Every once in a while there comes a moment in one’s career that inspires reflection. For me, as I begin my year as NCMB President, this is one of those rare moments. I started my career many years ago at Duke University sitting on the steps of what was then a brand new hospital overwhelmed with the possibilities and, at the same time, excited about the future of medicine and my life as a physician. I was humbled when I realized I was one of the first students to enter the doors of the magnificent new building. The emotions I felt then, I feel now as I rise to lead the Board during a challenging and transformative time in medicine.
Medicine is entering a new frontier of healthcare delivery. We are transitioning from volume-based to value-based healthcare, spurred by the expansion of telemedicine, the rise of innovations such as 3-D printing and robotics and consumer technologies including smartphones and other mobile devices. It is difficult to conceive how dramatically medicine has changed since 1859, when the North Carolina Medical Board was established. Yet amid all of the changes, the mission of the Medical Board has remained the same: to regulate medicine and surgery for the benefit and protection of the people of North Carolina. Patient safety is and will remain at the center of every important policy decision.
A new era requires new and innovative strategies, and the NCMB is committed to developing them. In September 2014, the NCMB took its first step by participating in a strategic planning retreat. Board Members and staff, with the help of an independent moderator, reviewed the NCMB’s organizational structure and Board governance to help ensure that we are optimally positioned to meet future challenges. Fortunately, we have a strong foundation upon which to build. For their prior contributions, I wish to thank the many leaders in North Carolina who have guided the NCMB with vision, dedication and strength, including recent past Board presidents, Drs. Janice Huff, Ralph Loomis, Will Walker and Paul Camnitz.
Dr. Camnitz, the Board’s immediate Past President, devoted his final President’s Message (A Medical Board of action: How the NCMB works to anticipate and address challenges in medicine, Forum, Fall 2014) to discussion of the many ways the Board has become a more proactive organization. The ability to identify emerging issues and act swiftly to find solutions is essential to any organization that hopes to remain relevant. The Board’s recent policy work on telemedicine is a prime example – one that, I believe, demonstrates the NCMB’s ability to successfully navigate the challenges of the changing healthcare marketplace.
The NCMB and telemedicine
The ways in which medical care is delivered has evolved over time. In the mid-19th century, when the NCMB was established, it was customary for patients to receive medical care at home. By the early 20th century, during the post-industrial era, the pendulum swung away from house calls and patients began seeking services outside of their homes as access to medical care and the types of medical care services expanded. This model has remained in place, with few exceptions, for the better part of the last one hundred years.
In the 21st century, patients are seeking immediate and convenient access to care. This trend can be seen in the rapid rise of retail medical clinics set in superstores and pharmacy chains over the past decade, and it is evident today in the momentum driving expansions in telemedicine and wearable technologies. The Board has an inherent interest in telemedicine, as it does in any process change in health care that directly impacts the delivery of patient care. The NCMB has a responsibility to patients to take steps to ensure that telemedicine practiced in our state, meets accepted standards of care and patient safety.
The most direct way the Board has influenced telemedicine in North Carolina is through its position statements on Telemedicine and on Contact with Patients Before Prescribing. After a comprehensive review, the Board adopted revised versions of both position statements at its November meeting. The review process included months of consultation with stakeholders including our licensees, professional groups and telemedicine industry representatives. The latest versions maintain the Board expectation that any care provided to patients in North Carolina must conform to the accepted and prevailing standards of the applicable specialty area of practice, regardless of how care is delivered. In other words, there is no separate standard of care for telemedicine. Revisions to the prescribing position statement address the important question of whether “contact” with the patient must always occur via an in-person encounter. The new version of the position statement makes clear that it need not, as long as sufficient clinical information upon which to base diagnostic and treatment decisions is obtained. Read the full texts of both of these position statements starting on p. 7.
The relationship between medical regulators and the telemedicine industry has never been comfortable. Some industry groups see medical boards, at best, as old fashioned in their attitudes towards telemedicine and, at worst, as outright obstructionists. However, this is simply not the case in North Carolina. The Board has never spoken out against telemedicine. Its priority has always been, as a 2011 Forum article by my colleague Janice Huff, MD, pointed out, to keep the emphasis on medicine in telemedicine. I respectfully submit that it is not old-fashioned to remain faithful to the NCMB’s mission – it is principled.
The NCMB is primarily concerned with the recent trend towards using telemedicine as a delivery system for primary care, which is without question the most active
segment of the industry. This broader use of telemedicine represents a significant change to our current healthcare delivery system. As with any change, it is prudent to proceed carefully. I am proud of the open, inclusive process the Board used to consider changes to its policies regarding telemedicine and believe the resulting revisions provide meaningful guidance to licensees.
At the end of the day, the NCMB is committed to ensuring the people of North Carolina have access to quality healthcare. We will continually review our processes to ensure transparency and opportunity for North Carolinians to have a voice in the formulation of policies that enable the Board to fulfill its obligation to protect patients.
The tasks that lie ahead may at times seem overwhelming, but I and my colleagues on the Board are excited about the possibilities and look forward to this new era in healthcare delivery.
Cheryl Walker-McGill, MD