The Federation of State Medical Boards (FSMB) has updated its voluntary telemedicine policy guidelines to ensure that as communication technologies and care delivery systems evolve, patients are protected.

The model guidelines, which state medical boards can chose to adopt or not, attempt to draw some basic distinctions between what types of electronic communication between a patient and a doctor would be telemedicine and which would not rise to that standard.

“Generally, telemedicine is not an audio-only, telephone conversation, e-mail/instant messaging conversation, or fax. It typically involves the application of secure videoconferencing or store and forward technology to provide or support healthcare delivery by replicating the interaction of a traditional, encounter in person between a provider and a patient,” noted the FSMB Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine.

However, promoting video in the standard is somewhat problematic, critics say, because not all patients have or want this capability. In addition, it leaves out the decades old practice of telephone consults as well as newer e-Visit technologies using secure email.

“Although there is an important move toward the use of video in providing telemedicine consults, the fact remains that the telephone is an important tool for current patient interactions,” noted the American Telemedicine Assocition in its proposed changes for the FSMB policy. “This year, it is estimated that approximately 250,000 telephone-based consultations will be made by two web-based providers alone. Use of the word ‘generally’ in the existing language does not clarify the problem of a rigid policy disallowing any use of telephones or emails as telemedicine. State policies that prohibit any such use could set back the practice of medicine and significantly limit the delivery of care.

But others liked the insistence that true telemedicine be more than just email and phone calls. The Robert J. Waters Center for Telehealth and e-Health Law (CTeL) in Washington, D.C., thought the guidelines should be updated to not allow telephone calls or email to establish the physician-patient relationship

The guidelines also stress that standards of care that protect patients during in-person medical appointments also apply to telemedicine, and that providers using telemedicine should establish a credible “patient-physician relationship.” The provider should also be licensed in the state where the patient is and should maintain licenses for every state where he or she “sees” patients.

However, the ATA points out that this could prohibit state medical boards from entering into reciprocal relationships with neighboring states or regions where a license to practice medicine awarded in one state is recognized by the other states and vice versa. It also may conflict with federal policy for physicians caring for members of the U.S. military.