Telemedicine Risk Management Strategies

Telemedicine is the practice of medicine using electronic communication, information technology, or other means, between a physician in one location and a patient in another location with or without an intervening healthcare provider. With recent advances in the practice of telemedicine, the appropriate application of medical services offers potential benefits in the provision of medical care.

These technologies, when utilized properly, can enhance medical care by facilitating communication between patients and their physicians or other healthcare providers, including prescribing medication, obtaining laboratory results, scheduling appointments, monitoring chronic conditions, providing healthcare information, and clarifying medical advice.  

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It is important for CAP members who wish to expand their practice to include telemedicine to contact CAP Membership Services to verify coverage. Once approved, the member should follow the guidelines, listed below from Risk Management, to maintain a risk-adverse telemedicine practice.

Physician-Patient Relationship

A physician-patient relationship must be established through, at minimum, a face-to-face examination, if a face-to-face appointment would otherwise be required in the delivery of the same service not provided via telemedicine.

A physician is discouraged from rendering medical advice and/or care using telemedicine technologies without:

  1. Fully verifying and authenticating the location and, to the extent possible, identifying the requesting patient;
  2. Disclosing the validation of the provider’s identity and applicable credential(s); and
  3. Obtaining appropriate consents from requesting patients after disclosures regarding the delivery models and treatment methods or limitations, including any special consents regarding the use of telemedicine technologies.

Documentation

The California Legislature has expressed its intent that all medical information transmitted during the delivery of healthcare via telemedicine become part of the patient’s medical record. In addition, the consent must be documented in the medical record as well. 

A documented medical evaluation and collection of relevant clinical history commensurate with the presentation of the patient to establish diagnoses and identify underlying conditions and/or contraindications to the treatment recommended/provided must be obtained prior to providing treatment, including issuing prescriptions, electronically or otherwise.

All patient-related electronic communications, including patient-physician communication, prescriptions, laboratory and test results, evaluations and consultations, records of past care, and instructions obtained or produced in connection with the utilization of telemedicine technologies must be documented.

Privacy and Security/HIPAA

Physicians should meet or exceed applicable federal and state legal requirements of medical/health information privacy, including compliance with the Health Insurance Portability and Accountability Act (HIPAA) and state privacy, confidentiality, security, and medical retention rules.

For the duration of the COVID-19 pandemic while HIPAA regulations are relaxed, a signed consent form is not a requirement, and verbal consent is adequate. It’s advisable to see if your technology vendor can support an electronic consent form. If not, consider other solutions, such as getting the form signed via email or physical mail, or having the patient take a photo of their signed consent form and sending it to the practice to upload into the chart. You may verbally state at the beginning of the visit that the patient initiated the visit, is aware that his or her insurance will be billed for the visit, and agrees to have the physician conduct the visit in this manner. When the patient comes to the office for a face-to-face visit, you can have him/her fill out a form at that time.

Risk Management Strategies

  • Provide the CAP telemedicine documents entitled “What Is Telemedicine?” and “Consent to Use Telemedicine” to the patient and receive the original executed and dated forms from the patient for the patient medical file. Visit the CAP website to download both documents listed under “All Practice Forms” - https://www.capphysicians.com/risk-management/tools-and-resources.
  • Verify and authenticate, at each encounter, the patient’s identity and location.
  • Verify, at each encounter, the patient’s readiness to proceed in a setting that is private and conducive to uninterrupted communication.
  • Obtain appropriate consents.
  • Document all medical information transmitted during the delivery of healthcare via telemedicine in the patient’s medical record.
  • Meet or exceed HIPAA and state privacy and confidentiality laws.

If you are a CAP member planning to start a telemedicine practice, it is important to contact CAP’s Membership Services Department (800-610-6642) to discuss coverage and special instructions. 

References:

California Telehealth Resource Center
www.caltrc.org

Medical Board of California: Practicing Medicine Through Telehealth Technology
www.mbc.ca.gov/Licensees/Telehealth.aspx

American Telemedicine Associations
www.americantelemed.org

Center for Telehealth and eHealth Law (Ctel)
http://ctel.org

Health Insurance Portability and Availability Act
www.hhs.gov/ocr/hipaa