Siv NEJM Group cov ntaub ntawv thiab cov kev pabcuam los npaj los ua tus kws kho mob, sau cov kev paub, coj lub koom haum saib xyuas kev noj qab haus huv thiab txhawb nqa koj txoj haujlwm.
Thaum lub sijhawm Covid-19 kis thoob qhov txhia chaw, kev loj hlob sai ntawm telemedicine tau rov tsom mus rau kev saib xyuas tshiab ntawm kev sib cav txog cov kws kho mob daim ntawv tso cai.Ua ntej muaj kev sib kis, xeev feem ntau tau tso cai rau cov kws kho mob raws li txoj cai tau teev tseg hauv txhua lub xeev Txoj Cai Kho Mob, uas tau teev tseg tias cov kws kho mob yuav tsum tau ntawv tso cai hauv lub xeev uas tus neeg mob nyob.Rau cov kws kho mob uas xav siv telemedicine los kho cov neeg mob sab nraud ntawm lub xeev, qhov kev xav tau no ua rau muaj kev cuam tshuam loj rau kev tswj hwm thiab nyiaj txiag rau lawv.
Nyob rau theem pib ntawm kev sib kis, ntau yam kev tso cai cuam tshuam txog cov teeb meem raug tshem tawm.Ntau lub xeev tau tshaj tawm cov nqe lus ib ntus uas lees paub cov ntawv tso cai kho mob tawm hauv lub xeev.1 Ntawm tsoom fwv teb chaws, Medicare thiab Medicaid Services tau zam ib ntus Medicare cov cai kom tau txais daim ntawv tso cai kws kho mob hauv tus neeg mob lub xeev.2 Cov kev hloov pauv ib ntus no tau ua rau muaj kev saib xyuas ntau tus neeg mob tau txais los ntawm telemedicine thaum lub sijhawm Covid-19 kis thoob qhov txhia chaw.
Qee cov kws kho mob, cov kws tshawb fawb, thiab cov neeg tsim txoj cai ntseeg tias kev txhim kho ntawm telemedicine yog qhov ci ntsa iab ntawm kev cia siab rau kev sib kis, thiab Congress tab tom txiav txim siab ntau daim nqi los txhawb kev siv telemedicine.Peb ntseeg tias kev hloov pauv daim ntawv tso cai yuav yog tus yuam sij rau kev siv cov kev pabcuam no.
Txawm hais tias cov xeev tau tuav txoj cai los siv daim ntawv tso cai kho mob txij li xyoo 1800s lig, kev txhim kho cov kab ke kev noj qab haus huv hauv tebchaws thiab cheeb tsam loj thiab kev siv xov tooj ntau ntxiv tau nthuav dav cov kev lag luam kev noj qab haus huv dhau ntawm lub teb chaws ciam teb.Qee zaum, cov txheej txheem hauv xeev tsis ua raws li kev xav.Peb tau hnov cov dab neeg hais txog cov neeg mob uas tsav tsheb ob peb mais hla lub xeev txoj kab los koom nrog hauv kev saib xyuas thawj zaug hauv telemedicine los ntawm lawv lub tsheb.Cov neeg mob no tsis tuaj yeem koom nrog tib lub sijhawm teem sijhawm hauv tsev vim tias lawv tus kws kho mob tsis muaj ntawv tso cai nyob hauv qhov chaw nyob.
Tau ntev, tib neeg kuj tau txhawj xeeb tias Lub Xeev Lub Chaw Tso Cai Tso Cai tau saib xyuas ntau dhau los tiv thaiv nws cov tswv cuab los ntawm kev sib tw, tsis yog ua haujlwm rau pej xeem.Xyoo 2014, Tsoom Fwv Teb Chaws Kev Lag Luam tau ua tiav foob rau North Carolina Pawg Neeg Saib Xyuas Kev Kho Hniav, sib cav hais tias Pawg Neeg Saib Xyuas txoj cai txwv tsis pub cov kws kho hniav los ntawm kev muab cov kev pabcuam ntxuav hniav dawb ua txhaum txoj cai tiv thaiv kev ntseeg.Tom qab ntawd, qhov teeb meem ntawm Tsev Hais Plaub Siab tau raug foob hauv Texas los tawm tsam cov cai tso cai txwv tsis pub siv telemedicine hauv lub xeev.
Tsis tas li ntawd, Txoj Cai Lij Choj muab tseem ceeb rau tsoomfwv tseem ceeb, raws li lub xeev txoj cai lij choj uas cuam tshuam nrog kev lag luam hauv xeev.Congress tau ua qee yam kev zam rau lub xeev?Muaj ntawv tso cai tshwj xeeb, tshwj xeeb tshaj yog nyob rau hauv tsoom fwv cov kev pab cuam noj qab haus huv.Piv txwv li, VA Lub Hom Phiaj Txoj Cai ntawm 2018 xav kom cov xeev tso cai rau cov kws kho mob sab nraud los xyaum siv telemedicine hauv Veterans Affairs (VA) system.Txoj kev loj hlob ntawm interstate telemedicine muab lwm lub sijhawm rau tsoomfwv los cuam tshuam.
