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Although lumped together into the category of telemedicine, the law of most U.S. states and territories treatsepisodic medical consultations (physician to physician consults or remote second opinions) differently. 

Currently, 15 states and territories specifically permit an out-of-state physician to provide a consultation or second opinion directly to a local patient. An expanded number of 35 jurisdictions allow this consult to occur as long as this consult or opinion is done in conjunction with the local physician who maintains the physician -patient relationship.

Only 4 states actually prohibit these consults, leaving 15 jurisdictions silent on whether this practice is or is not permitted.

Prior to the emergence and adoption of telemedicine, when your child became sick, you would start at your local pediatrician, and when it was serious, you would seek the best local specialty care, often from your local hospital. If you were lucky, your local hospital would either have a great pediatric department, or you would actually have access to a hospital that specialized in pediatric medicine. If it was complex or rare, and your local area did not have the expertise your child needed, you would need to choose between settling with the best they could offer, or seeking out the hospital with the right specialty. 

This can mean packing your family up, and traveling to get the right kind of treatment and medical expertise your child needs. You may travel to multiple facilities before finding the right expertise or desired treatment. The list of burdens and disruptions this places on families is long, from potentially exposing a child’s fragile immune system throughout the journey, to disruption of schooling, a parent’s ability to work, medical and travel costs, as well as overall continuity. This all during a time where you want to bring some level of predictability and stability back into your child’s and your family’s lives. For some families, this has meant permanently relocating. For others, traveling or moving is simply not possible, and you must settle with the best expertise accessible locally. 

Fortunately, that was then. While there is still room to grow, many children’s hospitals have recognized this need and have dramatically expanded access to care through online second opinion and consultation programs. Some of the nations top ranked children’s hospitals, from the east to west coasts, now offer online consultation services. This list includes, but is not limited to:

"Modern cancer care is all about coordinated care and access to subspecialists"
- Dr. Thomas Schwaab, Roswell Park Cancer Center

A few weeks ago, the American Telemedicine Association (ATA) held their annual conference in San Antonio, Texas. The show floor was filled with impressive futuristic devices from augmented reality glasses, to home health monitoring technologies, big data products, and more. Executives from Microsoft and Google, Kim Swafford and Bakul Patel, took the stage together, kicking off the weekend with exciting updates and reminders of helpful features that emerged from the pandemic era, such as YouTube’s improved searchability, now including personal stories to help people learn about health conditions.  When asked ‘what’s next?,’ panelists joked about the potential for ChatGPT, Kim learning about it from her teenager, but both ultimately settled on describing the buzzword of the weekend, ‘omnichannel.’ 

Cancer continues to be the second leading cause of death, with an estimated 1.9 million new diagnoses and 609,360 cancer deaths in the United States in 2022, according to the American Cancer Society. This statistic alone is astounding, with the number - 1.9 million -rivaling the population size of our largest cities. It would be like the entire population of Philadelphia being diagnosed with cancer or nearly all of Washington, D.C. passing away from it. And we are only talking about one year.