Is it safe to receive telemedicine care from a provider in another country in the United States?

Telemedicine Across International Borders: Safety and Legal Considerations

Receiving telemedicine care from providers located in other countries is generally not safe or legally permissible in the United States due to licensing restrictions, as physician licenses do not cross international boundaries, creating significant legal and regulatory barriers. 1

Legal and Regulatory Framework

• In the United States, medical licensure is regulated at the state level, with 12 states offering special licenses for telemedicine across state lines and 6 states requiring physician registration for cross-state practice, but these provisions do not extend to international practice 1

• The American Telemedicine Association offers accreditation programs for telemedicine services that promote patient safety, transparency, and adherence to relevant laws, but these are designed for domestic practice 1

• During the COVID-19 pandemic, there was temporary relaxation of federal regulations allowing telemedicine across state lines within the US, but these provisions did not extend to international practice 1

• The TELE-MED Act proposals (introduced in 2013 and 2015) would allow providers licensed in one state to provide telemedicine to Medicare patients in different states, but this legislation has not been enacted and would not address international practice 1

Technical and Security Considerations

• Telemedicine software used for medical purposes must be validated according to state-of-the-art standards and classified as medical devices in both the US (FDA regulations) and Europe (EU Regulation 2017/745) 1

• Patient confidentiality requires secure transmission and storage of electronic data and media, which becomes more challenging across international boundaries with different data protection standards 1, 2

• Telemedicine encounters should begin with confirmation of provider and patient identities, including possible display of photo identification, which may be complicated by international differences in identification standards 1

Clinical Quality and Safety Concerns

• Without proper monitoring information, updated laboratory results, and physical assessment capabilities, televisits have limited clinical value, potentially compromising patient safety 1

• International telemedicine faces additional barriers including linguistic differences between patients and remote providers, which may lead to miscommunication and medical errors 3

• Technological limitations such as inadequate bandwidth for high-resolution images or videoconferencing may compromise diagnostic accuracy when services cross international borders 3

Ethical Considerations

• Key ethical issues in cross-border telemedicine include informed consent (87% of studies), patient privacy (78%), data protection (74%), professional liability (70%), and confidentiality (57%) 2

• International telemedicine raises questions about which country's standards of care apply and how malpractice claims would be handled 4

• Gaps exist between current legislation, service providers, and patient interaction with medical data across international boundaries 4

Potential Benefits Despite Limitations

• Telemedicine can potentially reduce travel costs and time for patients, particularly in rural or underserved areas 3, 5

• Remote consultation by subspecialty experts can improve access to care in areas with limited specialist availability 1

• Educational opportunities exist through international telemedicine as a "university without borders," facilitating knowledge exchange between providers in different countries 3

Practical Recommendations

• Patients seeking telemedicine care should prioritize providers licensed in their state or country to ensure legal compliance and recourse in case of malpractice 1

• If considering international telemedicine, patients should verify the provider's credentials, licensing status, and whether their malpractice insurance covers international practice 1, 2

• Healthcare organizations implementing telemedicine should establish clear guidelines about application, training, certification, and licensing of operators to ensure quality of care 1

• Any telemedicine solution should be properly validated according to applicable regulations before implementation 1