The Des Moines Registrar reported:
Every day in Iowa, health care providers use technology at one location to connect with patients at another location. A doctor can oversee a procedure elsewhere using real-time videoconferencing. Psychiatrists can evaluate, diagnose and decide what drugs to prescribe for a patient they’ve never met in person. Specialists at the University of Iowa can treat burn and stroke victims remotely.
So-called telemedicine provides Iowans access to health services they may not otherwise have. Veterans, prison inmates and elderly residents do not need to travel long distances. This method of delivering care is especially important in a rural state, providing access to experts across the state and has been used in Iowa for many years.
Now the Iowa Board of Medicine is trying to catch up. For the first time, it has crafted administrative rules providing telemedicine standards for all physicians it oversees.
Unfortunately, board members are unable to reconcile the need to create basic guidelines with their fixation on driving abortion providers out of business by state rules.
The proposed rule rightly gives discretion about patient exams to doctors. The doctors must “ensure” patients undergo an exam “when medically necessary,” but the board acknowledges that “may not be in person.” Patients must also have “access” to follow-up care, but it does not need to be provided by the same doctor.
This guidance is at odds with another rule passed by the same board last year that imposes onerous requirements on Iowa doctors using videoconferencing to dispense abortion-inducing drugs. That rule, which is being challenged in court, requires the same physician who dispenses a drug to perform an in-person exam. Not a nurse. Not a physician’s assistant. Not even another doctor. The doctor also must be in the same room with a woman when she swallows the pill and schedule a follow-up exam at the same location.
Such requirements not only defy the very idea of telemedicine, but when combined with the newly proposed rule, create two sets of guidelines for Iowa doctors: one that applies to all physicians using technology to connect with patients and another for the three physicians now providing remote abortion services for Planned Parenthood of the Heartland.
Board members cannot have it both ways on telemedicine. They cannot recognize technology as a “useful tool” that can “provide important benefits to patients” and then refuse to extend those benefits to women seeking a medical service board members don’t like. The rules acknowledge a doctor does not need to be in the same room with a patient to provide quality care — unless that doctor is dispensing a specific drug that poses little risk to a woman. While the board recognizes telemedicine can provide Iowans “increased access to health care,” they don’t want that care to involve terminating a pregnancy.
The proposed telemedicine rules are a reminder of the hypocrisy of the current medical board. Members have made a mockery of a state entity that was previously a respected voice in medicine. They have used their positions to further a political agenda instead of remaining focused on patient care and safety.
RULES CREATE PROBLEMS FOR SOME PATIENTS
Years after Iowa health providers began using telemedicine to treat patients, the Iowa Board of Medicine is crafting administrative rules to provide guidance to those physicians. In addition to attempting to cement in place onerous requirements only on abortion providers, the proposed rules raise other questions that could cause problems going forward for many Iowa doctors and their patients.
The proposed new rules require, for example, a physician treating a patient to be licensed in the state of Iowa. This could make it difficult for Iowans seeking telemedicine care from a doctor at the Mayo Clinic in Minnesota, one doctor told The Des Moines Register editorial board.
That doctor also raised questions about a provision in the rules requiring physicians using telemedicine to ensure other health providers they work with remotely are qualified “by personally assessing” those individuals’ education, training and experience.
“When we are using telemedicine to help a patient and working with staff at another location, the last thing we ask about are the credentials of that worker,” said the doctor.