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Second Opinions

how can i give remote consults out of state?

I’m a Provider. Can I Give Consults to Patients Outside of My State?

Telehealth exploded at the start of the COVID-19 pandemic as patients and providers scrambled to find safe, effective ways to receive and deliver care remotely. While its popularity has more recently receded, it is fair to say that telehealth is now an engrained component of our healthcare delivery system.

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What's New With Expert View? Watch the latest and greatest celebrated features within Purview's market leading second opinion software

Expert View™ is used by some of the most prestigious centers of excellence across the United States to facilitate compliant online opinions to patients outside the hospital's local geography, enabling more patients access to specialized care.

Purview's Expert View™ software is most commonly used to digitize and streamline the online second opinion process, but some hospitals also use it for pre-surgical screening, peer-to-peer consultations, and other unique applications. The common thread being that through technology, specialized medical expertise can be shared faster and without burdening the patient to travel in-person, while simultaneously extending a hospital's brand to new geographies. It's a win for all involved.

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When is a patient a patient?

Hospitals and their specialist providers often raise the question: “When does a patient become ‘my patient,’” when seeking to provide medical services remotely, where the patient is in a geography that doesn’t fall within their current licensure. While this may seem like a simple question, its complexity can be determinative of a potentially complex legal issue.

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Why Having a Physician Licensed in Every Jurisdiction Doesn’t Completely Satisfy Licensure Regulations

The following is intended for informational purposes only and should not be construed as legal advice. The information provided in this post is not a substitute for professional legal advice and should not be relied upon as such. Readers should always consult with a licensed attorney or qualified legal professional for advice on specific legal issues. The author of this post and any entities associated with the author are not responsible for any actions or decisions taken by readers based on the information provided in this paper.

"If I have a physician or contract with a team of physicians licensed in every state,
does that make my remote second opinions issued anywhere legal?"

This question inevitably comes up. On its surface, you might expect that this encompassing licensure paves the way for your organization to issue remote second opinions anywhere in the country. However, a close reading of the law of each state contradicts that premise.

In order to provide a remote second opinion, a physician that is not licensed in the state in which the patient is physically located (ostensibly, one of your specialists), must either rely on an exception or exemption from that state’s licensure laws and regulations in order to legally deliver that opinion. Having another physician, not the one rendering the opinion, who is licensed in the target state, may actually not provide you with sufficient legal stature.

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Second Opinions for Children - An Interview with Dr. Jesse Skoch, Neurosurgeon at Cincinnati Children's Hospital

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:

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