Standards, guidelines and quality assurance mechanisms are important priority areas for the Association. The Standards and Guidelines Committee is charged with providing overall guidance in the following: identifying, overseeing, and assisting work groups that would be charged with developing individual standards and guidelines and recommending the relative priority for each specific area to the Board of Directors, reviewing existing telemedicine/telehealth standards documents that have been developed by other groups and acting on this information as appropriate, maintaining documents of telemedicine/telehealth terminology, guidance and policies that provide instructions and a framework for incorporation into specific standards that will be developed by work groups. (See documents below for completed guidelines and policy and guidance for the Committee.)

Completed ATA Standards and Guidelines 

The following Standards and Guidelines have been released by ATA. 

• Practice Guidelines for Videoconferencing-Based Telemental Health (October 2009) - These guidelines are designed to aid in the development and practice of coherent, effective, safe and sustainable telemental health practices. The guidelines focus on two-way, interactive videoconferencing as the modality by which telemental health services are provided.
• Evidence-Based Practice for Telemental Health (July 2009) - The American Telemedicine Association’s (ATA) Evidence-Based Practice for Telemental Health is designed to serve as a consensus best practice reference based on clinical empirical experience. The document is a companion document to ATA’s Practice Guidelines for Videoconferencing-Based Telemental Health, and is an educational tool to aid practitioners in meeting the practice guidelines set forth in the guidelines document for providing appropriate mental health services via telehealth technologies. The evidence-based document provides the reader with an analysis of current published literature. The evidence documents qualitative and quantitative research focused on interactive videoconferencing-based mental health services and telehealth/telemedicine. The document does not serve the purpose of outlining what should or should not be done by a mental health practitioner, but does provide reference and support for decision-making in developing and providing telemental health services. Interested practitioners and/or telehealth organizations should refer to ATA’s Practice Guidelines for Videoconferencing-Based Telemental Health for the specific methods to comply with the published standards and guidelines for telehealth and telemental health.
• Core Standards for Telemedicine Operations (February 2008) - These guidelines include the fundamental requirements to be followed in providing remote medical services, interactive patient encounters, and any other electronic communications between patients and practitioners for the purposes of health care delivery. They apply to individual practitioners, group practices, health care systems, and other providers of health related services where there are telehealth interactions between patients and service providers for the purposes of health care delivery. Administrative, clinical and technical aspects are addressed.
• Practice Guidelines for Teledermatology (December 2007)  - These guidelines, generated by special working group of experts in dermatology, technology and telemedicine in cooperation with staff from the National Institutes of Standards and Technology, have undergone a thorough consensus and rigorous review, with final approval by the ATA Board of Directors. These guidelines are designed to aid in the development and practice of coherent, effective, safe and sustainable teledermatology practices.
• Telehealth Practice Recommendations for Diabetic Retinopathy (May 2004)  - These guidelines, prepared by the American Telemedicine Association, Ocular Telehealth Special Interest Group, and the National Institutes of Standards and Technology Working Group, have undergone a thorough consensus and rigorous review, with final approval by the ATA Board of Directors. A roadmap of technical standards, clinical guidelines and administrative procedures.
• Home Telehealth Clinical Guidelines (2003) - Advances in telecommunication technologies used in health care over the last decade have expanded application possibilities. Home telehealth began with home health agencies providing virtual visits by collecting one or more personal vital signs, which were then sent to a remote monitoring station. Today, with the use of inter-active video and store and forward, applications in the home have expanded. In addition to remote monitoring of vital signs, services provided by home health agencies now include such diverse applications as hospice (palliative care), rehabilitation, case management, chronic disease management, virtual house calls, post-surgical follow-up and more. ATA has produced the Home Telehealth guideline to encompass these differences and establish a set of universal principles guiding the development and deployment of home telehealth in the future.
• Clinical Guidelines for Telepathology (May 1999)  - Prepared by ATA’s Special Interest Group on Telepathology. The concepts discussed in this document is applicable to all three types of telepathology; static (store and forward), dynamic (synchronous), and hybrid (static-dynamic) implementations.

