Telemedicine and other health IT tools can help physician assistants be more proactive in patient care. Some of the rules need to change too, however.
Advances in technology and EHRs make some of our work easier as healthcare providers, but how does it affect the physician-physician assistant relationship? Can technology make it easier for physicians to supervise the work of their PA colleagues?
It used to be really simple when all we had were landline phones. But with the expansion of cellular service, and now videophones as well as telemedicine, it appears that medical boards face the challenges of the electronic age and what it means to the various healthcare professionals and, more importantly, to their patients.
Most state laws, and notably those in California, allow for the electronic supervision of PAs. This means as long as I have the ability to contact my supervising physician, who remains responsible for the care of the patients that I am treating, I can practice in any setting. The supervising physician doesn't even need to be in the same locale. They can be across the country or for that matter on the other side of the world. The bottom line is that I have to be able to contact them directly and immediately.
According to the American Academy of Physician Assistants, a growing number of state laws are being modified to improve a physician’s ability to extend access to care through physician-PA teams. Some states are using language that defines supervision in a broad sense and are repealing laws requiring physicians to be present at their practices for a set number of hours. State laws governing the physician-PA team should include provisions requiring physician supervision, but allowing for reasonable flexibility to permit doctors and PAs to provide patient care effectively and efficiently with consistent quality.
In previous blogs, I have offered my view on how the electronic health record has dramatically eased the administrative duties that exist in a physician-physician assistant team practice. My records are now easily and electronically countersigned by my supervising physician with a couple of clicks of the mouse. This has been one of the more dramatic and progressive steps that I have seen when it comes to improvements to the administrative burden of both physician and physician assistant.
Advances such as video telephones, the ability to text pictures, telemedicine, and others have created some HIPAA headaches in our facility as well as other U.S. facilities. It was a lot simpler when I came into the practice of medicine and all we had to deal with were fax and copy machines and landline phones. The proliferation of smartphones and digital devices has created numerous headaches for providers and healthcare facilities administering and regulating their medical and nursing staff.
The tools that I currently use to accomplish effective supervision include my cell phone, landline phones, and telemedicine, which is a part of our unit's hardware and approved by our facility's medical staff office. What I'm not able to use at this point are my video phone features and texting pictures, due to HIPAA concerns and restrictions by the hospital's administrative staff as well as legal counsel. Finding a safe and legal way to integrate these handheld devices into the routine practice of medicine is the next great challenge and the technological advancement of consulting in medicine as well as documenting the care that we provide our patients.
The dilemma is that just because we can do something doesn't necessarily mean that we should do something. Concerns and questions regarding encryption, security of the records, protecting the patient's healthcare information and images, as well as other confidentiality concerns, make this an area that requires a lot of study and research prior to implementing widespread changes to the way we share information.
On the other hand, the widespread human resource problem that we have in healthcare, which is well documented in the industry as well as on these blogs, means that we have to find new ways to leverage the resources we have into more patient care. Think about the implications to rural practice and medically underserved communities where there aren't enough specialists to go around. Telemedicine could significantly and dramatically improve the level of care that we provide underserved populations in this nation. It also would help all healthcare providers, including nurse practitioners and physician assistants, better serve their populations with access to expert consultant care.
The future is here and we need to invest time, expertise, and resources into figuring out how to better integrate technology into the practice of medicine and for improvement in the practice of medicine.
This blog was provided in partnership with the American Academy of Physician Assistants.