Practicing Medicine Through Telehealth Technology
Telehealth (previously called telemedicine) is seen
as a tool in medical practice, not a separate form of medicine. There
are no legal prohibitions to using technology in the practice of medicine, as long
as the practice is done by a California licensed physician. Telehealth is not a
telephone conversation, email/instant messaging conversation, or fax; it typically
involves the application of videoconferencing or store and forward technology to
provide or support health care delivery.
The standard of care is the same whether the patient is seen in-person, through
telehealth or other methods of electronically enabled health care. Physicians need
not reside in California, as long as they have a valid, current California license.
Senate Bill 1665 (M. Thompson; Chap 864, Stats of 1996) enacted the "Telemedicine
Development Act of 1996" which imposed several requirements governing the delivery
of health care services through telemedicine and also made several changes to different
sections of law, which are also related to telemedicine.
Below we have listed a few highlights
of Senate Bill 1665:
- The act shall not be construed to alter the scope of practice of any health care
provider or authorize the delivery of health care services in a setting, or in a
manner, not otherwise authorized by law.
- Exempts out-of-state practitioners, as defined, from the Medical Practice Act when
consulting either within this state or across state lines, with a licensed practitioner
in California. Prohibits the out-of-state practitioner from having ultimate authority
over the care or primary diagnosis of a patient in California.
- Requires the practitioner to obtain verbal and written informed consent from the
patient prior to delivering health care via telemedicine, and also requires that
this signed written consent statement becomes part of the patient's medical record.
- Provides that no health care service plan contract that is issued, amended, or renewed,
on and after January 1, 1997, shall require face-to-face contract between a health
care provider and patient for services appropriately provided through telemedicine,
subject to all terms and conditions of the contract agreed upon.
In 2011, AB 415 repealed existing law related to telemedicine and replaced this
law with the Telehealth Advancement Act of 2011, which revises and updates existing
law to facilitate the advancement of telehealth as a service delivery mode in managed
care and the Medi-Cal program. This bill repeals and replaces section 2290.5 of
the Business and Professions Code to do the following:
- Defines “Asynchronous store and forward” as the transmission of a patient’s medical
information from an originating site to the health care provider at a distant site
without the presence of the patient.
- Defines “Distant Site” as a site where a health care provider is located while providing
services via a telecommunications system.
- Defines “Originating Site” as a site where a patient is located at the time health
care services are provided via a telecommunications system or where the asynchronous
store and forward transfer occurs.
- Defines “telehealth” as the mode of delivering health care services and public health
via information and communication technologies to facilitate the diagnosis, consultation,
treatment, education, care management, and self-management of a patient’s health
care while the patient is at the originating site and the health care provider is
at the distant site. States that telehealth facilitates patient self-management
and caregiver support for patients and includes synchronous interactions and asynchronous
store and forward transfers.
- States that this section shall not be construed to alter the scope of practice of
any health care provider.
- Provides that all laws regarding the confidentiality of health care information
and a patient’s rights to his or her medical information shall apply to telehealth
- This bill also applies the Business and Professions Code Section to the laws relating
to Health Care Service Plans and to the Insurance code and requires health care
service plans and health insurance companies to adopt payment policies to compensate
health care providers who provide covered health care services through telehealth.
This bill also applies these requirements to the Medi-Cal managed care program.
In 2015, AB 809 revised the informed consent requirements relating to the delivery of health care via
telehealth by permitting consent to be made verbally or in writing, and by deleting the requirement
that the health care provider who obtains the consent be at the originating site where the patient
is physically located. This bill requires the health care provider to document the consent.
Physicians using telehealth technologies to provide care to patients located in California must
be licensed in California. Physicians are held to the same standard of care, and retain the same
responsibilities of providing informed consent, ensuring the privacy of medical information, and
any other duties associated with practicing medicine regardless of whether they are practicing via
telehealth or face-to-face, in-person visits.