Telemedicine is a collection of means or methods for enhancing health care, public health and health education delivery and support using telecommunications technologies. With more than 95% of adults, and 100% of young adults between the age of 18-29 owning a cell phone in the United States, a technology-based health intervention can be available to hard-to-reach populations or underserved areas. Panelists will engage a rich dialogue and showcase innovative and effective ways to create prevention programs for HIV and STDs using the potential telehealth can offer, specifically with linking young people to HIV pre-exposure prophylaxis, or PrEP. This plenary brings together leaders in the field of HIV prevention, research and policy along with private organizations and companies that are currently active on the field of biomedical prevention.

1. Telemedicine Policy Update:
Victories & Challenges
René Quashie (rquashie@cozen.com)
202-912-4884, office
703-627-8930, cell

2. Definitions
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3. General Definitions of “Telehealth” and
“Telemedicine”
American Telemedicine
Association
Telemedicine: Use of medical
information exchanged from one site
to another via electronic
communications to improve patients'
health status
Medicaid
Telemedicine: Two-way, real-time
interactive communications between
and patient and provider
Medicare
Telehealth: Two-way, real-time
interactive communications
between originating site and
distant site physicians to deliver
health services
HRSA
Telehealth: Use of electronic
information and telecommunication
technologies to support and promote
long-distance clinical health care,
patient and professional health-
related education, public health and
health administration
California (Bus. & Prof. Code §
2290.5)
Telehealth: Mode of delivering health
care services and public health via
information and communication
technologies to diagnose, consult,
treat, educate, etc. while the patient is
at the originating site and the health
care provider is at a distant site.
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4. State Definitions of “Telehealth” and
“Telemedicine”(Center for Connected Health Policy Report—Fall 2017)
States alternate
between
“telehealth” and
“telemedicine”
Some states
define both
Many states place
restrictions
within the
definition (e.g.,
live, interactive,
etc.)
49 states define
“telehealth” or
“telemedicine” or
both
Only Alabama
lacks a def’n
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5. State Definition Trends
Center for Connected Health Policy Report
(Fall 2017)
Email, telephone, and
fax are rarely
acceptable forms of
delivery unless used
with other type of
system
States either are
silent or explicitly
exclude these forms,
sometimes even
within the definition
of telehealth and/or
telemedicine
Live, interactive video
communication fits
within definition of
“telehealth” or
“telemedicine” in
every state where
terms defined
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6. Definition – Example (Wisconsin)
Telehealth is a service provided from a remote location
using a combination of interactive video, audio, and
externally acquired images through a networking
environment between an individual at an originating site
and a provider at a remote location with the service being
of sufficient audio and visual fidelity and clarity as to be
functionally equivalent to face-to-face contact. Telehealth
does not include telephone conversations or Internet-
based communications between providers or between
providers and individuals.
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7. Definition – Example (Hawaii)
Telehealth encompasses four modalities: store and forward
technologies, remote monitoring, live consultation, and mobile health;
and which shall include but not be limited to real-time video
conferencing-based communication, secure interactive and non-
interactive web-based communication, and secure asynchronous
information exchange, to transmit patient medical information,
including diagnostic-quality digital images and laboratory results for
medical interpretation and diagnosis, to support long-distance clinical
health care.
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8. Federal Policy
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9. Introduction—Federal Overview
Telemedicine, telehealth, m-health, ehealth often used interchangeably
Almost 30 federal agencies engaged in some aspect of telemedicine
• Dep’t of Defense
• Dep’t of Commerce (ITA, NIST)
• Dep’t of Health & Human Services (CMS, CDC, AHRQ, FDA, HRSA)
• DOJ (Fed. Bureau of Prisons
• Dep’t of Veterans Affairs
• FCC
• FTC
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10. Federal Advances in Telemedicine Policy
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Bipartisan Budget Act of 2018
• ESRD
• Stroke
• Medicare Advantage
Medicare reimbursement for RPM
VA & DoD
USDA Distance Learning & Telemedicine Grants
FCC Connect2Health
FDA Digital Health Innovation Plan
Various Congressional bills (VETS Act, Evid.-Based Telehealth Expansion Act)

11. The States
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12. Progress in the States
Most states now
allow initial patient
evaluations to occur
via telemedicine
Rise of parity
laws
Rise of
licensure
compacts
Little
enforcement
activity
Little
malpractice
activity
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13. Physician Compact
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• 22 states are part of the Compact
• Expedited pathway to state licensure
for experienced physicians who have
outstanding practice histories
• Complements existing licensing and
regulatory authority of state medical
boards
• Must still become fully licensed in
each state
• Must still pay fees
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14. Non-Physician Compacts
Nurse Licensure Compact
• Allows a nurse (RN and LPN/VN) to have one compact license in the
nurse’s primary state of residence (the home state) and to practice in
other compact states (remote states)
• Nurse must follow the nurse practice act of each state
• Permits practice (physically and telephonically/electronically) across
state lines in Compact states
• Advanced practice registered nurses not included in this compact
APRN Compact (National Council of State Boards of Nursing)
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15. Policy Future
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16. Why Telemedicine Expansion May be Difficult—
Legislators’/Regulators’ View
Many legislators
& regulators not
persuaded by
clinical efficacy
of telemedicine
for many
indications
(MedPAC
Report)
Bias towards
keeping
telemedicine
available mostly
for rural
beneficiaries
Need for
telemedicine in
urban contexts
not fully
understood
Fear of
increased costs
with expanded
telemedicine
usage
Privacy and
security
concerns
Many studies have
been inconclusive
regarding
efficiency, cost
savings, efficacy
preventable
hospitalizations
from the use of
telemedicine
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17. Policy Recommendations
Broadband connectivity
Health IT standardization
Medicare/Medicaid reimbursement liberalization
Telemedicine-specific privacy and security standards
Licensure (“state-of-origin’)
Modality-neutral definitions of “telemedicine” or “telehealth”
Facilitate greater use of virtual care in emergencies (e.g., epidemics, natural disasters)
Ryan Haight Act reform
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