Performance improvement activities in telemedicine may be placed into
five categories. [1] Licensing and credentialing. Telemedicine overcom
es geographical boundaries, but its reach is constrained by state laws
on licensing. Some states require a state license, whereas others gra
nt ''consultation exemptions'' for out-of-state physicians. Simple ren
ewable licenses do not guarantee quality. Potential solutions include
a national telemedicine license or license reciprocity laws for teleme
dicine. (2) Data security and privacy. Telemedicine technology raises
some security concerns. Differences in reporting requirements among st
ates complicate the issue of privacy. Storage of telemedicine consulta
tion records may help physicians document care decisions for risk mana
gement, but conventional long-term storage may not be feasible because
of cost constraints and may not be required to document the encounter
appropriately. (3) Informed consent. Potential failures in security a
nd transmission are new, and should be communicated to the patient. (4
) Peer review. Peer review findings encourage thorough, accurate, and
legible documentation. Results should be recorded by provider and must
be available during the recredentialing process. (5) Tailored perform
ance improvement initiatives. By using established principles and tech
niques, performance improvement initiatives can gather, analyze, and c
ommunicate information about the cost-effectiveness of telemedicine. T
hese performance improvement efforts are the heart of quality manageme
nt and are critical to the justification of telemedicine. Walter Reed
Telemedicine has put into effect a performance improvement plan in acc
ordance with this outline. This article describes the plan and suggest
s it as a model for other telemedicine programs.