Thinking about telemedicine? Here are some issues to consider.

Posted in Coronavirus on Monday, March 23, 2020

The landscape is quickly changing and will continue to change for the foreseeable future. A hot topic is how telemedicine is becoming more prevalent to help practices to abide with the social distancing rules while maintaining a continuity of care for patients.

However, there are issues to address before you jump in. Keep in mind that each state may have different regulations regarding what can/cannot be done via telemedicine. Review your state’s guidelines.

Our guidance is that based on your judgment and in the interest of continuity of care, please use alternative methods such as telephone and video conferencing as available. For video conferencing, please work with the vendor to ensure the software includes encryption and HIPAA compliance.

Based on your judgment, consider postponing visits of an elective or non-emergent nature if you think it is not possible to adequately evaluate the patient over telephone or video conference methods.

While rules are being relaxed, keep in mind some rules are steadfast:

• You must provide healthcare consistent with the laws of state where the patient is located. While your patient may normally be located in your state, are they visiting family out of state? Do they go south for the winter?
• Some states require a special certificate to practice telemedicine in their state. Know the rules and conditions before you start.
• A specific informed consent for telemedicine should be used, one that acknowledges you are using this vehicle to provide treatments as well as telemedicine pros and cons.
• Practices using telemedicine are held to the same standards of care as for in-person care.
  • Have some means of verifying the patient’s identity.
  • Use your generally accepted practices during a telemedicine visit, such as confirming patient history, mental status examination, physical examination, and any appropriate diagnostic or laboratory testing (if not performed in person, then by using appropriate technology or utilizing a licensed telepresenter who is with the patient). Using a simple questionnaire without an adequate examination could violate the law.
  • Ensure the availability of appropriate follow-up care.
  • Maintain a complete medical record of the patient’s care which is available to the patient and other treating health care providers.
  • Comply with special rules that apply to treating patients prescribed controlled substances for chronic pain.
• Transporting records away from the office does pose a risk. Make sure records are secure in your care so they are not confiscated during travel (be sure not to leave them in the car). You should also make sure that while you are consulting from home, you are in a HIPAA compliant area – no family members or visitors should be able to overhear, see or have access to patient records.

Information on this is evolving quickly and though we have heard that licensure requirements will be relaxed to facilitate telemedicine, we do not have concrete guidance yet. Please let us know if you have any other specific questions.