Law Health Care University of Maryland School of Law NEWSLETTER Fall 2010 Vol. XVIII, No. 1 In this Issue: Law & Health Care Program Hosts Law & Health Care Program Roundtable on Legal Impediments to the Hosts Roundtable on Legal Diffusion of Telemedicine Impediments to the Diffusion of Telemedicine ........................ 1 • A radiologist interprets medical images coming from four clinics across UMDLaw to Establish the state. Regional Public Health • A consumer uses a wireless phone to automatically upload vital signs and Law Network ............................ 4 send it to a remote monitoring center. • A cardiologist checks up on a heart transplant patient while away on a Faculty Highlights .................... 4 business trip, reviewing the patient’s chart, looking at live heart rhythms and talking to the patient.1 First Meeting of NIH Probiotics Grant Team hese three scenarios are examples of a growing trend in medical practice Held at UMDLaw in June ........ 5 called telemedicine – which refers to the use of technology to provide Thealth care to patients where distance separates the participants. Although, Professor Deborah Weimer in many ways, the use of telemedicine is poised to expand dramatically in the Prepares Report on HIV/ coming years, the current legal framework may be a significant barrier to its AIDS and the Military further diffusion, especially on a national scale. To further the dialog on this im- for UNAIDS ............................. 6 portant issue, on April 16, 2010, the Law & Health Care Program held a Round- table on the Legal Impediments to Professor Karen Rothenberg the Diffusion of Telemedicine. The Goes “Back to the Future” ........ 6 Roundtable focused on three issues – physician licensure, credential- April Conference Focuses ing and privileging, and medical on Disability & Ethics malpractice – and brought together in Health Care ........................... 7 over 20 telemedicine stakeholders, Health Law Student Studies including telemedicine experts, gov- Global Health in Malawi ........ 12 ernment regulators, and health care providers, along with several policy 27 Graduates Earn Health makers and legal academics.2 Using Law Certificate ....................... 13 case studies in each focus area as a springboard for analysis and discus- sion, the Roundtable was organized to bring the stakeholders and aca- UMDLaw demics together to discuss the legal impediments to a more robust implementation Receives $1.3 of telemedicine; identify regulatory and legal options to address the identified million From RWJ impediments; and develop recommendations that might be used to establish new guidelines to govern the practice of telemedicine. to be regional HQ The Growth of Telemedicine for public health Although telemedicine is not new, changes in the health care system and ongo- law network ing concerns about access, quality and cost of health care are making telemedicine more and more attractive to health care providers, insurers and patients. Some See story on page 4 Cont. on page 2 ©2010 University of Maryland School of Law Telemedicine Cont. from p. 1 The Law & Health Care Newsletter of the potential benefits of telemedicine include increased access to health care is published by the Law & Health Care (especially in underserved areas and among underserved populations), expanded Program at the University of Maryland utilization of specialty expertise, system coordination and integration, ready School of Law availability of patient records, and reduced opportunity costs of care for pa- 500 West Baltimore Street tients.3 Baltimore, MD 21201 Telemedicine is generally thought to include two modalities: store-and-for- ward (or asynchronous communication) and real time.4 Services include remote L&HCP Faculty consultations, in-home monitoring and remote mentoring. Store-and-forward Diane E. Hoffmann, JD, MS telemedicine involves transmitting medical data (such as radiological images Director, L&HCP and Associate Dean and EEG readings) to a medical specialist for assessment offline. Store-and- Richard Boldt, JD forward services do not require the sending and receiving parties to communi- Kathleen Hoke Dachille, JD cate at the same time and these services are most commonly used for diagnosis I. Michael Greenberger, JD Deborah S. Hellman, JD, MA and treatment decisions. Leslie Meltzer Henry, JD, MSc Dermatology, radiology, and Amanda Pustilnik, JD pathology are specialties Karen Rothenberg, JD, MPA that are conducive to using Jack Schwartz, JD store-and-forward asynchro- Lawrence Sung, JD, PhD nous telemedicine. Remote Ellen M. Weber, JD Deborah J. Weimer, JD, LLM monitoring, also known as self-monitoring, allows medi- Adjunct Faculty cal professionals to monitor a Ellen Callegary, JD patient remotely