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Prior to the emergence and adoption of telemedicine, when your child became sick, you would start at your local pediatrician, and when it was serious, you would seek the best local specialty care, often from your local hospital. If you were lucky, your local hospital would either have a great pediatric department, or you would actually have access to a hospital that specialized in pediatric medicine. If it was complex or rare, and your local area did not have the expertise your child needed, you would need to choose between settling with the best they could offer, or seeking out the hospital with the right specialty. 

This can mean packing your family up, and traveling to get the right kind of treatment and medical expertise your child needs. You may travel to multiple facilities before finding the right expertise or desired treatment. The list of burdens and disruptions this places on families is long, from potentially exposing a child’s fragile immune system throughout the journey, to disruption of schooling, a parent’s ability to work, medical and travel costs, as well as overall continuity. This all during a time where you want to bring some level of predictability and stability back into your child’s and your family’s lives. For some families, this has meant permanently relocating. For others, traveling or moving is simply not possible, and you must settle with the best expertise accessible locally. 

Fortunately, that was then. While there is still room to grow, many children’s hospitals have recognized this need and have dramatically expanded access to care through online second opinion and consultation programs. Some of the nations top ranked children’s hospitals, from the east to west coasts, now offer online consultation services. This list includes, but is not limited to:

"Modern cancer care is all about coordinated care and access to subspecialists"
- Dr. Thomas Schwaab, Roswell Park Cancer Center

In a rural town in the United States, Jordan’s infant son, Milo, was born with a cranial abnormality. Upon medical evaluation at their local hospital, the infant was diagnosed with craniosynostosis, a congenital disorder characterized by premature fusion of cranial sutures leading to a misshapen skull and potential brain growth restriction. Milo required major surgery to address his condition, but due to the scarcity of specialized healthcare services in their region, particularly for such a complex procedure, the family could not access the necessary medical expertise. Desperate for support, Jordan researched her son's condition and located a children's hospital with a top-ranked Craniofacial surgeon. Yet, the facility was nearly one thousand miles away from their hometown, and due to financial constraints, such as the cost of transportation, lodging, and time off from work, Jordan doubted their ability to make the trip across the country for the surgical evaluation. She worried that even if they could get there, what would happen if her son was not a good candidate for the surgery? It was not a realistic option for them to visit multiple hospitals in person to receive second opinions, and she felt stuck. Jordan’s story represents the struggle of many Americans to access quality medical care for their children without facing significant geographic and financial barriers. For this reason, many families seek answers closer to home, instead of receiving care from top experts, which can reduce positive healthcare outcomes.

The following paper is intended for informational purposes only and should not be construed as legal advice. The information provided in this paper is not a substitute for professional legal advice and should not be relied upon as such. Readers should always consult with a licensed attorney or qualified legal professional for advice on specific legal issues. The author of this paper and any entities associated with the author are not responsible for any actions or decisions taken by readers based on the information provided in this paper.

In the United States, it is well established that individual states and territories, rather than the federal government, regulate the practice of medicine within their borders. That means that unless there is an exception, a provider must be licensed in the state in which the patient is located in order to deliver a medical diagnosis or to prescribe treatment to a patient in a specific jurisdiction. The licensure process is burdensome and expensive, effectively impeding all but the most determined physician from seeking this legal authority to practice beyond his or her state’s borders.

Congratulations! Your institution has considered the countless benefits of offering a Remote Second Opinion (RSO) program, such as improved patient access and increased geographic reach. Your team is undoubtedly ready to jump into planning out the best program for your patients and providers. While it can be easy and exciting to visualize your RSO program helping patients, the process of getting to your go-live date can feel overwhelming. Your team may be asking big-picture questions such as:

“How do I start a Remote Second Opinion program?”
“What stakeholders need to be involved in the RSO implementation process?”
“How long will the implementation of my RSO program take?”