Telemedicine, where medical services are delivered at a distance, has the potential to revolutionize the ways in which many people receive healthcare services.

Some medical services may be provided remotely, via telemedicine, as doctors and patients experience the many benefits offered by telemedicine.

For example, injured workers in remote areas (such as on offshore drilling platforms or remote pipeline building sites) may be able to access routine healthcare services through the use of phone contact and teleconferencing. Rural emergency departments can use telemedicine to confer by video with specialists from major hospitals when specialized care is needed in a hurry.

The main obstacles to wider implementation of telemedicine in the United States are not technological, because the technology already exists to provide these services. However, legislative and legal considerations have slowed the expansion of telemedicine as providers, insurers, and government agencies grapple with issues like:

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• Different state licensure requirements for healthcare providers
  
• Provision of telemedicine services across state lines
  
• Medicare, Medicaid, and private insurance reimbursement for telemedicine services
  

The provision of telemedicine services for women seeking abortions also has a complicated, if brief history, due to different state laws concerning abortion services.

How Can Telemedicine Deliver Abortion Services?

Telemedicine delivery of abortion services involves the use of an oral medication that is taken in two doses. The first dose is a drug called mifepristone, taken at a clinic or doctor’s office. Then, at home, at a prescribed time 6 to 72 hours later, a second medication called misoprostol is taken as instructed by a healthcare provider. Within four hours of taking the second drug, the abortion process proceeds, with cramps and bleeding similar to that of a heavy menstrual period. Abortions provided in this manner may be done up to 10 weeks after the woman’s last menstrual period.

With telemedicine, a woman seeking an abortion who qualifies for use of the medication engages in a video conference with a physician, who explains the steps involved in taking the medication. While this type of service still requires a woman to travel to a clinic or doctor’s office to sign informed consent forms and undergo an ultrasound to determine how far along the pregnancy is, she will not have to make a long drive to an abortion clinic located far away, as is the case for the majority of women in states that are predominantly rural.

States That Have Blocked Telemedicine Abortion Services

Abortion is a politically and emotionally charged subject, and several states have either outlawed or preventively prohibited telemedicine abortion services. One such battleground state is Iowa, where Planned Parenthood has offered telemedicine abortion services since 2008. In 2013, the Iowa Board of Medicine banned this telemedicine practice, but Planned Parenthood appealed the Board’s decision. In September of this year, the Iowa Supreme Court decided to allow Planned Parenthood of the Heartland to continue providing telemedicine abortion services for the time being. The decision was granted as a last-minute stay before the 2013 Iowa Board of Medicine ban would have gone into effect. Meanwhile, Planned Parenthood’s appeal of a district judge’s ruling that would strike down this type of telemedicine service is ongoing.

As of September 1, 2014, according to a study by the Guttmacher Institute, 15 states require that the clinician prescribing the medications used for medication-induced abortions be physically present, thereby prohibiting the type of telemedicine abortion services provided by Planned Parenthood in Iowa. These states are: Alabama, Arizona, Indiana, Kansas, Louisiana, Michigan, Mississippi, Missouri, Nebraska, North Carolina, Oklahoma, South Dakota, Tennessee, Texas, and Wisconsin.

Provision of abortion services via telemedicine is being evaluated by Planned Parenthood in the state of Iowa.

Other Sexual Health Services in Telemedicine Pilot Programs

Planned Parenthood is also initiating pilot programs in the states of Minnesota and Washington to allow provision of birth control services via telemedicine. In these pilot programs, women have an online video consultation with a healthcare provider, and if they are suitable for prescription birth control, they can order the medication, which is then shipped directly to their homes. Participants download an app for their smartphone, or register online. The consultations take approximately 15 minutes and cost $45.

This service is designed to expand access to birth control for women who live in rural areas, or who are about to run out of birth control pills and cannot get a traditional physician’s appointment in time to renew their prescriptions. The pilot programs currently do not accept insurance, although Planned Parenthood is in talks with insurers to work out ways for patients to use their insurance coverage for these telemedicine services. The pilot programs are also set to expand to include online consultations for sexually transmitted disease (STD) counseling, which will allow treatments for common STDs like chlamydia and gonorrhea to be shipped directly to patients.

Uncharted Legal Territory

Telemedicine as a whole is entering uncharted legal territory, since advances in technology far outpace changes in legislation and policy at the state and national levels. The inclusion of politically charged services, like medication-based abortion, in telemedicine services complicates the picture even more. However, in Iowa, and potentially in other states, legislatures, state medical boards, and other entities are starting to at least acknowledge telemedicine advances and deal with the legal issues surrounding them in legislatures and court systems.

Telemedicine’s application to provision of abortion services is only one small aspect of telemedicine, however. Doctors, patients, insurers, and legislators are considering the many advantages of expanded access to medical care through telemedicine, including the significant cost savings telemedicine can deliver.

Conclusion

Telemedicine is changing how medical care is delivered in the US and around the world, and in addition to teleconferencing, it includes processes that you as a patient may be totally unaware of. For example, doctors may forward digital medical images like x-rays to specialists for consultation. As lawmakers, courts, insurers, and medical practices work out the legal and financial details of telemedicine provision and reimbursement for those services, Americans can expect to have access to more telemedicine services in coming years.

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