Telemedicine seems to have been swept up in the contentious abortion debate, as Texas has effectively banned the remote prescribing of "abortion pills" and several states are considering similar restrictions. But some proposed legislation may have the side effect of curtailing telemedicine in many other, less-controversial cases, while mobile technologies may provide a means of getting around the restrictions anyway.
As Bloomberg News reported, since last year, a Texas law now requires physicians to show and explain fetal ultrasounds to women looking to terminate their pregnancies. That law prompted Whole Woman's Health Clinic in Austin, Texas, to stop prescribing abortion medications like RU-486 to women at remote locations.
According to the Bloomberg story, nine other states have passed similar laws aimed at shutting down what some have derisively called "webcam" or "push-button" abortions. Similar bills are pending in Alabama, Indiana, Iowa, Mississippi and Missouri, while Texas is considering further limitations, Bloomberg reported.
While not wading into the controversy over abortion itself, Jonathan Linkous, CEO of the American Telemedicine Association, tells MobiHealthNews that some of the restrictions may threaten telemedicine itself, exacerbating general healthcare access problems in underserved communities.
Linkous noted that the Georgia Composite Medical Board proposed a general rule last year, not specific to abortion, that would have required patients to be examined by a physician first, either in person or by video link, before a nurse practitioner or physician assistant could provide care by telemedicine. The board tabled the plan in December after a backlash from nursing groups and advocates for expanding access to care. "It was very poorly done," Linkous says.
In Iowa, an early version of the legislation would have effectively outlawed prescribing drugs by telemedicine statewide after one right-to-life group called telemedicine abortion consultation an "experimental remote-controlled abortion pill distribution scheme," lawmakers later narrowed the focus.
"Why cut off a life-saving technology?" Linkous wonders. "You wouldn't want to take stethoscopes away," even though physicians use those when making medical decisions.
"If you don't like abortion, ban the abortion, but not the provider," Linkous says.
While Linkous told Bloomberg that abortion is the only area he is aware of in which states have rolled back or prevented the expansion of telemedicine, he remains optimistic about the future of remote consultations. "We are concerned about it but we're not alarmed because at this point it doesn't look like there is harm to the wider use of telemedicine," the ATA chief says.
Regardless of the intent of the new telemedicine laws that seem to target abortion pills, new technologies like the handheld and smartphone ultrasound may actually make the restrictions obsolete by bringing imaging capabilities to remote clinics, and they do not require the presence of a physician. "Ultrasound equipment might still be in the room with the patient," Linkous notes.