On Monday, during the annual meeting of the American Medical Association (AMA) House of Delegates, the delegates voted to table a proposed measure to adopt ethical guidelines for physicians who provide telemedicine services. The proposed guidelines, which were based on recommendations by the AMA’s Council on Ethical and Judicial Affairs (CEJA), focused on issues such as ensuring patient privacy and educating patients on the limitations of telemedicine.

Most delegates supported CEJA’s recommendations and applauded CEJA for striking the appropriate balance between setting clear standards without being too restrictive. However, one AMA delegate from Texas urged CEJA to revise certain recommendations that conflict with new rules issued by the Texas Medical Board. Specifically, the AMA’s current guidance on telemedicine requires a face-to-face interaction for initial physician-patient telemedicine visits; the face-to-face interaction may occur in-person or via real-time videoconferencing. The Texas rule requires physicians to perform a face-to-face examination of a patient before issuing any prescription order.  The physician may conduct the face-to-face examination in person or via real-time videoconferencing, but the patient must be in a healthcare setting with another provider physically present.

The Texas Medical Board is currently embroiled in a legal battle over its telemedicine rules. The Texas delegate noted that the AMA guidelines as currently written would place Texas physicians in conflict with their own Medical Board’s rules.

In the midst of this criticism, the delegates voted to send the ethical guidelines back to CEJA for review. The ethical guidelines could be reintroduced for a vote at the interim meeting of the House of Delegates scheduled in November.

It remains to be seen whether CEJA will succumb to pressure to adopt more stringent standards related to establishing a physician-patient relationship or whether it will continue to recommend a more practical approach that appears to be more in line with the future of telemedicine. Telemedicine providers, particularly those using a service model that does not require an initial in-person physician examination, should carefully monitor the AMA’s activity in this area.