The advancement of technology now allows physicians to administer treatment to patients located nearly anywhere in the world via videoconferencing and other telehealth technology.  While telehealth treatment is held to the same standard of care as traditional face-to-face interactions between patient and physician, institutional challenges, such as credentialing, pose difficulties for the full realization of telehealth’s potential.

Credentialing is founded on the principle that hospitals are responsible for ensuring the highest quality of care possible for patients.  Therefore, medical care facilities take steps to verify their healthcare providers’ proficiency through the collection, verification, and evaluation of data relevant to the practitioner’s professional performance.  Once a practitioner is credentialed, the hospital will take further steps to assess the practitioner’s competence in a specific area of patient care, through a process known as privileging.

Credentialing poses a potential conflict with practicing telehealth medicine because the telehealth provider may not be credentialed at the hospital in which they are providing telehealth services.  For instance, a practitioner can be located in what is referred to as a “hub” facility, or main practicing location, and administer healthcare services to patients anywhere in the country in multiple “spoke” hospitals, in just one day.  The issue then becomes, what hospital is responsible for credentialing the practitioner – the distant cite receiving the telemedicine consult or the originating cite giving the assistance? 

The contemplation of this problem has created an administrative and legal conundrum in the eyes of many. One solution to address this potential conflict, is to have a separate entity that approves credentials of telehealth care providers.  In 2001, the Joint Commission (JC), formerly known as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), introduced standards for institutional credentialing of telehealth providers.  Under these standards, a physician credentialed in any JC facility would be permitted to provide telehealth services in another JC facility.  JC allows the facility where the patient is being treated to credential the treating physician in two ways: (1) the treating facility could fully credential the physician based on their own facility’s standards; or (2) the treating facility could accept the credentials of the treating physician based on the fact that the remote institution is JC certified.  JC standards for credentialing are based on patient care, medical/clinical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.  

It is important to note that the Centers for Medicare and Medicaid Services (CMS) have indicated that a telehealth physician’s compliance with JC credentialing rules are not sufficient to ensure compliance with the Medicare “conditions of participation.”  CMS has stated that any physician who provides a “medical level of care” should be credentialed by the facility providing the care. This means that telehealth providers might be forced to be credentialed by multiple hospitals nationwide, creating an administrative challenge for hospitals and providers.