Gwiritsani ntchito zidziwitso ndi ntchito za NEJM Gulu kukonzekera kukhala dokotala, kudzikundikira chidziwitso, kutsogolera bungwe lazaumoyo ndikulimbikitsa chitukuko cha ntchito yanu.
Panthawi ya mliri wa Covid-19, kukwera kwachangu kwa telemedicine kwasinthanso chidwi chatsopano pamkangano wokhudza chilolezo cha madokotala.Mliriwu usanachitike, mayiko nthawi zambiri ankapereka ziphaso kwa madotolo potengera mfundo zomwe zafotokozedwa m'boma lililonse la Medical Practice Act, zomwe zimati madokotala ayenera kukhala ndi zilolezo m'boma lomwe wodwalayo ali.Kwa madotolo omwe akufuna kugwiritsa ntchito telemedicine kuchiza odwala kunja kwa boma, izi zimawabweretsera zopinga zazikulu pakuwongolera komanso zachuma.
Kumayambiriro kwa mliriwu, zopinga zambiri zokhudzana ndi chilolezo zidachotsedwa.Maiko ambiri apereka zidziwitso kwakanthawi zomwe zimazindikira zilolezo zachipatala zakunja.1 Ku federal level, Medicare ndi Medicaid Services achotsa kwakanthawi zofunikira za Medicare kuti apeze chilolezo chachipatala m'boma la wodwalayo.2 Kusintha kwakanthawi kumeneku kudapangitsa chisamaliro chomwe odwala ambiri adalandira kudzera pa telemedicine panthawi ya mliri wa Covid-19.
Madotolo ena, akatswiri, komanso opanga mfundo amakhulupirira kuti kutukuka kwa telemedicine ndi chiyembekezo cha mliriwu, ndipo Congress ikulingalira za ngongole zambiri zolimbikitsa kugwiritsa ntchito telemedicine.Tikukhulupirira kuti kusintha kwamalayisensi kudzakhala chinsinsi chowonjezera kugwiritsa ntchito mautumikiwa.
Ngakhale kuti mayiko akhala ndi ufulu wochita zilolezo zachipatala kuyambira kumapeto kwa zaka za m'ma 1800, chitukuko cha machitidwe akuluakulu a zaumoyo m'mayiko ndi m'madera komanso kuwonjezeka kwa kugwiritsa ntchito telemedicine kwakulitsa kukula kwa msika wa chisamaliro chaumoyo kupitirira malire a dziko.Nthawi zina, machitidwe a boma samagwirizana ndi nzeru.Tamva nkhani za odwala omwe adayenda mtunda wa makilomita angapo kudutsa mzere wa boma kuti achite nawo maulendo oyendera telemedicine kuchokera pamagalimoto awo.Odwalawa sangathe kutenga nawo mbali pa nthawi yokumana kunyumba chifukwa dokotala wawo alibe chilolezo m'malo okhala.
Kwa nthawi yayitali, anthu akhala akuda nkhawa kuti State Licensing Commission ikuyang'ana kwambiri kuteteza mamembala ake ku mpikisano, osati kutumikira zofuna za anthu.Mu 2014, bungwe la Federal Trade Commission lidazenga mlandu ku North Carolina Board of Dental Inspectors, ponena kuti chiletso chosasunthika cha Komiti choletsa osakhala mano kuti apereke ntchito zoyera ndikuphwanya malamulo oletsa kukhulupilira.Pambuyo pake, mlandu wa Khothi Lalikululi udaperekedwa ku Texas kukatsutsa malamulo oletsa kugwiritsa ntchito telemedicine m'boma.
Kuphatikiza apo, Constitution imapatsa boma la federal patsogolo, malinga ndi malamulo a boma omwe amasokoneza malonda apakati.Kongeresi yapanga zosiyana ndi boma?Ulamuliro womwe uli ndi chilolezo, makamaka m'mapulogalamu azaumoyo a federal.Mwachitsanzo, lamulo la VA Mission Act la 2018 limafuna kuti mayiko azilola asing'anga omwe akuchokera kunja kuti azigwira ntchito pa telemedicine mkati mwa dongosolo la Veterans Affairs (VA).Kupangidwa kwa interstate telemedicine kumapereka mwayi wina kuti boma la federal lilowererepo.
