Telemedicine

1. Telemedicine Kenneth B Simons, MD Chair, WI MEB Chair, FSMB SMART Workgroup

2. Definitions • Telemedicine --- the practice of medicine using electronic communications, information technology or other means between a licensee in one location, and a patient in another location with or without an intervening healthcare provider. Generally, telemedicine is not an audio only, telephone conversation, e-mail/instant messaging conversation or fax. It typically involves the application of secure videoconferencing or store and forward technology to provide or support healthcare delivery by replicating the interaction of a traditional in person encounter between a provider and a patient • Telemedicine Technologies – devices and technologies enabling secure electronic communications and information exchange between a licensee in one location and a patient in another location with or without an intervening healthcare provider

3. First Principles • Welfare of patients comes first • Maintain acceptable & appropriate standards of practice • Adhere to recognized ethical codes governing medical profession • Properly supervise non-physician clinicians • Protect patient confidentiality

4. Establishing the Physician-Patient Relationship • When does it begin? • Fundamental to the provision of acceptable medical care • Physicians must recognize the obligations, responsibilities and patient rights associated with establishing and maintaining the relationship • Thus with telemedicine technologies: • Fully verify and authenticate the location and to the extent possible, the requesting patient • Disclose and validate provider’s identity and applicable credentials • Obtain appropriate consents after disclosures re: delivery models, rx methods or limitations regarding the use of telemedicine technologies

5. Licensure • A physician must be licensed by, or under the jurisdiction of, the medical board of the state where the patient is located.

6. Evaluation and Treatment of the Patient • Documented medical evaluation and history c/w patient presentation to establish dx and id underlying conditions and/or contra-indications to rx recommended/provided MUST be obtained prior to providing rx, including issuing prescriptions • Rx and consultation recommendations in an online setting will be held to the same standards as a traditional F2F (in person) setting • Rx (including issuing prescriptions) based solely on an online questionnaire does not constitute an acceptable standard of care

7. Informed Consent • Appropriately includes: • Identification of the patient, the physician and physician’s credentials • Types of transmissions permitted using telemedicine technologies • Patient agrees that the physician determines whether or not the condition being dx’d or rx’d is appropriate for telemedicine • Details on security measures taken with use of telemedicine technologies • Hold harmless clause for information lost due to technical failures • Requirement for express patient consent to forward pt. identifiable data to a third party

8. Continuity of Care • Referrals for Emergency Services • Medical Records • Privacy and Security of Pt. Records & Exchange of Information • Disclosures and Functionality on Online Services Making Available Telemedicine Technologies • Parity of Professional and Ethical Standards