Telemedicine rules in the District of Columbia underwent a second round of revisions as the Department of Health published a new set of proposed rules . The recently revised revised Telemedicine Rules, published in July, replace the first draft of the Ministry's Telemedicine Regulation issued in early 2016 and incorporate comments submitted by several industry advocates of the telehealth. With the exception of a policy statement of 2014 the current laws of the Medical Council of D.C. are silent as to the practice of telemedicine.
Changes to the newly revised telemedicine rules
Following the review of public comments and recommendations on the telemedicine working group, the Medical Council amended its proposed initial regulations for clarity and to remove unnecessary barriers. Here is a summary of the notable changes contained in the new rules:
Simplify the definition of telemedicine by entering the following sentence: "Generally, telemedicine does not include telephone conversations only audio [sic] e-mail, IM conversations or fax communications. Telemedicine generally involves the application of secure videoconferencing or storage and retransmission technology to provide or support the provision of health care by replicating the interaction of a traditional in-person meeting between a licensee and a patient.
Revise the modality required to create a valid physician-patient relationship by telemedicine in the absence of any in-person prior review.
The previous rule stated that "the physician shall use real-time auditory communications or real-time visual and auditory communications to allow for the free exchange of protected health information between the patient and the physician performing the examination." patient evaluation.
The proposed new rule states that "the physician may use telemedicine in real time to allow for the free exchange of protected medical information between the patient and the physician in order to establish the physician-patient relationship and to Evaluate the patient. emph added)
The new rules also change the definition of "real time" to mean "a system in which information is provided in a manner that allows near-immediate feedback". The previous rule defined it as "simultaneously or fast enough to allow two or more individuals to communicate. "
Require that the physician be licensed to practice medicine in Washington DC if the patient is located in Washington DC, and eliminate the requirement that the physician be licensed in the jurisdiction where the physician is physically located and where the patient is physically located.
Replace the word "face to face" with the word "in person" to better describe that the doctor and the patient are physically in the presence of each other.
Eliminate certain requirements for physicians to develop specific written policies and procedures for telemedicine.
Eliminate the proposed definitions for terms that have not been used in regulation (eg Group Practice, Counseling Service).
What Telehealth Providers Need to Know
Key points to keep in mind: Health care providers, hospitals, and start-ups looking to enter the CD market should consider whether the proposed telemedicine rules are being implemented without further changes:
The proposed rules define telemedicine as "the practice of medicine by a licensed practitioner to provide care, treatment or services to patients, between a licensee in one location and a patient in another location with or without a health care provider intermediate health, through the use of information and technology communications, subject to existing standards of care and conduct. "
The rules are flexible on modality and do not require the use of real-time audio-video technology for all telemedicine services.
Valid doctor-patient relationship. A physician can create a valid physician-patient relationship through telemedicine without the need for an in-person examination. In doing so, the physician "may use telemedicine in real time to allow free exchange of protected health information between the patient and the physician to establish the doctor-patient relationship and perform patient assessment." The real-time information system is provided in such a way as to allow near immediate feedback.
Telemedicine examinations. In all cases of use of telemedicine, the physician should perform an assessment to establish diagnoses and identify underlying conditions or contraindications to recommended therapeutic options before prescribing treatment or prescribing medicines for a patient who meets the appropriate standards of care. . (The interpretation services are "official readings of images, plots or specimens by telemedicine", including "remote and real-time monitoring of a patient supported in a health facility or at home "). A physician approved by the CD may rely on a patient assessment performed by another physician authorized by the OC if the former provides coverage for the latter.
Informed Consent The rules require the physician to obtain and document the patient's consent, except when providing interpretation services. Patients should be informed of other forms of communication between the patient and the doctor for urgent matters.
Doctor's license . Physicians providing telemedicine to patients in D.C. must hold an active D.C.
Standard of Care According to the rules, a physician who uses telemedicine is held to the same standard of care as when he makes medical decisions when meeting with a patient in person.
The rules allow the prescription of medications by telemedicine without in-person examination, provided that the patient's assessment adheres to the guidelines and meets the standards of care.
Medical records The physician must create and maintain adequate medical records of the encounter. The physician must comply with D.C. and federal laws and regulations governing the confidentiality and disclosure of medical records. All relevant patient-physician communications, including those performed by an electronic method such as an email or other electronic messaging system, must be documented and archived in the patient's medical record.
We will continue to monitor the proposed telemedicine rules for the release of the final version.
For more information on telemedicine, telehealth, virtual care and other innovations in health, including the team, publications and other documents, visit the website of Foley Telemedicine .
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