Internists Emphasize Importance of Balancing Benefits of Telemedicine Against Risks for Patients

ACP Position Paper Offers More Than a Dozen Statements and Recommendations

(Washington, September 8, 2015)- The American College of Physicians (ACP) today emphasized the importance of balancing the benefits of telemedicine against its risks for patients. The summary to A Guide to the Use of Telemedicine in Primary Care Settings: An American College of Physicians Position Paper also noted that conscious scrutiny is especially important as policymakers and stakeholders shape the landscape for telemedicine going forward. A summary of the paper is in today's Annals of Internal Medicine online edition.

"Telemedicine - the use of technology to deliver care at a distance - is rapidly expanding and holds the potential to improve access for patients, enhance patient-physician collaboration, improve health outcomes, and reduce medical costs," said Wayne J. Riley, MD, MPH, MBA, MACP, president of ACP. "However, the potential benefits of telemedicine must be measured against the risks and challenges associated with its use, including the potential absence of the physical exam, variation in state practice and licensing regulations, and issues surrounding the establishment of the patient-physician relationship."

In 2008, ACP published a position paper, E-health and Its Impact on Medical Practice, discussing how the use of technology, including electronic health records, patient portals, and telemedicine can augment the practice of medicine in an efficient and secure way. Since that paper's release - just one year after the first iPhone was introduced - the use of technology is ingrained into the everyday lives of people across the U.S. and the world.

"The use of these technologies has been shown to increase patient satisfaction while delivering similar quality, and in some cases more efficient care, as in-person care and support," Dr. Riley noted. "Research shows that telemedicine holds the potential to reduce costs, improve health outcomes, and increase access to primary and specialty care."

The ACP position paper offers more than a dozen policy statements and recommendations for the practice and utilization of telemedicine in primary care and reimbursement policies associated with telemedicine use:

  • ACP supports the expanded role of telemedicine as a method of health care delivery that may enhance patient-physician collaborations; improve health outcomes; increase access to care and members of a patient's health care team; and reduced medical costs when utilized as a component of a patient's longitudinal care.
    • ACP believes the most efficient, beneficial telemedicine use occurs between a patient and physician with whom they have an established, ongoing relationship.
    • ACP believes telemedicine is a reasonable alternative for patients who lack regular access to relevant medical expertise in their geographic area.
    • ACP believes episodic, direct-to-patient telemedicine services should be used only as an intermittent alternative to a patient's primary care physician when necessary to meet the patient's immediate acute care needs.
  • ACP believes a valid patient-physician relationship must be established for a professionally responsible telemedicine service to take place. A telemedicine encounter itself can establish a patient-physician relationship through real time audio/visual technology. A physician using telemedicine who has no direct prior contact or existing relationship with a patient must:
    • Take appropriate steps to establish a relationship based on the standard of care required for an in-person visit, or
    • Consult with another physician who does have a patient-physician relationship and oversees the patient's care.
  • ACP recommends that telehealth activities address the needs of all patients without disenfranchising financially disadvantaged populations or those with low-literacy or low technological literacy. Specifically, telehealth activities need to consider:
    • The literacy level of all materials (including written, printed, and spoken words) provided to patients and/or families;
    • Affordability and availability of hardware and Internet access;
    • Ease of use, which includes accessible interface design and language.
  • ACP supports the ongoing commitment of federal funds to support the broadband infrastructure needed to support telehealth activities.
  • ACP believes physicians should use their professional judgment as to whether the use of telemedicine is appropriate for a patient. Physicians should not compromise their ethical obligation to deliver clinically appropriate care for the sake of new technology adoption.
    • If an in-person physical exam or other direct face-to-face encounter is essential to privacy or maintaining the continuity of care between the patient's physician or medical home, telemedicine may not be appropriate.
  • ACP recommends physicians ensure their use of telemedicine is secure and compliant with federal and state security and privacy regulations.
  • ACP recommends that telemedicine be held to the same standards of practice as if the physician were seeing the patient in-person.
    • The College believes there is a need to develop evidence-based guidelines and clinical guidance for physicians and other clinicians on how to appropriately use telemedicine to improve patient outcomes.
  • ACP recommends physicians who use telemedicine should be proactive in protecting themselves against liabilities and ensure their medical liability coverage includes the provision of telemedicine services.
  • ACP supports the ongoing commitment of federal funds to establish an evidence base on the safety, efficacy, and cost of telemedicine technologies.
  • ACP supports a streamlined process to obtaining multiple medical licenses that would facilitate the ability of physicians and other clinicians to provide telemedicine services across state lines while allowing states to retain individual licensing and regulatory authority.
  • ACP supports the ability of hospitals and critical access hospitals to "privilege by proxy" in accordance with the 2011 Centers for Medicare and Medicaid Services (CMS) final rule allowing a hospital receiving telemedicine services (distant site) to rely on information from hospitals facilitating telemedicine services (originating site) in providing medical credentialing and privileging to medical professionals providing those services.
  • ACP supports lifting geographic site restrictions that currently limit reimbursement of telemedicine and telehealth services by Medicare to those that originate outside of Metropolitan Statistical Areas (MSAs) or for patients who live in or receive service in a Health Professional Shortage Areas (HPSA).
  • ACP supports reimbursement for appropriately structured telemedicine communications, whether synchronous or asynchronous and whether solely text-based or supplemented with voice, video, or device feeds in public and private health plans, as this form of communication may be a clinically appropriate comparable service alternative to a face-to-face encounter.

"The positions put forward by ACP highlight a meaningful approach to telemedicine policies and regulations that will have lasting positive impact for patients and physicians," concluded Dr. Riley. "The health care system will, then, realize the full potential of telemedicine."


The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 143,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter and Facebook.

Contact: David Kinsman, (202) 261-4554