# Presentation: 776900

## Regulatory Issues in E-Health:A State Medical Board Perspective

## Slide 2

**Notes:**
This cartoon illustrates some of the challenges to transforming the licensure system to be more “portable”, user friendly for physicians and, at the same time safeguarding the public health and safety from unqualified, incompetent, or unethical practitioners. 

We are a federation of 70 state medical boards – why 70?  14 states have separate boards for the regulation of MDs and DOs.  Our membership includes the territories of Guam, US VI, Puerto Rico, and the Commonwealth of the Northern Mariana Islands, and finally NY has a bifurcated system with one board responsible for licensure and falls under the Department of Education and the disciplinary board falls under the Health Department.

There is a great deal of commonality among boards’ licensure requirements – such as graduation from a medical school accredited by the LCME or AOA, international medical graduates must be certified by the Educational Commission for Foreign Medical Graduates or ECFMG, passage of the USMLE or COMLEX-USA (for DOs) and  postgraduate training in a program accredited by the ACGME or AOA. 

On the other hand, there is a great deal of variance such as (1) length of postgraduate training required for licensure (2) state specific jurisprudence examinations (3) number of attempts and timeframe for completion of the USMLE series and (4) verification of criminal history.

But – we remain confident that we will get to that point that the miracle occurs – and I believe it may be sooner rather than later.  Someday is to Today.

## FSMB: Organization & Mission

- Organization
- 70 member state medical boards
- Non-Profit Association since 1912
- Located in Dallas/Fort Worth
- _[www.fsmb.org](http://www.fsmb.org/)_

- Mission
- Improve the _quality_, _safety_ and _integrity_ of health care in the U.S. through the development and promotion of _high_ _standards_ for physician licensure and practice.

## MEDICAL Boards

**MEDICAL Boards**

## Issues Must Be Addressed

- License Portability
- Standards for online medical practice
- Challenges
- Potential Solutions

## Increase License Portability

- Objectives:
- Reduce burden faced by applicants in seeking licensure in multiple states
- Reduce administrative redundancies and encourage uniformity
- Facilitate the mobilization of physicians to disaster-affected areas
- Maintain the same level of public protection as the current regulatory system

## Increase License Portability

- Assumptions:
- State-based structure has failed to keep pace with advancements in health care delivery
- State-based regulation of health care practitioners continues to best serve the interests of patients
- Increased access to e-health services can improve the quality and cost effectiveness of health care
- Sharing licensee credentials and disciplinary information is central to portability
- Boards are dependent upon licensure fees to perform their regulatory function
- Additional funding will be necessary to implement innovations

## License Portability Demonstration Project

- A 3-year demonstration project, funded by HRSA and FSMB
- to develop and implement a centralized information data management system in two regions of the U.S.
- to conduct, assess and report on legal and technical variations, barriers, and solutions to determine the feasibility of expanding the system nationwide
- to evaluate the utility of special telemedicine licenses utilized by 9 states
- Participating state medical boards:
- Colorado, Idaho, Iowa, Kansas, Minnesota, North Dakota, Oregon, Wyoming
- Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont

## Standards for Online Medical Practice

- Appropriate licensure
- Parity of ethical and professional standards regardless of mode of delivery
- Legitimate physician-patient relationship
- Patient evaluation prior to diagnosis/treatment (including prescribing)
- Prescriptions based solely on an online questionnaire fails to meet an acceptable standard of care = violation of the medical practice act
- Electronic communications
- Authentication of patient’s identity
- Privacy/Security
- Access
- Response
- Archival and retrieval
- Documented in the medical record

## Challenges

- Regulating “rogue” Internet pharmacies without creating regulatory barriers to legitimate telehealth practice
- Lack of resources
- Discourages innovation
- Impedes technical advancement
- Expected to “do more with less”
- Inconsistencies in laws, standards, procedures and processes
- Requires statutory/rule/regulation change in multiple jurisdictions
- Discourages technical interoperability
- Complicates and discourages multi-state medical practice
- Discourages interstate cooperation and information sharing

## Possible Solutions

- Federal legislation to regulate “rogue” Internet pharmacies
- Define a qualifying physician patient relationship
- Disclosure of associated pharmacists and physicians
- Nationwide injunctive authority for state AGs
- Appropriate funding for state medical boards
- All revenues generated from board activities (fees, reimbursed costs) allocated to the state medical board
- Incentives for “new approaches”
- Common license application
- Online credentials verification
- Utilization of electronic medical records
- Advance technical capabilities to support board operations

## Possible Solutions

- Conduct a comprehensive evaluation of state laws, standards and procedures relevant to licensing requirements, confidentiality, electronic prescriptions and health records
- Develop and promulgate recommendations, including model legislation, standards for electronic health records, prescribing and reimbursement
- Assure technical interoperability

## “I’m sorry, Nathan, but I need to color outside the lines.”

*“**I’m sorry, Nathan, but I need to color outside the lines.”*

## Resources

- Model Guidelines for the Appropriate Use of the Internet in Medical Practice
- Essentials of a Modern Medical Practice Act
- _[http://www.fsmb.org/grpol_policydocs.html](http://www.fsmb.org/grpol_policydocs.html)_
- eRisk Working Group for Healthcare’s - Guidelines for Online Communication
- _[http://www.omic.com/resources/risk_man/forms/managed_care/2006%20eRisk%20Guidelines%20Final.rtf](http://www.omic.com/resources/risk_man/forms/managed_care/2006%20eRisk%20Guidelines%20Final.rtf)_

## Lisa Robin

**Lisa Robin**
**Vice President**
**Government Relations, Policy and Education**
**PO Box 619850**
**Dallas, TX 75261-9850**
**Tel: 817.868.4053  ********  ****Fax: 817.868.4153**
**Email: **_[lrobin](mailto:lrobin@fsmb.org)__[@fsmb.org](mailto:lrobin@fsmb.org)_