Who regulates health on the net?
| Leonard Holmes, Ph.D. http://mentalhealth.about.com |
The internet is a little like the Wild West. There are pockets of regulation, but attempts to regulate the whole thing are doomed to failure because of the vastness of the net. This article was originally written in 1997. I had hoped that by 2002 things would have changed enough that it would be completely out-of-date. This has not happened.
By 1997 therapists were using the net, and using other networks, to provide services from a distance. A psychiatrist at the Veterans Affairs Medical Center in Salem, Virginia now sees patients across state lines in Beckley, West Virginia using a large screen T.V. system over ISDN lines (a high speed network protocol sometimes used on the internet). Behavioral telehealth is a developing discipline which will allow therapy to actually take place on the net. High speed networks allow full screen, full motion video. Finally the nonverbal components of communication are available to therapists and clients.
Other health care professionals are using similar techniques to serve rural areas and other under-served populations. The Telemedicine Network in Utah links the University of Utah Health Sciences Center (UUHSC) and rural West Wendover, Nevada. Many other telemedicine projects are featured on web sites. A few examples include: The Washington, Wyoming, Alaska, Montana, and Idaho Rural Telemedicine Network connecting Seattle with rural physicians, and Rural Health Futures--a company which focuses on rural medicine.
Telehealth is facing some interesting problems as hospitals, insurance companies, and state legislatures wrestle with how to regulate this new field. California has written telehealth into its health regulations. Insurance companies are required to reimburse telehealth providers in the same manner as face-to-face providers. The new law reads in part:
It is the intent of the Legislature to recognize the practice of telemedicine as a legitimate means by which an individual may receive medical services from a health care provider without person-to-person contact with the provider....
On and after January 1, 1997, no health care service plan contract that is issued, amended, or renewed shall require face-to-face contact between a health care provider and a patient for services appropriately provided through telemedicine, subject to all terms and conditions of the contract agreed upon between the enrollee or subscriber and the plan.
Other sections of the law prohibit professionals outside California from offering telehealth services in the state. How does this affect the internet? Can the sites listed in the resources page offer services in California? If states restrict telemedicine from crossing state lines, what will happen in rural areas which are closest to a city in another state? Tell us what you think.
| Leonard Holmes, Ph.D. http://mentalhealth.about.com |