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Telemedicine: Credentialing and privileging implications

Credentialing Resource Center Connection, November 3, 2003

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Dear Credentialing Colleague:

We've all heard the stories about hospitals that secure radiology readings from off-site radiology groups: the Massachusetts facility that has readings performed in Asia, the Oregon facility whose readings are done by a California group. What, if any, are the credentialing implications of this innovation?

Actually, it depends. If the "remote" radiologists will be appointed to the "receiving" facility's medical staff and be granted clinical privileges, there are significant credentialing implications. Medical staff bylaws generally don't contemplate such physicians actually applying for medical staff membership. And, as all of you know, the granting of clinical privileges requires extensive inquiries to verify current clinical competence.

If, however, "teleradiology" is confined to providing radiological interpretations under the supervision of a physician member of the medical staff (presumably a radiologist), there are no accreditation standards that require either appointment or privileges for the remote radiologists.

The hospital will, however, have to secure answers to a few fairly concrete questions, especially, "Has the state determined that remote readings constitute the practice of medicine within the state, thus requiring a state license?" In most states, the answer to this question is "no," not at present. State licensure boards have long understood that physicians can use the telephone, mail, e-mail, or image transfer to secure consultation from physicians throughout the country and across the world. In fact, it is a rare hospital laboratory that hasn't submitted specimens for evaluation at the Mayo Clinic or some other world-renowned medical center.

Many physicians use the telephone, e-mail, or other electronic media to discuss clinical cases with colleagues, evaluate a radiology film, or obtain opinions regarding treatment options. Physicians engaging in such activities need not be members of your medical staff. You also need not grant them clinical privileges because they do not render final diagnoses that direct patient treatment. In most instances, they provide a written consultation. Such a consultation will become part of the patient record, but will be reviewed by a local attending physician and supervised by an onsite member of the medical staff.

The JCAHO and other accrediting bodies recently have created new standards pertaining to telemedicine. These standards are not only reasonable, but provide very good guidance for hospitals that choose to use the services of physicians located a considerable distance from the actual facility.

Credentials committees should understand the flexibility they have regarding this issue and attempt to design policies and systems that don't make the granting of permission more complicated than necessary. In most instances, this endeavor should be fairly easy, as most remote physicians do not actually direct care and treatment.

We surely have not heard the last word on telemedicine, and we are just beginning to reap the benefits of "world-wide consultation" in clinical situations.

That's all for this week.

All the best,

Hugh Greeley

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