using various Callegary and Steedman technological devices. This Stephen Carney method is primarily used for Funk & Bolton, PA managing chronic diseases Marc Charmatz, JD or specific conditions, such National Assn. of the Deaf as congestive heart failure, chronic obstructive pulmonary disease, diabetes James Doherty, Jr., JD mellitus, and asthma. Real-time interactions between patient and provider (or Pecore & Doherty, LLC provider and provider) include phone and videoconferencing. Remote monitor- W. Lawrence Fitch, JD ing involves interaction between providers performing medical procedures and Maryland Dept. of Health surgeries to ensure quality and patient safety. and Mental Hygiene The Roundtable Janet Lord, LLB, LLM The genesis of the Roundtable was a confluence of factors that came together Blue Law, LLC to convince Law & Health Care Program faculty that providing a forum to dis- Kevin McAnaney, JD cuss the legal impediments to telemedicine was both timely and important. The Law Office of Kevin G. McAnaney Law & Health Care Program has a long history of collaborating with the health Lisa Ohrin, JD sciences schools at the University of Maryland Baltimore (UMB) on issues of Katten Muchin Rosenman LLP mutual interest. Telemedicine presented an opportunity to examine an issue Robert T.M. Phillips, MD, PhD that has both wide-ranging medical and legal implications. UMB was an early Forensic Consultation Association, Inc. leader in the deployment of telemedicine, particularly in emergency care. Tele- Frank Palumbo, PhD, JD medicine programs in the university’s Brain Attack Center, Greenebaum Cancer University of Maryland Center, and Department of Psychiatry are providing health care to individuals School of Pharmacy outside of the four walls of the hospital. Sanford Teplitzky, JD Another reason for the L&HCP interest in telemedicine is a number of initia- Ober|Kaler tives currently underway at the state and federal level to promote the use of the technology. In Maryland, the State Office of Rural Health within Maryland’s L&HCP Managing Director Department of Health and Mental Hygiene and the Rural Maryland Council Virginia Rowthorn, JD are currently focusing on the issue. At the federal level, in addition to research funding, the FCC promoted use of telemedicine in its 2010 National Broadband Plan. In addition, the Health Information Technology for Economic and Clinical Health Act (HITECH) enacted under the American Recovery and Reinvestment Act (ARRA) of 2009 provides both incentives for the adoption of technology 2 │ Law & Health Care Newsletter Maryland Telemedicine Groups Using L&HCP Expertise Representatives of the State Office of Rural Health within Maryland’s Department of Health and Mental Hygiene and the Rural Maryland Council attended the April 16 Telemedicine Roundtable at the law school and are currently focusing on telemedicine. Roundtable organizers, Diane Hoffmann and Virginia Rowthorn, prepared a white paper summarizing recommendations from the Roundtable. The DHMH group will incorporate the Roundtable white pa- per in their upcoming telemedicine report and Hoffmann and Rowthorn have been invited to speak in Annapolis in December at a Rural Roundtable including legislators and state health policy makers organized by the Rural Mary- land Council to present issues and conflicts related to licensing and credentialing of telemedicine practitioners. and penalties for non-adoption. that any alternative to current licensure laws must preserve To encourage a robust exchange of ideas at the Round- the fundamental goals of licensure – to protect the public table, the organizers prepared case studies in each of the from incompetent physicians or sub-standard care. Howev- three topical areas, namely licensure, credentialing and er, participants expressed a wide range of views regarding privileging, and malpractice, for discussion. A summary which model would be considered “ideal.” FSMB (which of the discussion along with background information and was represented at the meeting) has proposed an “expedited areas of consensus and recommendations for each topic are endorsement” model for licensure supported by a uniform presented below. application form. Thirty-three state medical and osteopathic Physician Licensure boards are now using (at some level) the uniform medi- State laws regarding physician licensure perhaps pres- cal license application developed by FSMB. Although the ent the greatest legal challenge to the interstate practice of uniform application was developed to encourage unifor- telemedicine. Every state and U.S. territory has enacted mity across the boards rather than to promote telemedicine, laws relating to the practice of medicine within that state’s FSMB believes that the uniform application