If you are planning to use telemedicine on a longer-term basis, you should set up HIPAA-compliant services and platforms right from the get-go. Fortunately, there are many platforms that meet government requirements. And you should be thoroughly familiar with the HIPAA regulations that relate to telemedicine so there are no unpleasant surprises. The Office of Health and Human Services provides a list of vendors that provide HIPAA-compliant video communications.3
It should be noted that, although you may have a consultation with a patient via an unencrypted platform during the COVID-19 crisis with less concern about HIPAA, electronic medical records (EMRs) should be maintained with the same rigor that you would for a patient seeing you in person. This applies not only to you but also to any of your staff (such as a nurse or bookkeeper) who is working from his or her home. (Precautions that providers must take in keeping EMRs secure can be found here.)
2. Address licensing issues.
At present, licensing requirements have also loosened, and clinicians in good standing are allowed to treat patients across state lines; again, in deference to the extenuating circumstances we are facing with COVID-19. But under ordinary circumstances, you can only treat patients who are located in the state or states in which you are licensed. If you develop new relationships with patients in other states, you should consider if you want to continue those relationships, which would necessitate being licensed in those states. The State Federation of Medical Boards provides a list of these state requirements.4
3. Understand what type of prior relationship, if any, you need to have with the patient.
Some states are requiring that you have met the patient at least once in person before you can have a telemedicine visit, and some are also requiring at least one in-person consultation before you can prescribe medication. While this may be the case for many types of medication, it is especially the case with opioids and other controlled substances. So it is important for you to ascertain what these requirements are from your state’s medical board.
4. Develop and post notices regarding telemedicine policies and consent forms on your website.
Patients should be aware right up front that telemedicine may not be able to offer the same type of service that they would receive at an in-person appointment.
The informed consent forms that you have patients sign prior to their telemedicine appointment are also somewhat different from those that patients sign prior to an in-person visit. The form should specify what patients can and cannot expect during the appointment and follow-up. Although states may vary in their requirements for the contents of telemedicine informed consent documents, the Federation of State Medical Boards provides a great overview in its “Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine.”5