Walmart health kiosks potential way to spread telemedicine model in Arkansas

Could HealthSpot kiosks now being used in South Carolina Walmarts letting patients virtually connect with doctors be one way that telemedicine spreads in Arkansas? That was a subject discussed in a Tuesday (Dec. 8) meeting of the State Medical Board Telemedicine Advisory Committee.

Michael Lindsey, Wal-Mart’s director of public affairs, said the kiosks let customers establish an audiovisual connection with a South Carolina-based doctor in realtime over the Internet. A medical assistant at the kiosk helps facilitate the visit by helping with equipment such as a stethoscope.

The committee is preparing recommendations for the State Medical Board for the use of telemedicine in Arkansas. Under one model used elsewhere in the country, companies like Teladoc provide an employee benefit where, after providing a medical history, patients can visit a doctor they have not met about minor health issues by using a telephone and online tools such as photos and video. Patients pay a $40 fee per visit that can be applied to their insurance deductibles.

Under Arkansas regulations and a law passed by the Legislature this year, patients cannot be treated virtually unless they have already had an in-person visit with that doctor. The law also defines telemedicine services as those occurring through two-way audiovisual means. Teladoc says its model is available in 49 states but not Arkansas.

The law, however, included a provision that allows the Arkansas State Medical Board to broaden the definition of telemedicine and the times it can be used.

Committee members on Monday agreed that doctors and patients must be able to communicate through audio and visual means in real time, meaning they would need to have a video conversation. Medical providers should have available appropriate peripherals, though they declined to try to specify what those are, and should engage in appropriate follow-up care. The committee is relying on policies adopted by the American Medical Association. They will present those policies as well as their own to the State Medical Board.

During the committee’s previous meeting, Sen. Cecile Bledsoe, R-Rogers, who sponsored the law passed this year, Rep. Michelle Gray, R-Melbourne, Sen. Missy Irvin, R-Mountain View, and Rep. Deborah Ferguson, D-West Memphis, expressed concerns about the Teladoc model. On Monday, Rep. Dan Sullivan, R-Jonesboro, presented a letter signed by more supportive legislators and spoke before the committee. 

“We needed innovation. In California, they were working on driverless cars, and when California over-regulated them, those folks moved to Texas,” he said afterwards.

Sixteen businesses and organizations sent a letter to the committee dated Dec. 7 offering support for the telemedicine concept and adding, “certain requirements such as the in-person establishment of the patient-physician relationship, use of a site presenter, and narrow definitions of acceptable technologies diminish that opportunity and stifle innovative efforts to bring care to every corner of the state.” Signers included representatives from J.B. Hunt Transport, America’s Car Mart, the Arkansas State Chamber of Commerce and the Arkansas Trucking Association.

Julie Rautio, a consultant who works with Teladoc, was encouraged by the meeting.

“It sounds like the board is moving in the direction of allowing the relationship between patient and physician to be established using telemedicine,” she said.

She said Idaho also requires an audiovisual connection, and Teladoc is able to operate there.

Rep. Stephen Magie, D-Conway, a member of the committee and an ophthalmologist, said he practices telemedicine in concert with other offices and makes clinical decisions that way. He said he would be uncomfortable with any doctor-patient visit that does not involve an established personal relationship.

“I think you have to have established relationships with doctors. That’s for the safety of the patients,” he said afterwards.

David Wroten with the Arkansas Medical Society, said telemedicine is not new and doctors already provide telemedicine services for their patients.

“The question is, what does it take to establish a doctor-patient relationship? It’s an important relationship,” he said. “It has legal, ethical, moral implications, and I think most of us, most of the physicians in the Medical Society, think that doctor-patient relationship needs to begin by seeing that patient. Certainly not over the telephone.”