administration, 2013).…”

“…Much like in traditional mental health treatment, the client and provider should develop goals, set treatment expectations and outline the process for the work that will be done together. Often, therapists will have clients sign paperwork that explains limitations, fees, and procedures for mental health emergencies (Cwiek et al, 2007). Those engaging in online treatment will need to cover all of the same topics as face-to-face therapists do, but they may also have additional responsibilities that must be covered prior to treatment, such as helping clients create passwords to secure privacy of their treatment sessions.…”

“…The therapist may also need to set up after-hours technical support for issues such as accessing the site or providing a method for password reset if the client cannot remember their passwords. In a review of existing mental health websites, 59% of these sites provided information about mental The subject of jurisdictional boundaries has been one of the most difficult issues relating to the regulation of online therapy (Cwiek et al, 2007). Despite the NAS/ASWB Standards and recommendations, one study of online counselors found that 78% of online therapists offered services in states other than the ones in which they were licensed to practice (Maheu & Gordon, 2000).…”

“…Although there are some laws and policies that regulate therapy practices, because the Internet is a global system, there are questions about which jurisdiction would have responsibility for enforcement of the laws (Cwiek et al, 2007). If a law is violated by a practitioner in another state, there may be no way to prosecute residents of other jurisdictions.…”

Provision of mental health care services to deaf individuals using telehealth.

“…Another obstacle to the use of telehealth relates to the issue of licensure boundary limitations (Cwiek, Rafiq, Qamar, Tobey, & Merrell, 2007). The licensure boundary issue has spurred the United States's Association of State and Provincial Psychology Boards, the APA, and the American Psychological Association Insurance Trust to collaborate in developing guidelines for the practice of telehealth (APA, 2013).…”