Tsawg kawg yog plaub hom kev hloov kho tau raug npaj los yog qhia los txhawb kev sib tham hauv xov tooj.Thawj txoj kev tsim los ntawm lub xeev daim ntawv tso cai kho mob tam sim no, tab sis ua kom yooj yim rau cov kws kho mob kom tau txais daim ntawv tso cai tawm hauv lub xeev.Daim ntawv cog lus daim ntawv tso cai kho mob interstate tau ua tiav xyoo 2017. Nws yog kev pom zoo ntawm 28 lub xeev thiab Guam txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau kho mob yog kev pom zoo sib koom ua ke ntawm 28 lub xeev thiab Guam.Tom qab them tus nqi $ 700 franchise, cov kws kho mob tuaj yeem tau txais daim ntawv tso cai los ntawm lwm lub tebchaws uas koom nrog, nrog rau cov nqi txij li $ 75 hauv Alabama lossis Wisconsin txog $ 790 hauv Maryland.Raws li lub Peb Hlis 2020, tsuas yog 2,591 (0.4%) ntawm cov kws kho mob hauv cov xeev uas koom nrog tau siv daim ntawv cog lus kom tau txais daim ntawv tso cai hauv lwm lub xeev.Congress tuaj yeem dhau txoj cai lij choj los txhawb cov xeev ntxiv kom koom nrog daim ntawv cog lus.Txawm hais tias qhov kev siv tus nqi ntawm qhov system tau qis dua, kev nthuav dav daim ntawv cog lus rau txhua lub xeev, txo cov nqi thiab kev tswj hwm lub nra, thiab kev tshaj tawm zoo dua tuaj yeem ua rau muaj kev nkag mus ntau dua.
Lwm txoj cai xaiv yog los txhawb kom muaj kev sib raug zoo, raws li cov xeev tau lees paub cov ntawv tso cai tawm ntawm lub xeev.Congress tau tso cai rau cov kws kho mob ua haujlwm hauv VA system kom tau txais kev sib koom ua ke, thiab thaum muaj kev sib kis, feem ntau lub xeev tau ua raws li cov cai sib txawv ib ntus.Hauv xyoo 2013, tsoomfwv txoj cai lij choj tau hais kom muaj kev ua haujlwm ruaj khov ntawm kev sib raug zoo hauv Medicare txoj kev npaj.3
Txoj kev thib peb yog kev xyaum tshuaj raws li qhov chaw ntawm tus kws kho mob es tsis yog qhov chaw ntawm tus neeg mob.Raws li National Defense Authorization Act of 2012, cov kws kho mob uas muab kev saib xyuas raws li TriCare (Military Health Program) tsuas yog yuav tsum tau ntawv tso cai nyob hauv lub xeev uas lawv nyob, thiab txoj cai no tso cai rau kev coj noj coj ua hauv xeev.Senators Ted Cruz (R-TX) thiab Martha Blackburn (R-TN) tsis ntev los no tau qhia txog "Equal Access to Medical Services Act", uas yuav siv cov qauv no ib ntus rau kev coj noj coj ua hauv tebchaws.
Lub tswv yim kawg –?Thiab cov ncauj lus kom ntxaws tshaj plaws ntawm cov lus pom zoo sib tham - tsoomfwv daim ntawv tso cai ua haujlwm yuav raug siv.Hauv xyoo 2012, Senator Tom Udall (D-NM) tau thov (tab sis tsis tau qhia tawm) ib daim nqi los tsim cov txheej txheem kev tso cai serial.Nyob rau hauv cov qauv no, cov kws kho mob xav nyob rau hauv interstate xyaum yuav tsum tau thov rau lub xeev daim ntawv tso cai ntxiv rau lub xeev daim ntawv tso cai4.
Txawm hais tias nws yog qhov xav tau los txiav txim siab txog ib daim ntawv tso cai ntawm tsoomfwv, txoj cai no yuav ua tsis tau vim nws tsis quav ntsej txog ntau tshaj li ib puas xyoo ntawm lub xeev cov ntawv tso cai.Pawg neeg kuj tseem ua lub luag haujlwm tseem ceeb hauv kev qhuab qhia, ua rau ntau txhiab tus kws kho mob txhua xyoo.5 Kev hloov mus rau tsoomfwv daim ntawv tso cai yuav ua rau lub xeev txoj kev qhuab ntuas tsis zoo.Tsis tas li ntawd, cov kws kho mob thiab cov kws kho mob hauv xeev uas feem ntau muab kev saib xyuas ntsej muag muaj kev txaus siab rau kev tswj hwm lub xeev cov ntawv tso cai los txwv kev sib tw los ntawm cov kws kho mob sab nraud, thiab lawv tuaj yeem sim ua kom tsis zoo li kev hloov kho.Kev muab cov ntawv tso cai kho mob raws li qhov chaw ntawm tus kws kho mob yog ib qho kev daws teeb meem ntse, tab sis nws kuj nyuaj rau cov txheej txheem ntev uas tswj xyuas kev kho mob.Kev hloov kho lub tswv yim raws li qhov chaw yuav ua rau muaj teeb meem rau pawg thawj coj?Kev qhuab ntuas thiab kev ua haujlwm.Kev hwm rau kev hloov kho hauv tebchaws Yog li ntawd, keeb kwm kev tswj hwm ntawm daim ntawv tso cai yuav yog txoj hauv kev zoo tshaj plaws rau yav tom ntej.
