In October 2014, Larry Lee of Albert Lea, Minn., left his house to take his dog for a walk. He would not walk back. While strolling, Lee was abruptly disabled by a stroke. His dog, Dee, raced home and got the attention of Larry's wife, Pat, who called 911. Larry was taken to the hospital near his home.
Too small to have its own full-time neurologist, the Albert Lea hospital used telemedicine to permit a two-way video connection to a stroke specialist at the Mayo Clinic in Rochester. Through the use of a telestroke program, brain-saving medications could be started even before Larry was put on the helicopter to Rochester.
It is an amazing story of a man's best friend, his quick-thinking wife and the use of technology to deliver world-class medical care in a small town.
Yet had Larry lived just 30 miles farther south, in Iowa, his story might have turned out differently. It is illegal for a physician in Minnesota to provide care to a patient in Iowa without an Iowa state license.
While human biology doesn't change across state lines, the rules that govern the right to practice medicine do. Although technology is able to liberate health care, the delivery of that care is significantly complicated by a patchwork of state laws.
Historically, state medical laws were developed to protect the public. When America was a young nation, medical treatment was unpredictable. An encounter with a health care provider was as likely to kill you as to cure you.
The practice of medicine dramatically changed in the 1800s when European scientists demonstrated that previously unseen organisms can cause infection and that sterile techniques can prevent pus formation following surgery. In the U.S. in 1910, Abraham Flexner released a report that highlighted the importance of a commitment to the scientific method. As a result, for-profit schools were closed and medical licensure laws were strengthened. The states began implementing laws to ensure that practitioners of medicine were trained at quality, credentialed medical schools.
Each state developed its own physician licensing laws. In most cases, a physician cannot practice medicine in a state without going through the rigorous task of becoming licensed there. These laws have ensured the quality of practitioners, and they are important. Yet these laws are now snarling efforts to deliver care efficiently using telemedicine.
The need for efficient care has never been more pressing. The U.S. spent $3.8 trillion on health care last year — but it has ranked below all wealthy and many poor nations in its population health. Getting care is often difficult due to logistical barriers. Remote health care — the use of smartphones and other technology to transmit medical information, permit peer-to-peer networking or facilitate initial diagnosis — is poised to deliver specialized care where it is needed. But the variance in state licensing laws affects telemedicine practice within states and between states. The complexity is overwhelming, and it is expensive.
It doesn't need to be that way. While medical licensure remains essential to govern quality practice, there needs to be a better option to overcome state barriers for those who are already duly licensed physicians in one state.
One change could protect patients and simplify care delivery: Permit physicians to acquire a national remote health care credential, allowing them to practice telemedicine regardless of patient location. Just as physicians are certified in a uniform way nationally to specialize in cardiology or neurology, a telemedicine credential would allow for physician regulation, but would not inhibit a duly licensed physician in one state from treating a patient located in another.
The strategy we apply today will critically shape health care in America. Recently, Iowa developed its own telestroke program, and Larry Lee's outcome may have been no different had he been treated in Iowa. But not all states have such programs.
A strategy that frees all of us to seek treatment from the provider of our choice licensed in any state will guarantee access to care, maintain quality of practice, promote healthy competition between care delivery organizations and value the protection offered by state licensure. At times, care may be delivered by the neighborhood practitioner; at other times, it may be provided by an expert at a major medical center 500 miles away. But at all times, our laws should be structured to allow all of us to get the best care possible, and to bring the greatest value that American ingenuity can to the delivery of health care.
Lindsay R. Friedman is an attorney in Chicago. Paul A. Friedman is a cardiologist at the Mayo Clinic in Rochester and is president of the Remote Healthcare Society. The opinions expressed are solely those of the authors.