We last wrote about telemedicine in this column 15 years ago. Much has happened since then, so it’s time for a refresher on some of the legal and practical issues related to telemedicine.

Telemedicine comes in many variations. It can be a physician sitting in an office at a hospital, viewing a patient’s X-ray, laboratory tests and medical record, and discussing treatment options with the patient via video conference. It can be a telemetry unit in an ambulance relaying a patient’s heart function information to a physician in a hospital’s emergency room, enabling the physician to instruct the ambulance crew in stabilizing and caring for the patient during transportation to the hospital. It can be a midwife communicating with a distant obstetrician to manage complications that arise with a delivery of a baby in a birthing center or at home. It can be an internist at a hospital on the East Coast consulting with a physician on the West Coast who has expertise in an obscure medical condition. Outside of general medicine, video consults have been used widely and successfully in the behavioral health area.