Page 7 - Telemedicine - Essentials of Virtual Care Delivery Part Two

SVMIC Telemedicine: Essentials of Virtual Care Delivery

It can be the cocktail party type of encounter where you have

a face time call from a neighbor or a family member perhaps
with a complaint. So, a question arises: Has a doctor patient

relationship been established? Many state medical boards
have telemedicine guidance that specifically addresses mutual

consent.

Most authorities are clear that telemedical activity, including
consultation, diagnosis, treatment, or rendering advice, occurs

in the context of a professional relationship that falls under the
applicable rules and standards for the practice of medicine.

During the pandemic, the Drug Enforcement Agency (DEA) and
most states suspended requirements for a prior in-person visit.

Prior to the pandemic (and it is unknown if states will revert to
former rules), states differed about whether the patient-provider

relationship can be established for the first time via telemedicine
without a prior in-person visit. In Arkansas, for example, a

patient must be seen in the office, subject to some exceptions,
prior to the establishment of a relationship by telemedicine. In
1
Tennessee, for example, this was not a requirement. In Kentucky,
the relationship is “clearly established when the physician

agrees to undertake diagnosis and treatment of the patient, and
the patient agrees to be treated, whether or not there has been

an encounter in person between the physician . . . and patient.”

1 Arkansas Code Annotated section 17-80-403 (2017) provides when “the establishment of
the professional relationship is permitted via telemedicine[,] . . . telemedicine may be used to
establish the professional relationship only for situations in which the standard of care does
not require an in-person encounter.” Arkansas State Medical Board Regulation No. 2.8 (cross-
referenced in Regulation No. 38) requires, in the telemedicine context, in order to establish a
patient-physician relationship, that the “physician performs a face to face examination using
real time audio and visual telemedicine technology that provides information at least equal to
such information as would have been obtained by an in-person examination.”
Full text of Kentucky Board of medical licensure’s Board Opinion Regarding the Use of
Telemedicine Technologies:
https://kbml.ky.gov/board/Documents/Board%20Opinion%20regarding%20The%20Use%20
of%20Telemedicine%20Technologies%20in%20the%20Practice%20of%20Medicine.pdf.
Full text of Senate Bill No. 112: https://apps.legislature.ky.gov/record/18rs/SB112.html.

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