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I’m a pathologist licensed in NC, presently practicing in TN. I think this position statement should specifically address radiology, where telemedicine has become an indispensable part of practice, and pathology, where rapidly evolving “virtual slide” technology, not yet quite ready for prime time, is probably going to effect similar changes.

By Robert S. Richmond on Nov 10, 2009 at 10:44am

It is important to emphasize confidentiality also.  Most e-medicine programs like Relay Health are HIPPA compliant however having a dedicated “AOL” address for billing email encounters is NOT guaranteed to be confidential.  It is important to maintain this important part of the interaction.

By Maureen Whelihan MD FACOG on Nov 15, 2009 at 4:20pm

I have found telemedicine to be very helpful in monitoring ALS patients in the home when they cannot attend clinic later in the disease course.  Home monitoring via telemedicine in the presence of the home care RN is helpful for identifying and treating issues before they become problematic.

By Benjamin Rix Brooks, MD on Nov 23, 2009 at 5:51pm

Depending on how the “Examinations” part of this policy is interpreted, a physician who treats a UTI or vaginitis over the telephone (telemedicine involving a verbal questionnaire) or Secure email could be in violation of this policy.  I am sure that the Board does not intend that this would be a violation, so I would hope that clarification would be included in the language to specifically address the provision of care to an established patient using any of the current or newly developed electronic technologies that allow physicians and patients to communicate without being physically together.

By Steve Hill, MD on Nov 23, 2009 at 8:16pm

Does a Pathologist or Radiologist need consent if they reside in NC and are sending an image to a physician in another State for a Primary interpretation or consultation?

By Jared N Schwartz MD PhD on Nov 23, 2009 at 10:09pm

As licenses for telemedicine providers are issued I would recommend that the board consider the development of specific, limited licenses for teleradiology, teledermatology, and telepathology.  These applications are well researched and do not require direct patient interaction in the same manner that telepsychiatry requires.

By Steve North, MD, MPH on Nov 23, 2009 at 10:09pm

There is a difference between teleconsultation (that may be physician-physician and in the absence of the patient, but with the consultant relying on the requesting physician?s data) in which advice is given to the referring physician for their consideration, and telemedicine where the physician is writing notes and providing orders in a medical record for direct implementation.  The responsibilities for disclosure to the patient, location of the resulting medical records, and credentialling/privileging of the teleconsultant at the home and referring institution (if hospital-hospital) could differ in requirements.  I work in the VA healthcare system, where most of the issues have been well worked out and addressed.

By David L Simel, MD MHS on Nov 24, 2009 at 2:42pm

I think this is an excellent statement.  It confirms the responsibilities of the clinician while allowing room for future technology to improve patient care.  No matter what improvements occur in telecommunications, it does not alter the patient-clinician relatiionship/

By Ed Ermini MD on Nov 26, 2009 at 9:46pm

In this era of global outreach and one world platform of internet, what is the licensure required if a patient in NC wants to consult a physician located in another country? What are the medico-legal implications in such a circumstance?

By Arbinder Singal, MD on Feb 12, 2010 at 12:29am