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Doctors online
New changes in NH law enable telemedicine expansion

11/12/15
By Ryan Lessard news@hippopress.com



Patients in the Granite State are going to see more ways to get medical help over video chat in the coming months thanks to a new app and an expansion in the New England hospital network.

 
The changes
Two bills that were passed in the last legislative session have now taken effect. The first took effect in July and requires the Medicaid program to cover telemedicine services, which has opened it up to be used by more than 180,000 residents.
The second took effect in September and changed the definition of a practitioner-patient relationship to include “2-way real-time interactive communication.” This means patients can get an evaluation and a prescription from a doctor they find through telehealth services whom they have never met before.
“Prior to [the change], it was only allowed if there was a pre-existing face-to-face relationship with the doctor,” Anthem spokesperson Colin Manning said in a phone interview.
 
There’s an app for that
Anthem is helping to roll out a telehealth app in New Hampshire called LiveHelp Online, which is available on Android and Apple mobile platforms and is free to download. Manning says it will be the first service of its kind to launch in New Hampshire.
Folks who download the app and sign up can look through a list of available providers, mostly family doctors. When they pick a doctor, they can interact with them just as one would through Facetime or Skype.
“If you’re a parent and you’ve got children and you wake up on a Sunday night and the kid’s got a bad cough or a rash that looks a bit odd … you can get on LiveHelp Online, see a doctor right away, in the middle of the night, and they can take a look,” Manning said.
He says the video allows for the doctors to make visual assessments they wouldn’t otherwise be able to make.
Starting Jan. 1, patients with an Anthem plan pay the same co-pay they would for an in-person doctor visit while non-Anthem patients pay a flat fee, likely somewhere around $50.
According to the law, doctors on the app will not be able to prescribe controlled drugs with risk of abuse unless they are prescribers in a community mental health center who already conducted an initial in-person exam of the patient. Opioids of any kind cannot be prescribed through telemedicine unless the prescriber works at a federally certified treatment center and examined the patient in person first. Manning says since the service is not for emergencies, most of the prescriptions will likely be for antibiotics.
 
Doctors on board
So far, all the providers on the Anthem app are out-of-state but certified by the New Hampshire Board of Medicine. The doctors have the flexibility to decide how often they make themselves available through the app.
“Some of them, this has become their practice,” Manning said.
Dr. Richard Lafleur, Anthem’s medical director, says he’s been spreading the word to the state’s medical community about the service and so far hasn’t come up against any major pushback from doctors.
Dr. Ovidiu Lungulescu at Lakeview Internal Medicine in Hooksett just launched his telemedicine program two weeks ago, though none of his eligible patients have used it yet. His practice will be using the WebeX program by Cisco, and it’s only available to existing patients in his practice covered by Anthem. Lungulescu is not concerned about liability or reimbursement issues, but he does worry about technical problems and the use of low-definition cameras.
“If they want to show us a skin rash or something, I would need to have a good view of that,” Lungulescu said.
 
The network
The existing telemedicine network for hospitals and clinics is growing quickly, which is good news for patients. The more medical providers on the network, the more options for patients to connect to doctors remotely.
About 100 hospitals and clinics in New Hampshire will be interconnected with dedicated cables by the end of the year, according to New England Telemedicine Consortium Managing Agent Jim Rogers. These connections allow for high-definition video and data between hospitals and clinics and can also connect to patients via the Internet.
“We’ve got requests from New Hampshire hospitals and clinics for 106 additional sites,” Rogers said. “They’ve come in in the last [six] months.”
He says he normally sees about 100 requests in the course of a whole year.
Andrew Solomon, the project manager for the Northeast Telehealth Resource Center, says New Hampshire’s telemedicine coverage already outpaces that of most other states. The American Telemedicine Association gave New Hampshire an A grade for its telemedicine coverage in its 2015 State Telemedicine Gaps Analysis.





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