Pafupifupi mitundu inayi yosintha yaperekedwa kapena kuyambitsidwa kuti ilimbikitse interstate telemedicine.Njira yoyamba imamanga pa ndondomeko ya chilolezo chachipatala cha boma, koma zimapangitsa kuti madokotala azitha kupeza zilolezo kunja kwa boma.Mgwirizano wa chilolezo chachipatala pakati pa mayiko unakhazikitsidwa mu 2017. Ndi mgwirizano pakati pa mayiko 28 ndi Guam kuti afulumizitse ndondomeko ya chikhalidwe ya madokotala kupeza zilolezo za boma (onani mapu).Atalipira chindapusa cha $700, madotolo atha kupeza zilolezo kuchokera kumayiko ena omwe akutenga nawo gawo, ndi chindapusa kuyambira $75 ku Alabama kapena Wisconsin mpaka $790 ku Maryland.Pofika pa Marichi 2020, madotolo 2,591 (0.4%) okha m'maiko omwe atenga nawo gawo adagwiritsa ntchito mgwirizanowu kuti apeze chiphaso m'boma lina.Congress ikhoza kukhazikitsa malamulo olimbikitsa mayiko otsala kuti alowe nawo mgwirizano.Ngakhale kuti kugwiritsidwa ntchito kwadongosolo kwakhala kochepa, kukulitsa mgwirizano ku mayiko onse, kuchepetsa ndalama ndi zolemetsa zoyendetsera ntchito, komanso kutsatsa kwabwinoko kungapangitse kuti anthu alowe kwambiri.
Njira ina ndikulimbikitsa kuyanjana, komwe mayiko amazindikira ziphaso zakunja.Congress yalola madotolo omwe akuchita machitidwe a VA kuti apindule nawo, ndipo panthawi ya mliriwu, mayiko ambiri adakhazikitsa kwakanthawi ndondomeko zobwezera.Mu 2013, malamulo a federal adalimbikitsa kukhazikitsidwa kokhazikika kwa kubwerezana mu dongosolo la Medicare.3
Njira yachitatu ndiyo kugwiritsa ntchito mankhwala malinga ndi malo a dokotala osati malo omwe wodwalayo ali.Malinga ndi National Defense Authorization Act ya 2012, asing'anga omwe amapereka chithandizo pansi pa TriCare (Military Health Program) amangofunika kupatsidwa zilolezo m'boma lomwe akukhala, ndipo lamuloli limalola chipatala chapakati.Aphungu a Ted Cruz (R-TX) ndi a Martha Blackburn (R-TN) posachedwapa adayambitsa "Equal Access to Medical Services Act", yomwe idzagwiritse ntchito chitsanzochi kwakanthawi kumayendedwe a telemedicine m'dziko lonselo.
Njira yomaliza -?Ndipo lingaliro latsatanetsatane kwambiri pakati pa malingaliro omwe akukambidwa mosamala - chilolezo cha federal chidzakhazikitsidwa.Mu 2012, Senator Tom Udall (D-NM) adakonza (koma osati mwadala) bilu yokhazikitsa njira yoperekera zilolezo.Muchitsanzochi, asing'anga omwe ali ndi chidwi ndi zochitika zapakati pa mayiko ayenera kufunsira laisensi ya boma kuphatikiza laisensi ya boma4.
Ngakhale kuli kosangalatsa kulingalira laisensi imodzi ya boma, ndondomeko yotereyi ikhoza kukhala yosatheka chifukwa imanyalanyaza zomwe zachitika zaka zoposa zana zamalayisensi opangidwa ndi boma.Komitiyi imagwiranso ntchito yofunika kwambiri popereka chilango, kuchitapo kanthu kwa madokotala ambirimbiri chaka chilichonse.5 Kusinthira ku dongosolo la federal licensing kungawononge mphamvu za boma.Kuonjezera apo, madokotala onse ndi mabungwe azachipatala a boma omwe makamaka amapereka chisamaliro cha maso ndi maso ali ndi chidwi chofuna kusunga ndondomeko ya chilolezo cha boma kuti achepetse mpikisano kuchokera kwa opereka chithandizo kunja kwa boma, ndipo angayese kusokoneza kusintha koteroko.Kupereka zilolezo zachipatala malinga ndi komwe dokotala ali ndi yankho lanzeru, koma kumatsutsanso dongosolo lakale lomwe limayang'anira ntchito zachipatala.Kusintha njira yotengera malo kungayambitsenso zovuta kwa gulu?Zochita zolanga ndi kuchuluka kwake.Kulemekeza kusintha kwa dziko Choncho, kulamulira mbiri ya zilolezo kungakhale njira yabwino yopitira patsogolo.
