Thursday, July 28, 2011

Do you know how your patients use social media?

When I participated in a typically frantic Tweetchat discussion on Health Care and Social Media (#hcsm) last Sunday (9PM eastern) the subject of patient use of social media came up. Some tweeters focused on communication among patients and providers using, for example, Facebook and Twitter, but several voiced concerns about HIPAA compliance and privacy. Although I use both in connection with BehaveNet, as far as I know none of my patients even knows that I am Moviedoc or that I publish BehaveNet.

It has occurred to me that the ability to discuss patient care in a private and secure forum might enhance that care. I envision a virtual place where all providers involved can collaborate with the patient and even significant others or other caregivers, all with the patient's consent of course. Google Wave seemed to provide the right kind of platform, but if it has not already departed it may be on the way out. It appears though that the cloud based contact management service I use might allow me to create and host invitation-only spaces where we could hold conversations and collect and share resources.

Then it occurred to me that I don't even know whether or how any of my patients uses social media now, especially whether they use these technologies to communicate with other patients or providers about illness and treatment. I resolve now to start asking with the next patient to find out whether any might want to jump in. Next I will have to pole a few primary cares and psychotherapists.

Thursday, July 21, 2011

Traveling sick? WA beats MD beats MA.

As patients continue to move or travel in different states I have the opportunity to update my table of information on legality of practice of medicine across state lines.

Massachusetts gets an F

In two voice mail messages a representative of the Board of Registration in Medicine on June 30, 2011 explained, "If the patient is in Massachusetts, you would need a Massachusetts license." This applies not only to patients moving to the state, but also to patients traveling in the state. They even consider calling in a prescription to a pharmacy in MA to constitute practice of medicine, requiring a license to be legal.

Maryland gets a C

In a series of emails on July 18 and 19 a "Public Policy Analyst" at the Maryland Board of Physicians cited: Code of Maryland Regulations (COMAR) which specifically addresses "telemedicine" in stating that even a phone call with no fee would require a MD license, but she also pointed out that the Board would not likely know and that investigation might only occur after a complaint.

In a followup message, however, the Analyst told me that MD has a reciprocity agreement with DC, so physicians and patients located in or licensed in either jurisdiction might pretend it's just one state.

But there's more: In her final message she cited: §14–302.  Health Occupations Article, Annotated Code of Maryland:

"Subject to the rules, regulations, and orders of the Board, the
following individuals may practice medicine without a license:
(4)   A physician who resides in and is authorized to practice medicine
by any state adjoining this State and whose practice extends into this
State, if:
(i)   The physician does not have an office or other regularly
appointed place in this State to meet patients; and
(ii)   The same privileges are extended to licensed physicians of this
State by the adjoining state..."

As I read the map this covers: DC, VA, DE, PA, and WV. I know of no other state with such a rational statute. Every state should enact a similar law.

Washington gets an A+

I still have to pinch myself to make sure I'm not dreaming. Yesterday a representative of the WA Medical Quality Assurance Commission repeatedly assured me that WA considers the practice of medicine to take place where the physician -- not the patient -- is located. At least for purposes of patients traveling to other states I believe this is as it should be. I have a feeling this policy will not last, but until then, if you are sick, come to Washington! Or at least if your patient plans to travel, and you the physician want to retain your status as a non-criminal, encourage all your patients to choose WA as the place to vacation or travel on business.