AOA spearheads conditions for evolution of telemedicine technology

Prepared to embrace head-on the rapid rise of telehealth-based care in optometry, the AOA Board of Trustees spearheaded a newly revised, agenda-setting position statement on telemedicine’s role in optometry.

The new position statement replaces the board’s 2017 policy statement and represents a yearlong look by the AOA Telehealth Council and input from leaders in eye and vision care, artificial intelligence, telehealth platforms and doctors. The new position paper includes AOA’s stance on telemedicine, criteria for ensuring high-quality telemedicine in optometry, legal and privacy considerations, a section on the essentialness of the doctor-patient relationship, as well as reaffirmation of the in-person, comprehensive eye exam as optometry’s “gold standard” of care.

“In-person, comprehensive eye exams will continue to be the gold standard,” says Teri K. Geist, O.D., board liaison to the Telehealth Council. “However, for the sake of our patients, doctors of optometry must take an active role in the evolution of telemedicine technology and use.

“That means we help define how this technology-based care is optimally developed and implemented,” says Dr. Geist, who thanked the council for its work. “Then we must embrace improved patient access and outcomes, while fighting against care that is substandard and puts patients at risk.”

Key excerpts from the position statement:

• Where the AOA stands on telemedicine. “The AOA supports the appropriate use of telemedicine in optometry to access high-value, high-quality eye, health and vision care. Telemedicine in optometry can serve to expand patient access to care, improve coordination of care, and enhance communication among all health care practitioners involved in the care of a patient. The AOA supports coverage of and fair and equitable reimbursement for telemedicine in optometry.”
  
  
• Uncompromising standard of care. “The standard of care for eye, health and vision services must remain the same regardless of whether services are provided in-person, remotely via telehealth, or through any combination thereof. Doctors may not waive this obligation or require patients to waive their right to receive the standard of care.”
  
  
• Appropriate uses. “The use of remote patient monitoring may be appropriate for data acquisition, patient communication, confirmation of expected therapeutic results, confirmation of stability or homeostasis, and assessing changes in previously diagnosed chronic conditions.”
  
  
• Doctor-patient relationship and direct-to-patient technology. “Use of direct-to-patient eye and vision health applications (including online vision tests and other mobile eye and vision-related applications) does not constitute telemedicine in optometry unless used under the direction of a doctor of optometry.”
  
  
• Established doctor-patient relationship. “Fundamental elements of the doctor-patient relationship must be established and maintained. Physicians must act as advocates on behalf of the patient and are obligated to discuss necessary and appropriate treatment alternatives, and in good faith to fully inform the patient of all treatment options.”

Read the full 2020 position statement on telemedicine.

How to use the policy statement

Christopher Quinn, O.D., telehealth council chair, calls the statement a guide for doctors of optometry and others.

“A significant amount of work went into the project of the last year,” Dr. Quinn says. “The policy is the result of insightful work by the council’s members, the industry partners who provided input, the AOA staff and AOA leadership provided by Drs. Jacqueline Bowen and Geist. Following our face-to-face industry listening sessions in the spring, the council met multiple times in an iterative process to consider these important changes, many of which are informed by our collective real-life experiences during the COVID-19 pandemic.

“We hope doctors will use the policy to guide their decisions about the delivery of clinical care through telemedicine,” he says. “Always keeping the best interest of patients in mind and understanding their responsibility to provide quality care that is compliant with laws and ethical obligations will guide their decision-making.”

View a case study by the AOA Ethics and Values Committee on ethically incorporating telehealth/telemedicine services into your practice.