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AOA leaders: Telehealth debate comes down to standard of care
WASHINGTON – Optometrists should always participate in new technology but, “at the same time, we’re looking at ways to make sure our patients are cared for properly and the doctor-patient relationship is maintained,” according to American Optometric Association former President Steve Loomis, OD.
Loomis joined former AOA President and Advocacy Executive Committee member David A. Cockrell, OD, and State Government Relations Chair Deanna Alexander, OD, for a panel discussion on disruptive technology, moderated by journalist Paul Brandus, here at Optometry’s Meeting.
Cockrell specified the difference between the terms “telemedicine” and “telehealth.”
“Telemedicine is considered to be the clinical application of technology and involves a practicing clinician of some type,” he said. “Telehealth is a broader consumer-facing application.”
Brandus said that one-sixth of the world’s population lives on $1 a day or less, and half have significant vision impairment due to refractive error. In Africa, there are fewer than three ophthalmologists per million people and fewer than four optometrists per million, while in the U.S. there are 133 ODs per million.
“Are access solution technologies used in other parts of the world applicable here?” he asked the panel.
“It gets down to the fundamental question of standard of care,” Loomis said.
In sub-Saharan Africa, the standard of care is “essentially zero,” he said. “Refractions you can take with an iPhone and take a picture of the retina; and at least they give some people some access to something. An argument can be made that access to some care is better than access to no care.”
When the concept is applied to the U.S., Loomis continued, standard of care must be considered.
“Inferior care is never a step forward,” he said.
Alexander listed some of the new technologies permeating the ophthalmic industry.
“Simple Contacts is an app where you can renew your contact lenses online,” she said. “It’s functioning in 40 states. Opternative has been out for 2 years. They’ve been fighting back hard about being regulated. InstaRx partners with 1-800 CONTACTS. They put you through their quasi-eye test and send you contact lenses through their business model. The EyeQ Personal Vision Tracker is a smartphone mini-adaptor that’s an autorefractor that will hook to your phone and do an autorefraction. You monitor your prescription to see if you need to go to your doctor.
“Warby Parker said it will have an online app,” Alexander continued. “It’s functioning in two states. SVOne (Smart Vision Labs) is more to skip the doctor and maybe an optical shop.”
Alexander said that optometry is not the first health care profession to deal with such technological competition.
“Dermatology is a very good example,” she said. “There are a number of apps out there where you can take a picture of something on your skin and send it to the dermatologist. They have tried to regulate the doctor-patient relationship. They have national guidelines that outline what is good, standard of care.
“The common thread is the doctor-patient relationship,” she continued. “It’s been established. They know this person and know their condition.”
Loomis said it is the doctor’s responsibility to convince the patient of the importance of the role of the doctor-patient relationship.
Alexander added: “Originally when we had some idea that these technologies were coming out, a few states passed laws that would limit the refraction from being separated from the eye exam.”
States recently passing such legislation include Michigan, Alabama, Maine, Nebraska, South Caroline, Georgia, Virginia, Indiana, Rhode Island and Mississippi, and similar bills are pending in other states, she said.
“Technology is moving quicker than we can pass state laws,” she said. In addition, “Enforcement is difficult,” she added.
Cockrell said he believes optometry is better positioned than some other fields to adapt to these new technologies.
“We have had to change in the last 30 years to broaden our scope of practice,” he said. “It will be painful for individual doctors, but I think we’ll make the curve.”
Loomis referred to a resolution that was scheduled to be heard in the AOA’s House of Delegates – and was eventually passed – indicating that with telemedicine, the standard of care must be upheld the same as with a personal visit to the doctor.
“That’s the line in the sand,” he said. “If not, then it’s inferior.”
Cockrell added: “Under Medicare, you have to have at least one physical interaction with that patient in order to be able to do subsequent telemedicine. That’s our fallback to make sure adequate care got delivered that first time – seeing the patient on an annual basis, and the interim care can be done through telemedicine.” – by Nancy Hemphill, ELS, FAAO
Reference:
Alexander D, et al. In the pipeline: Disruptive technology. Presented at: Optometry’s Meeting; Washington; June 21-25, 2017.
Disclosures: Alexander is chair of AOA State Government Relations. Brandus reported no relevant financial disclosures. Cockrell is an AOA past president and a member of the AOA Advocacy Executive Committee. Loomis is an AOA past president.