Does telemedicine need stricter rules for engagement?

Issue: BCMJ, vol. 56, No. 2, March 2014, Page 74 Editorials

Until recently, with very few exceptions, MSP fee compensation for a patient service was contingent on a face-to-face patient visit, regardless of whether the visit was an efficient use of time for the patient or physician. Times have evolved and MSP will now compensate physicians for limited patient services delivered by telephone. In addition, it is possible to receive MSP compensation for virtual visits via telemedicine.

Telemedicine goes a step beyond the telephone—it is a combination of telecommunication and information technology, in varying degrees of sophistication, which allows for real-time voice and visual communication between the parties involved. At its most straightforward it involves contact through a service such as Skype or FaceTime, which should be compliant with the CMPA’s legal advice and the College’s standards regarding privacy and security. A more sophisticated type of real-time telemedicine captures vital signs and oxygen saturation and uses instruments such as otoscopes, ophthalmoscopes, and electrocardiography monitors. Some of these instruments provide a magnified image with clarity that is better than in real life. Telemedicine technology may one day be able to transmit tactile response, making the virtual visit almost indistinguishable from a face-to-face visit; however, only the real-life visit will convey the personal interaction so valuable as a therapeutic tool and in the creation of a good physician-patient relationship.

The biggest challenges facing telemedicine today are not the gaps in technology but how telemedicine is applied. If telemedicine is allowed to flourish as a new form of medicine rather than as a tool that a physician chooses to optimize patient encounters, the risk is that it will become an industry in itself and lead to tele-walk-in clinics and prescription-refilling services. And depending on how remunerative it is, it could potentially draw physicians away from clinic or hospital-based work. Should we not learn from the example of walk-in clinics eroding the traditional primary care home?

In some circumstances telemedicine can provide a valuable medical service to communities with scarce physician resources, despite its diagnostic and treatment limitations. However, the question remains: How should telemedicine evolve in urban settings and how should it be funded? In my opinion, it is up to the primary care physician to determine how best to provide care in specific circumstances, be it face-to-face, by telephone, by telemedicine, or by e-mail. Telemedicine has tremendous potential value in enhancing comprehensive longitudinal care and should not result in more fragmented care. The implementation of this technology deserves a sophisticated utilization strategy. As for public funding, would it not be best for physician remuneration to be based on comprehensive patient care rather than on the modality used to service patients?

Willem R. Vroom, MD. Does telemedicine need stricter rules for engagement?. BCMJ, Vol. 56, No. 2, March, 2014, Page(s) 74 - Editorials.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit

BCMJ Guidelines for Authors

Leave a Reply