The practice of telemedicine and medical informatics has important implications for state, national and international health-care policy. Advances in telecommunications have greatly expanded the opportunities for medical care and consultation at a distance. The growing use of telemedicine and the electronic availability of medical information promise benefits to patients, physicians, the health-care system, and the public. They also offer the potential for fraud and abuse; and they will alter economic arrangements in ways that cannot yet be totally predicted.

    This memorandum is to remind all interested parties, including licensed and registered physicians, that the "consultation" exemption of the Education Law (Section 6526(3)) is only intended for occasional consultation between a New York State licensed and registered physician and a physician licensed in another jurisdiction. If, however, a physician licensed in another jurisdiction wishes to engage in the practice of medicine in New York State, such physician must be licensed and registered to practice medicine in New York State. The practice of medicine is defined by Section 6521 of the Education Law: "as diagnosing, treating, operating or prescribing for any human disease, pain, injury, deformity or physical condition."

    Telemedicine has essentially been defined as the provision of medical services over geographical distances by means of modern telecommunications and computer systems. Advances in technology are rapidly expanding the use of telemedicine for swift, remote medical diagnosis and consultation. A patient's scans, X-rays, laboratory findings, or live physical examination can be transmitted via electronic networking to a distant specialist, who participates in diagnosis, decisions about treatment, and follow-up. The same technology, deployed in an integrated health-care system, has many promising uses in continuing medical education and consumer health education.

    Although the concept of telemedicine has existed since the 1970s, recent developments in technology (especially high-speed computer networking) have accelerated its growth -- a trend that will surely continue. The benefits are many. For patients, telemedicine can provide access to previously unavailable specialists and facilities. The results can be more accurate, speedier diagnosis and treatment. For physicians, telemedicine makes possible broader consultation, advancement of medical knowledge, improved medical education, and enhanced opportunities to keep up with the field through continuing education. For the public, telemedicine makes possible cost-effective, improved medical care and more widespread, interactive consumer health education. Like any new development, telemedicine poses questions for the established system of health care. How can the benefits be made widely available, while assuring the quality of professional services? What are the implications for licensure requirements, which are set by states?

    In New York, the statute is currently silent regarding New York State licensure for out-of-state medical consultants, with the exception of the previously noted "exempt" provision of Section 6526(3) of the Education Law. At present, telemedicine usually takes the form of consultation between local physicians and distant colleagues. However, distant physicians could potentially examine and treat patients without the collaboration of a local physician. As noted, Education Law (section 6526) broadly permits consultation between a physician in New York State and a physician licensed in another state or country. A physician practicing in New York State, on the other hand, must be licensed in New York State (with certain exceptions defined in the law, such as residents in postgraduate training programs). Therefore, the licensure requirement includes physicians licensed in another jurisdiction who wish to practice medicine in New York State except for an occasional consultation.

cc: Commissioner Richard Mills
Chancellor Carl T. Hayden