Click here to read part 1 of our ATA 2010 Edition entitled “The U.S. Military and Telemedicine”.

On opening day, the ATA special interest group for international telemedicine met to hear presentations from two panels on the advertised topic of “issues related to cross-border telemedicine.” The first panel was on mHealth (see yesterday’s Digest for a report from a US military meeting on that topic); the second was about the provision of care and telecom facilities in-country when a disaster happens.

Neither panel talked about cross-border issues; in particular, they had nothing to say about the thorny issue of medical licensure and credentialing. When I raised the issue in Q&A, the panelists met me with a blank stare. Three people in the audience jumped up to assure me that it really wasn’t a problem. I could hardly believe what I was hearing, having recently been involved in lengthy and expensive research into the matter, involving several lawyers, including international lawyers.

In most countries, the practice of medicine is highly regulated. Doctors must be licensed and credentialed to provide medical services. In a disaster situation, one can appreciate that perhaps the niceties must be put aside but even there, one would want quickly to be assured that the people showing up and claiming to be doctors are what they claim.

In a non-emergency situation, it goes without saying that a doctor who practices without being licensed to do so is probably breaking the law and is certainly at risk from several perspectives, including a heightened risk of malpractice suit. If that physician is a representative of a foreign hospital or other institution, the risk may extend to them also.

Treating patients in another country via telemedicine probably requires licensure in that country. I say probably, because in our research, it soon became clear that this is a fuzzy area that governments have not really tackled. As a result, it is very hard to get a clear answer from the health authorities. So if a doctor or institution wishes to provide international telemedicine services, s/he or it must be prepared either to go through the trouble and expense of becoming licensed in the country or countries in which they wish to provide telemedicine services, or they must accept the legal risks of operating without a license.

It seems to me this is a showstopper for telemedicine; certainly for international telemedicine. If the promise of telemedicine is to be fulfilled, the issue needs some serious attention from the one body with the interest and the clout to make something happen.

What that something might be is for a later discussion, but it probably will involve a UN effort to get international agreement on cross-border telemedicine at least for disaster situations.