The use of telemedicine in health care has expanded rapidly over the past few years. The benefits and numerous, and include increased access to health care and a reduction in healthcare costs. However, the risks and drawbacks of telemedicine are numerous, too. The Texas legislature and the Texas Medical Board have created rules and regulations aimed at protecting patients and the effectiveness of medical care.
In May 2017, the Texas legislature passed SB1107 on Telemedicine and Telehealth Services. The Bill provides for definitions of telemedicine, telehealth, and defines the patient-practitioner relationship in regard to telemedicine medical services.
- “Telemedicine medical services” means a health care service delivered by a physician licensed in this state, or a health professional acting under the delegation and supervision of a physician licensed in this state, and acting within the scope of the physician’s or health professional’s license to a patient at a different physical location than the physician or health professional using telecommunications or information technology. SB 1107 Sec. 4.
- “Telehealth service” means a health service, other than a telemedicine medical service, delivered by a health professional licensed, certified, or otherwise entitled to practice in this state and acting within the scope of the health professional’s license, certification, or entitlement to a patient at a different physical location than the health professional using telecommunications or information technology. SB1107 Sec. 3.
Practicing Telemedicine in Texas
Certainly, the benefits of providing telemedicine to patients are vast. Though, offering this service creates new risks for health care providers regarding licensing issues and standards of care. The Texas Medical Board regulates telemedicine, who can provide it, and to whom, where, and for what medical conditions. The medical care provided via telemedicine is held to the same standards of acceptable medical practices as those made in the traditional in-person clinical settings.
Who May Practice Telemedicine in Texas?
In Texas, telemedicine providers are called “distant site providers.” Distant site providers must be licensed to practice in Texas and can be a physician, physician assistant, or an advanced practice nurse who is supervised by and has delegated authority from a physician.
What Requirements Must be Met for Medical Care to Be Provided Via Telemedicine?
For a distant site provider to provide medical care via telemedicine, the provider must establish a physician-patient relationship, which at a minimum includes:
- Establishing that the person requesting the treatment is in fact who the person claims to be;
- Establishing a diagnosis using acceptable medical practices, including documenting and performing patient history, mental status examination, appropriate diagnostic and laboratory testing, and for medical care other than mental health services, a physical examination;
- Discussing with the patient the diagnosis and the evidence for it, the risks and benefits of various treatment options; and
- Ensuring the availability of the distant site provider or coverage of the patient for appropriate follow-up care.
Where May Telemedicine Care Be Provided?
Under the Texas Medical Board’s rules, if a patient is being seen for the first time by a distant site provider, or is presenting with a new condition, telemedicine may only be used at a location that has qualified staff present and sufficient technology and medical equipment to allow the distant site provider to conduct an adequate physical evaluation. The Board rules refers to such a location as an “established medical site.”
An established medical site has:
- Qualified staff known as “patient site presenters,” who are health care professionals licensed or certified in Texas, such as nurses, EMT’s, or pharmacists.
- Sufficient medical equipment to allow the distant site provider to conduct an adequate physical evaluation for the patient’s presenting complaint.
- Sufficient size of the location to ensure patient privacy.
Must a Distant Site Provider See A Patient In-Person Prior to Providing Treatment via Telemedicine?
No. A provider must conduct a “face-to-face” evaluation via telemedicine at an established medical site. A “face-to-face” evaluation is defined under the rules as including an evaluation performed by a distant site provider for a patient who is located at a different location qualifying as an established medical site.
Alternatively, a provider may provide telemedicine care for a patient referred by another physician who completed a “face-to-face” evaluation via telemedicine at an established medical site.
Telemedicine service cannot be used to treat chronic pain conditions with scheduled drugs.
Facing Disciplinary Action from the Texas Medical Board
The foregoing was only a brief overview of the complex regulations on practicing telemedicine in Texas. If you are a distant site provider, it is critical that you understand and follow the regulations. This is an area of medicine ripe with potential pitfalls for professionals licensed by the Texas Medical Board.
If you have been notified of a complaint filed against you or are facing disciplinary action by the Texas Medical Board based on medical care you provided via telemedicine, it is critical that you seek the advice of an experienced Medical license defense attorney immediately.
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