Nyob rau tib lub sijhawm, nws zoo li lub tswv yim tsis muaj txiaj ntsig los cia siab tias cov xeev yuav tsum nqis tes ua ntawm lawv tus kheej kom nthuav dav cov kev xaiv rau kev tso cai tawm ntawm lub xeev.Ntawm cov kws kho mob hauv cov tebchaws uas koom nrog, kev siv cov ntawv cog lus hauv lub xeev tsis tshua muaj, qhia tias kev tswj hwm thiab nyiaj txiag cuam tshuam tuaj yeem cuam tshuam kev cuam tshuam hauv lub xeev telemedicine.Xav txog kev tawm tsam sab hauv, nws tsis zoo li tias cov xeev yuav tsim cai lij choj kev sib raug zoo ntawm lawv tus kheej.
Tej zaum lub tswv yim zoo tshaj plaws yog siv tsoomfwv cov cai los txhawb kom muaj kev sib raug zoo.Congress tuaj yeem xav tau kev tso cai rau kev sib raug zoo hauv cov ntsiab lus ntawm lwm qhov kev pabcuam tseemfwv qibsiab, Medicare, raws li txoj cai dhau los tswj cov kws kho mob hauv VA system thiab TriCare.Tsuav lawv muaj daim ntawv tso cai kho mob siv tau, lawv tuaj yeem tso cai rau cov kws kho mob los muab kev pabcuam telemedicine rau cov neeg tau txais txiaj ntsig Medicare hauv txhua lub xeev.Ib txoj cai zoo li no yuav ua rau kom nrawm dhau ntawm lub teb chaws txoj cai lij choj ntawm kev sib raug zoo, uas tseem yuav cuam tshuam rau cov neeg mob uas siv lwm hom ntawv pov hwm.
Covid-19 kev kis thoob qhov txhia chaw tau tsa cov lus nug txog qhov muaj txiaj ntsig ntawm daim ntawv tso cai uas twb muaj lawm, thiab nws tau dhau los ua qhov tseeb tias cov tshuab uas cia siab rau kev kho mob yog tsim nyog rau lub kaw lus tshiab.Cov qauv muaj peev xwm nthuav dav, thiab qib kev hloov pauv cuam tshuam los ntawm kev nce ntxiv mus rau kev faib tawm.Peb ntseeg hais tias tsim kom muaj cov ntawv tso cai hauv tebchaws uas twb muaj lawm, tab sis kev txhawb nqa kev sib raug zoo ntawm cov teb chaws yog txoj hauv kev tiag tiag rau pem hauv ntej.
Los ntawm Harvard Tsev Kawm Ntawv Kho Mob thiab Beth Israel Deaconess Medical Center (AM), thiab Tufts University School of Medicine (AN) -?Ob leeg nyob hauv Boston;thiab Duke University School of Law (BR) hauv Durham, North Carolina.
1. Lub koom haum ntawm National Medical Councils.Tebchaws Asmeskas thiab thaj chaw tau hloov kho lawv tus kws kho mob daim ntawv tso cai raws li COVID-19.Lub Ob Hlis 1, 2021 (https://www.fsmb.org/siteassets/advocacy/pdf/state-emergency-declarations-licensures-requirementscovid-19.pdf).
2. Kev tuav pov hwm kho mob thiab chaw pab kho mob.Daim pam tshaj tawm xwm txheej ceev rau COVID-19 rau cov kws kho mob raug zam.Lub Kaum Ob Hlis 1, 2020 (https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf).
3. 2013 TELE-MED Act, HR 3077, Satoshi 113. (2013-2014) (https://www.congress.gov/bill/113th-congress/house-bill/3077).
4. Cov neeg txhawb nqa ntawm Norman J. Telemedicine tau siv zog tshiab rau kev tso cai tus kws kho mob ua haujlwm hla lub xeev ciam teb.New York: Tsoom Fwv Teb Chaws Fund, Lub Ib Hlis 31, 2012 (https://www.commonwealthfund.org/publications/newsletter-article/telemedicine-supporters-launch-new-effort-doctor-licensing-across).
5. Lub koom haum ntawm National Medical Councils.US Medical Regulatory Trends and Actions, 2018. Kaum Ob Hlis 3, 2018 (https://www.fsmb.org/siteassets/advocacy/publications/us-medical-regulatory-trends-actions.pdf).
Post lub sij hawm: Mar-01-2021