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Credentialing for telemedicine

Credentialing Resource Center Connection, February 10, 2005

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Dear credentialing colleague:

Developments in communications technology have led to innovations in the way some physicians practice medicine. One of these innovations is telemedicine: practicing medicine at a distance. One form of telemedicine occurs when a physician provides patient services by telephone or some other mode of communication. Another form of telemedicine occurs when a doctor has virtually no contact with the patient, but provides only interpretation of raw data, such as test results; the doctor then sends a report of his or her findings to be entered into the patients record.

Although telemedicine is decades old, it raises some tricky economic and legal issues. For example, will third parties be willing to reimburse organizations for services provided via telecommunications? Do physicians have to obtain licenses in all states in which they provide consultation? Does the same hold true for states in which physicians prescribe or engage in telesurgery?

These questions complicate credentialing matters when a physician provides consultation across state lines and does not have a license to practice in the state in which the patient is receiving care. Some states have specific requirements regarding telemedicine, mandating that out-of-state practitioners obtain either the state's special license to practice telemedicine or the state's regular license to practice medicine. Because of these and many other complex issues, the process of credentialing physicians who practice telemedicine can be a complicated undertaking.

The JCAHO requires that all physicians be credentialed and that all physicians who provide patient-care services be privileged. The JCAHO's standards also apply to telemedicine. If a physician provides consultation that is then used in patient care, the physician must be privileged by the organization that receives the consultation or he or she must have similar privileges at another JCAHO-accredited organization.

Hospitals might want to consider granting temporary privileges (provided they meet the JCAHO's standards for temporary privileges) to individuals providing telemedicine services. However they decide to handle the issue, hospitals should credential and privilege all physicians who provide consultation services from remote sites. At the very least, hospitals should adopt a policy on this issue.

That's it for today.

All the best,

Hugh Greeley

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