Telemedicine Guidelines and Teladoc
Understanding that, sometimes, members need care but can’t get to a doctor’s office, the 1199SEIU Benefit Funds offer a telemedicine benefit, as well as access to Teladoc. This allows members to receive quality care when it fits their schedule and from the comfort of their own home.
The Benefit Funds require its participating providers to recognize that the health and well-being of members depends upon a collaborative effort between the physician and patient. The physician–patient relationship is fundamental to the provision of acceptable medical care. When engaged in the practice of telemedicine, including the prescribing of medications, providers are required to adhere to the following guidelines.
“Telemedicine” means the practice of medicine using electronic communications, information technology or other means between a licensee in one location and a patient in another location with or without an intervening healthcare provider. Generally, telemedicine is not any audio-only, telephone conversation, email/instant messaging conversation or fax. It typically involves the application of secure videoconferencing or store and forward technology to provide or support healthcare delivery by replicating the interaction of a traditional, in-person encounter between a provider and a patient.
“Telemedicine technologies” means technologies and devices enabling secure electronic communications and information exchange between a licensee in one location and a patient in another location with or without an intervening healthcare provider.
Providers are not permitted to render medical advice and/or care to members using telemedicine technologies without:
- Fully verifying and authenticating the location and, to the extent possible, identity of the requesting patient; an appropriate physician–patient relationship has not been established when the identity of the physician may be unknown to the patient
- Disclosing and validating the provider’s identity and applicable credential(s)
- Obtaining appropriate consents from requesting patients after disclosures regarding the delivery models and treatment methods or limitations of telemedicine, including any special informed consents regarding the use of telemedicine technologies
The provider must be licensed by, or under the jurisdiction of, the medical board of the state where the patient is located. The practice of medicine occurs where the patient is located at the time telemedicine technologies are used. Providers who treat or prescribe through online services sites are practicing medicine and must possess appropriate licensure in all jurisdictions where members are receiving care.
Establishment of a physician–patient relationship
Where an existing physician–patient relationship is not present, the provider must take appropriate steps to establish such a relationship consistent with these guidelines. While each circumstance is unique, physician–patient relationships may be established using telemedicine technologies, provided the standard of care is met.
Evaluation and treatment of the patient
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 contra-indications to the treatment recommended/provided must be obtained prior to providing treatment, including issuing prescriptions. Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in traditional (in-person) settings. Treatment, including issuing a prescription, based solely on an online questionnaire does not constitute an acceptable standard of care.
Evidence documenting appropriate patient informed consent for the use of telemedicine technologies must be obtained and maintained. Appropriate informed consent should, as a baseline, include the following:
- Identification of the patient, the physician and the physician’s credentials
- Types of transmission permitted using telemedicine technologies (e.g., prescription refills, appointment scheduling, patient education, etc.)
- An understanding on the part of the patient that the physician determines whether or not the condition being diagnosed and/or treated is appropriate for a telemedicine encounter
- Details on security measures taken with the use of telemedicine technologies, such as encrypting data, password-protected screen savers and data files or other reliable authentication techniques, as well as potential risks to privacy notwithstanding such measures
- A hold harmless clause for information lost due to technical failures
- Requirements for express patient consent to forward patient-identifiable information to a third party
Continuity of care
Members should be able to seek, with relative ease, follow-up care or information from the provider who conducts an encounter using telemedicine technologies. Providers solely providing services using telemedicine technologies with no existing physician–patient relationship prior to the encounter must make documentation of the telemedicine encounter easily available to the patient and, subject to the patient’s consent, any identified care provider of the patient immediately after the encounter.
Medical records of services rendered by a provider through telemedicine technologies are required to be kept in the same manner as identified in Medical Record Guidelines.
Telemedicine technologies, where prescribing may be contemplated, must implement measures to uphold patient safety in the absence of traditional physical examination. Such measures should guarantee that the identity of the patient and provider is clearly established and that detailed documentation for the clinical evaluation and resulting prescription is both enforced and independently kept. Prescribing medications via telemedicine technologies is at the professional discretion of the physician; however, the indication, appropriateness, medical necessity and safety considerations for each telemedicine visit prescription must be evaluated by the physician in accordance with current standards of practice and state laws in the jurisdiction where the service is being rendered.
Teladoc, a telehealth and video conferencing service, gives members access to licensed Teladoc doctors 24 hours a day, 7 days a week, by phone or video. Teladoc allows members to get quality care in minutes, which results in fewer trips to an urgent care center or emergency department. The Teladoc benefit also includes behavioral and mental health care for our members. Now, members struggling with stress, anxiety, relationship or family problems or work pressures can contact Teladoc and speak with a licensed professional who can help. If you have 1199SEIU Benefit Funds patients who are suffering from these issues, refer them to Teladoc so they may connect with a counselor, therapist, psychologist or psychiatrist by phone, web or mobile app seven days a week. Please be advised that Teladoc should not be used for emergency medical situations.