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Best practices: Setting the standards for telemedicine

By Jeff Rowe, Contributing Writer

When it comes to conducting medical proceedures, not all practices can claim the title of "best." That's why since 2004, the American Telemedicine Association (ATA) has taken an increasingly prominent role in developing and disseminating practice standards for telemedicine – for both its members and their colleagues across the medical community.

Jordana Bernard

According to Jordana Bernard, ATA's senior director of program services, "part of the mission of ATA is increasing the role of telemedicine." Consequently, it only makes sense that ATA would also be involved in ensuring that telemedicine practices are as effective as possible.

The first set of ATA telehealth guidelines, which focused on ocular telehealth clinical and administrative issues, was released in 2004 under the direction of ATA's Ocular Telehealth Special Interest Group. The next year, ATA formally etablished its Standards and Guidelines Committee (S&G). Consisting of a dozen representatives of the numerous specialties practiced by ATA members, the committee has since released 10 more documents, including "A Blueprint for Telerehabilitation Guidelines," "Expert Consensus Recommendations for Videoconferencing-Based Telepresenting" and "Practice Guidelines for Teledermatology."

If those titles don't seem to sound quite the same, it's because the S&G actually develops three different levels of documents.

As Bernard explains it, the first step in developing any guiding document consists of a comprehensive literature search to determine the level of evidence available for consideration. If there is a significant body of research, and if that research is considered sufficiently rigorous, then the S&G sets out to develop specific support guidelines. If not, however, then the committee aims either to outline a "best practice consensus" document or a white paper that provides a preliminary overview of the telemedicine specialty being considered.

Elizabeth Krupinski

While the S&G is looking for new ways to streamline the standard development process, Elizabeth Krupinski, MD, a former ATA president and currently the vice chairman of the S&G, says "the challenge is to make people aware that the standards exist and that they are useful." She points out that ATA promotes its standards documents in several ways – on the ATA website, in telemedicine journals and via a range of specialty professional groups – but it's hard to judge the impact.

That said, she's confident that as telemedicine spreads, the obstacles to raising awareness of best practices should diminish.  

 "As expertise develops," she predicts, "and the practice of telemedicine becomes more routine, providers will more easily understand the state of the art."

For the moment, however, Krupinski says, "People need to be aware that these standards exist," and she urges ATA members to "look them up, use them in your research and promote them in other professional societies."

The more the standards are used, she says, "the more readily they're going to be adopted by others."

Echoing that sentiment, Bernard says that part of the association's plan for the coming year is to develop new, more effective ways of disseminating the guidelines so that more ATA members and their colleagues can put them to good use.

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