Policy and Guidance for the Establishment of Telemedicine Standards

• Public Comment Period Guide (31 March 2009)
• Review Steps for Standards and Guidelines Documents (12 September 2008) - The Review Steps document is a guide to chair and co-chairs of standards and guidelines work groups and other interested parties that outlines the minimum requirements for review of any developing standards or guidelines documents published by ATA.
• Models for Work Groups (12 September 2008) - The purpose of this document is to provide work group chairs and members with a guide when structuring the work to be accomplished when developing standards or guidelines.
• Policy and Guidance for ATA Standards, Guidelines and Quality Assurance Initiatives (20 November 2007)
• Request Form for ATA Standards and Guidelines Initiatives (20 November 2007)
• Instructions for Completing Standards and Guidelines Request Form (20 November 2007)
• ATA Conflict of Interest Policy and Disclosure Form (20 November 2007)

Standards and Guidelines Working Groups

Special Interest Groups (SIGs) that are interested in forming a work group to develop standards and guidelines prepare a petition to submit to the Standards and Guidelines Committee. The specific area or scope of effort to be addressed by each work group is determined by consensus among the members of the SIG. The composition of each standard-setting work group is comprised of representation from clinical, industry, government and other potentially affected parties with volunteers recruited broadly from the ATA membership as well as from individuals and organizations outside of ATA. (See below Policy and Guidance for ATA Standards, Guidelines and Quality Assurance Initiatives, Instructions for Completing Standards and Guidelines Request Form, and Request Form for Standards and Guidelines Initiatives.) To join a work group, please email info@americantelemed.org.

Telemental Health - Evidence-Based Practice (Completed)

Co-Chairs:

Brian J. Grady, MD
Director, TeleMental Health
University of Maryland
Baltimore, MD
grady@telepsychiatrist.com

Kathleen Myers, MD, MPH
University of Washington School of Medicine
Child Study and Treatment Center
Seattle, WA 
kathleen.myers@seattlechildrens.org

Eve-Lynn Nelson, PhD
University of Kansas Medical Center
Kansas City, KS
enelson2@kumc.edu

Telemental Health (in progress)

Co-Chairs:

Jay H. Shore MD, MPH
Associate Professor
Veterans Rural Health Resource Center - Western Region
American Indian & Alaska Native Programs
Aurora, CO
jay.shore@uchsc.edu

Peter Yellowlees MD, MBBS, FRANZCP
Director
UC Davis Academic Information Systems
Sacramento, CA
peter.yellowlees@ucdmc.ucdavis.edu

Lisa Roberts PhD
Business Manager, Health Innovations and Grants
Bayer Healthcare
Bellvue, WA
lisa.roberts@viterion.com

Telepresenting (in progress)

Chair:

Cindy K. Leenknecht, MS, APRN-CS, CCRP
St. Vincent Healthcare/Partners in Health Telemedicine Network
Billings, MT
cindy.leenknecht@svh-mt.org

Teledermatology (Completed)

Co-Chairs:

Elizabeth A. Krupinski, PhD
Assistant Director, Program Evaluation
University of Arizona
Department of Radiology - Research
Tucson, AZ
krupinski@radiology.arizona.edu

Anne Burdick, MD, MPH
Associate Dean for Telemedicine and Clinical Outreach
Professor of Dermatology
Director, Leprosy Program
University of Miami Miller School of Medicine
Miami, FL
aburdick@med.miami.edu

Telerehabilitation (in progress)

Co-Chairs:

David Brennan, MBE
Senior Research Engineer
National Rehabilitation Hospital - Center for Applied Biomechanics and Rehabilitation Research
Washington, DC
david.m.brennan@medstar.net

Lyn Tindall
Speech Pathologist
Veterans Affairs Medical Center
Lexington, KY
lyn.tindall@va.gov

Home Telehealth and Remote Monitoring (in progress)

    Chair: TBD

Diabetic Retinopathy (in progress)

Chair:

Helen K. Li, MD
Associate Professor
University of Texas Medical Branch
Houston TX
hli@utmb.edu

Documents Open for Public Comment

• No documents are currently open for comment.

