Furthermore, the USA Drug Enforcement Administration (DEA) approved an exception that allows prescriptions for controlled substances via telemedicine without a prior in-person evaluation. Also, the USA Center for Medicaid and Medicare Services released a guidance on Maallowing patients to be seen via videoconferencing in their homes, without having to travel to a qualifying “originating site” for Medicare telehealth encounters. However, governmental agencies in the USA have issued an emergency waiver suspending the requirement for complying with HIPPA and have noted that popular applications for video chats, such as Apple FaceTime and Facebook Messenger video chat, which are not HIPAA compliant, may be used if necessary. In a time of crisis, these stipulations present barriers to rapid and broad implementation of telemedicine.
These include: (1) licensure requirements which usually dictate that the provider must be licensed in the state where the patient is located at the time of service (2) malpractice insurance for telemedicine (3) status of insurance coverage for virtually delivered services (4) adherence to confidentiality and security regulations including those of the Health Insurance Portability and Accounting Act (HIPAA) in the USA and (5) establishment of protocolsfor managing laboratory tests, prescriptions, and scheduling. These experts in telemedicine have outlined key administrative issues for implementation. Another valuable resource is an overview of administrative, clinical, and technical issues in videoconferencing by Jay Shore, MD, MPH. Among the resources that can help clinicians learn about telemedicine, “Best Practices in Videoconferencing-Based Telemental Health” (), a consensus guideline from the American Psychiatric Association and the American Telemedicine Association, is a good place to start. However, most clinicians have not used telemedicine as a routine part of their daily work. If you are already familiar with telemedicine methods and have used them in the past, the transition may not be daunting.
Email channels among health care professionals are pulsing with questions about the use of telemedicine and other technologies.
As we write this editorial, the situation in the USA is extremely fluid with some clinics shuttering their doors and delivering services only via telephone, telemedicine, or other technologies other clinics are continuing some face-to-face visits while moving toward the use of alternatives. Because containment efforts for the COVID-19 pandemic include social distancing, quarantine, and isolation, if indicated, health care providers are confronted with major challenges in delivery of care.