Guidelines adopted for telemedicine
The Federation of State Medical Boards (FSMB), representing 70 states and territories, approved updated guidelines that constitute a model policy for the safe practice of medicine with telemedicine technology.
The model policy is only advisory. An individual state medical board may adopt the model policy, modify it, or retain its existing telemedicine standards. It is uncertain how many states will adopt the model policy in its proposed form or incorporate elements of the model policy into existing laws, regulations, and/or guidance.
This is a summary of the most significant elements of the model policy:
Physician-patient relationship.
Under the model policy, a physician practicing via telemedicine technology must maintain a proper physician-patient relationship. When rendering medical advice via telemedicine technologies, a physician should:
(1) verify and authenticate the patient’s location and identity;
(2) disclose and validate the provider’s identity and credentials;
(3) obtain appropriate consents regarding the delivery model and treatment methods. An inappropriate relationship might exist if the identity of the physician is unknown to the patient. A patient should be able to choose a physician for telemedicine services rather than be randomly assigned to one.
Licensure.
The model policy provides that a physician must be licensed by the state medical board in the jurisdiction in which the patient is located at the time the services are provided. Further, the "practice of medicine" occurs at the patient’s location, not in the state where the physician is located.
Prescriptions.
The model policy holds prescriptions issued via electronic means to the same standards as those issued in traditional patient-encounter situations. Thus, physicians practicing medicine via telemedicine technology may not circumvent face-to-face requirements or other state law requirements by relying solely upon online questionnaires completed by patients.
Informed consent.
The model policy provides prescriptive terms for appropriate informed consent regarding the use of telemedicine technologies. The American Telemedicine Association (ATA) in Washington, DC, noted that these terms create an extensive informed-consent requirement that currently does not exist when a patient sees a physician in an office setting, and that most state medical boards do not have any informed consent requirements. The ATA acknowledged that patients should be educated about telemedicine technologies. The policy is available free online at http://tinyurl.com/oj2ussv.