Panthawi imodzimodziyo, zikuwoneka kuti ndi njira yosagwira ntchito yoyembekezera kuti mayiko achitepo kanthu pawokha kuti awonjezere njira zopezera chilolezo kunja kwa boma.Pakati pa madotolo m'maiko omwe akutenga nawo gawo, kugwiritsa ntchito makontrakitala pakati pa mayiko ndikotsika, kuwonetsa kuti zopinga zautsogoleri ndi zachuma zitha kupitiliza kulepheretsa telemedicine yapakati.Poganizira kukana kwamkati, sizingatheke kuti mayiko akhazikitse malamulo okhazikika okha.
Mwina njira yodalirika kwambiri ndiyo kugwiritsa ntchito maulamuliro a federal kulimbikitsa kuyanjana.Congress ingafunike chilolezo kuti chibwezedwe malinga ndi pulogalamu ina ya federal, Medicare, kutengera malamulo am'mbuyomu omwe amawongolera madokotala mu VA system ndi TriCare.Malingana ngati ali ndi chilolezo chovomerezeka chachipatala, amatha kulola madokotala kuti apereke chithandizo cha telemedicine kwa opindula ndi Medicare m'dziko lililonse.Ndondomeko yotereyi ikuyenera kufulumizitsa ndime ya malamulo a dziko pa kubwerezabwereza, zomwe zidzakhudzanso odwala omwe amagwiritsa ntchito mitundu ina ya inshuwalansi.
Mliri wa Covid-19 wadzutsa mafunso okhudza kufunika kwa chiphaso chomwe chilipo, ndipo zawonekeratu kuti machitidwe omwe amadalira telemedicine ndi oyenera dongosolo latsopano.Zitsanzo zomwe zingatheke ndizochuluka, ndipo kuchuluka kwa kusintha komwe kumakhudzidwa kumachokera ku zowonjezereka mpaka kumagulu.Tikukhulupirira kuti kukhazikitsa njira yoperekera ziphaso za dziko, koma kulimbikitsa kuyanjana pakati pa mayiko ndi njira yodalirika kwambiri yopititsira patsogolo.
Kuchokera ku Harvard Medical School ndi Beth Israel Deaconess Medical Center (AM), ndi Tufts University School of Medicine (AN) -?Onse ali ku Boston;ndi Duke University School of Law (BR) ku Durham, North Carolina.
1. Bungwe la National Medical Councils.Mayiko ndi madera aku US akonzanso zofunikira za laisensi ya adotolo kutengera COVID-19.February 1, 2021 (https://www.fsmb.org/siteassets/advocacy/pdf/state-emergency-declarations-licensures-requirementscovid-19.pdf).
2. Inshuwaransi yachipatala ndi malo othandizira chithandizo chamankhwala.Chovala chodziwikiratu cha COVID-19 chaothandizira azaumoyo sichipezeka.Disembala 1, 2020 (https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf).
3. The 2013 TELE-MED Act, HR 3077, Satoshi 113. (2013-2014) (https://www.congress.gov/bill/113th-congress/house-bill/3077).
4. Othandizira a Norman J. Telemedicine apanga zoyesayesa zatsopano za ntchito yopereka chilolezo cha madokotala kudutsa malire a boma.New York: Federal Fund, January 31, 2012 (https://www.commonwealthfund.org/publications/newsletter-article/telemedicine-supporters-launch-new-effort-doctor-licensing-across).
5. Bungwe la National Medical Councils.Zomwe Zachitika ku US Medical Regulatory Trends, 2018. December 3, 2018 (https://www.fsmb.org/siteassets/advocacy/publications/us-medical-regulatory-trends-actions.pdf).
Nthawi yotumiza: Mar-01-2021