For telemedicine, the state of play in 2015 resembles this hypothetical banking scenario. As telecommunications technologies continue to transform multiple industries, medical interventions using electronic devices and interconnectivity are creatively disrupting the practice of medicine, presenting a need to rethink many of the traditional rules that were developed for in-person interactions, procedures, policies, and payment. But because medicine is largely governed by state rules, the changes are creating a patchwork of rules and standards that are difficult to follow for both practitioners and consumers.
Amidst an evolving array of regulations, entrepreneurs are trying to reshape (and, in many cases, succeeding in reshaping) the delivery of medicine by providing virtual care via phone, video, email, and combinations thereof. Guidelines are far from settled, but the body of evidence on the efficacy, safety, and cost-effectiveness of virtual care is growing. This paper will review both scientific research and policy positions regarding telemedicine and describe some of the challenges confronting practitioners and policymakers as they work to improve access to health care, improve practice protocols, and fuel further innovation in this rapidly evolving field.