Guidelines Established By Other Organizations

• American College of Radiology (ACR) Guidelines For Electronic Medical Information Privacy and Security - These practice guidelines are designed to address privacy and security of electronic medical information for telemedicine and telehealth services.  In May 2010, the ATA board of directors approved adoption of the ACR Practice Guideline for Electronic Medical Information Privacy and Security.
• American College of Radiology Standard for Teleradiology
• American Academy of Dermatology Association Position Statement on Telemedicine (22 May 2004)
• American Psychological Association's Statement On Services By Telephone (5 November 1997)
• AMA Guidelines for Physician-Patient Electronic Communications (6 December 2004)
• Medem's eRisk Guidelines for Physician-Patient Online Communications (January 2007)
• National Institute of Standards and Technology (NIST) - The National Institute of Standards and Technology is a federal technology agency that develops and promotes measurement, standards, and technology.
• Guidelines for the Surgical Practice of Telemedicine (March 2004) - Established by the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) 
• FDA Guidances Related to Telemedicine - Information within the Food and Drug Administration related to their approval and review of telemedicine including medical imaging, software, telemetry and other subjects.

Technical Standards

• X12N - is the dominant standard for electronic commerce. The American National Standards Institute Accredited Standards Committee X12 (ASC X12) selected X12N as the standard for electronic data interchange (EDI) used in administrative and financial health care transactions (excluding retail pharmacy transactions) in compliance with the Health Insurance Portability and Accountability Act of 1996. Used for external financial transactions, financial coverage verification and insurance transactions and claims.
• Digital Imaging and Communications in Medicine - DICOM is the industry standard for transferral of radiologic images and other medical information between computers.
  HL7 is a standard for the electronic interchange of clinical, financial and administrative information among independent health care oriented computer systems; e.g., hospital information systems, clinical laboratory systems, enterprise systems and pharmacy systems.
• International Telecommunications Union (ITU) - H.320 encompasses a set of standards for narrow band visual telephone systems and terminal equipment, commonly used in interactive live video applications for telemedicine. It specifies technical requirements for narrow band visual telephone systems and terminal equipment, typically for videoconferencing and videophone services. It describes a generic system configuration consisting of a number of elements, definition of communication modes and terminal types, call control arrangements, terminal aspects and interworking requirements.
• Association for the Advancement of Medical Instrumentation has a standards program consists of over 100 technical committees and working groups that produce Standards, Recommended Practices and Technical Information Reports for many medical devices.

Nomenclature

• ATA Glossary of Terms - A list of terms and definitions that are commonly used in telemedicine/telehealth. The list was assembled for the purpose of encouraging consistency in employing these terms in ATA related documents and resource materials. The list is not all-inclusive and may be augmented by for specialty areas as deemed appropriate by ATA member groups.
• Logical Observations: Identifiers, Names, Codes - LOINC is a coding system for the electronic exchange of laboratory test results and other observations. LOINC development involved a public-private partnership comprised of several federal agencies, academia, and the vendor community. This model can be applied to other standards setting domains.
• Unified Medical Language System - The UMLS Metathesaurus is a long term research and development project of the National Library of Medicine (NLM) that began in 1986. This project develops and distributes multi-purpose, electronic "Knowledge Sources" and associated lexical programs. System developers can use the UMLS products to enhance their applications -- in systems focused on patient data, digital libraries, Web and bibliographic retrieval, natural language processing, and decision support. Researchers will find the UMLS products useful in investigating knowledge representation and retrieval questions.
• International Health Terminology Standards Development Organisation - IHTSDO oversees the strategic direction and scientific maintenance of the Systematized Nomenclature of Medicine, better known as SNOMED®.