Legal, Regulatory, and Ethical Issues in the Use of Telemedicine

With major pressures to provide greater levels of care with fewer care providers, there are significant incentives to expand telemedicine/telehealth to achieve efficiency. Advancement in technology of telemedicine has far outpaced the political, legislative, legal, and ethical maturation yielding considerable uncertainty and confusion. The aim of this chapter is to review the state of the literature and legal atmosphere surrounding telemedicine and provide guidance, where possible, for providers of telemedicine services. Regarding the legislative environment, the practitioner will have to consult references provided for specifics of each state. Regarding licensure, there is an expected evolution toward or approximating national licensure or reciprocity but each state will reserve the right to design their own licensure requirements. Regarding the state of malpractice, the case law is immature and time will provide more guidance. The ethics of telemedicine and standards applicable to traditional face-to-face medicine will apply with some fine nuances. Finally, reimbursement for telemedicine services seems to have been evolving positively until the recent rules changed.