Telemedicine: Managing your risks

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Telemedicine: Managing Your
Risks
Presented by Cathy Bryant and Kassie Toerner
June 23, 2020

Kassie ToernerCathy Bryant
Speakers

The information and opinions in this presentation and the supplemental materials
are provided “AS IS” and should not be us...

Alternative to in-person visits
Offer care from a remote location

▪ understanding the legal risks of
telemedicine;
▪ planning how to use telemedicine;
▪ documenting the telemedicine visit;...

▪ Claims of malpractice liability involving telemedicine are rare.
▪ In general, claims are similar to those for in-person...

Know the law in the state where the patient is located
▪ Licensure
▪ 49 state boards, plus the medical boards of District ...

▪ You need a license in the state
where the patient is located.
▪ Minor exception for your own
patients that you usually s...

Medicare Telemedicine Health Care Provider Fact Sheet
Mar 17, 2020
https://www.cms.gov/newsroom/fact-sheets/medicare-telem...

HIPAA
Effective March 20,2020, the HHS Office for Civil Rights (OCR)
will exercise enforcement discretion and waive penalt...

▪ Vendor agrees to enter into a Business Associate Agreement
▪ Encryption: AES 256 for transmission
▪ Data center, redunda...

Telemedicine protocols
Rule 174.3
Telemedicine complaint notice
Rule 174.4(3) and 178.3
Telemedicine privacy notices
Rule ...

• In Texas, telemedicine involves a health care provider’s medical care
delivered to patients physically located at sites ...

• Telemedicine services can be provided by:
• (A) synchronous audiovisual interaction between the practitioner and the pat...

RULES. The Texas Medical Board, in consultation with the commissioner of insurance, as appropriate, may
adopt rules necess...

A health professional providing a
health care service or procedure as a
telemedicine medical service is
subject to the sam...

▪ Emergency COVID-19 rule — TMB FAQ April 9, 2020
“3. What types of care can be provided by a phone-only
encounter?
Physic...

▪ Policies and procedures for telemedicine
▪ Staff training
▪ Educating patients
Planning for telemedicine

https://www.texmed.org/Telemedicine/
Policies and procedures for telemedicine

Policies and procedures
for telemedicine
https://www.texmed.org/Telemedicine/

Informed Consent
(1) Physicians that communicate with patients by
electronic communications other than telephone or
facsim...

Telemedicine protocols
Rule 174.3
All physicians utilizing telemedicine medical
services in their practices shall adopt pr...

Telemedicine complaint notice
Rule 174.4(3) and 178.3
Texas Medical Board
Texas telemedicine requirements

§174.4(3) Complaints to the Board
Physicians that utilize telemedicine medical services must provide
notice of how patient...

Telemedicine privacy notices
Rule 174.4 & 174.6
§174.4 Notice to Patients
Privacy practices.
(1) Physicians that communica...

(2) The notice of privacy practices shall include language
that is consistent with federal standards under 45 CFR
Parts 16...

Texas Medical Board
Texas telemedicine requirements
Telemedicine privacy notices
Rule 174.4 & 174.6
§174.6
(a) A health pr...

Staff training
▪ Technology
▪ Patient selection for telemedicine
▪ Scheduling instructions
Educating patients
▪ Getting re...

Documenting the telemedicine visit

According to AHIMA’s “Telemedicine Services and the Health Record” Practice Brief,
the process for a telemedicine encounte...

Source: https://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=4&ti=22&pt=9&ch=165&rl=Y
Documenting the teleme...

Contents of Medical Record. Regardless of the medium utilized, each licensed physician of the board shall
maintain an adeq...

Contents of Medical Record. Regardless of the medium utilized, each licensed physician of the board shall
maintain an adeq...

Contents of Medical Record. Regardless of the medium utilized, each licensed physician of the board shall
maintain an adeq...

Contents of Medical Record. Regardless of the medium utilized, each licensed physician of the board shall
maintain an adeq...

▪ The encounter; interview, assessment, limitations of the visit.
▪ Document the plan and the patient’s understanding.
➢ R...

Tips on
successfully
conducting
telemedicine visits

▪ “Webside Manner” is the new bedside manner.
▪ A webcam creates an intimate vantage point, it sees everything.
▪ Room des...

TMA
telemedicine
visit checklist
https://www.texmed.org/Telemedicine/

Conducting a successful telemedicine
visit
Source: The Rapid Transition to Telemedicine: Insights and Early Trends
Optimiz...

Conducting a successful telemedicine
visit
Source: The Rapid Transition to Telemedicine: Insights and Early Trends
▪ Authe...

“The rapid adoption of telehealth has enabled caregivers to meet the
needs of patients with the levels of attentiveness, e...

Navigating federal and state rules on telemedicine
Investigations
Time away from patient care to deal with the investigati...

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