- One of the last states to restrict initial telemedicine encounters may be changing its tune.
The Arkansas Board of Medicine is eyeing an amendment to its current codes that would, if approved, allow a physician to establish a valid relationship with a new patient via “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."
Legislators railed against the idea during a public hearing last November, with State Rep. Michelle Gray, R-Melbourne, saying it was “not the intent of the Legislature to take away that initial face-to-face visit.”
"They (legislators) latched on to that very quickly and were very concerned that we not move too quickly, that we slow down and think about what we're doing and make sure that the interests of the patients and safety come before everything else," David Wroten, of the Arkansas Medical Society, told Arkansas Online following the hearing.
But according to Nathaniel M. Lacktman, a noted telemedicine attorney with Foley & Gardner, the state medical board recently moved ahead with the proposal, which would complement existing statutory requirements and give the clinician leeway to use telemedicine for a first encounter,
Writing in Mondaq, Lacktman said proposed Regulation 38, a revision of Article 2.8 in Arkansas Code 17-80-117 – which faces a public hearing on June 9 – doesn’t answer all the questions. Chief among the concerns is that the proposed rule doesn’t define an originating site, so it’s unknown whether the board would allow a patient to connect with a clinician from his or her home.
Like other states, Arkansas’ telemedicine regulations include a list of guidelines, laid out by Lacktman as follows:
- Physicians using telemedicine in the state must be licensed to practice medicine in Arkansas.
- Telemedicine encounters are held to the same standards of care as traditional in-person encounters.
- A physician using telemedicine can’t prescribe controlled substances unless there has been an in-person exam or “unless a relationship exists through consultation or referral; on-call or cross-coverage situations; or through an ongoing personal or professional relationship.”
- A documented medical record, including medical history, must be prepared after the telemedicine session.
- At the patient's request, the physician must produce an electronic or hard-copy version of the patient's medical record documenting the encounter. That physician must also pass along to the patient’s primary care provider a record of that encounter, unless the patient declines.
- The telemedicine session must be transparent, including information identifying the physician before the encounter, with licensure and board certifications, and patient financial responsibilities.
- If the telemedicine visit prompts a follow-up in-person visit, the physician must arrange that appointment or direct the patient to the appropriate follow-up care, with that referral included in the patient record.
- Physicians using telemedicine must have a protocol for emergency care referrals.
- The physician must have a detailed explanation of the patient’s complaint, either from the patient or the patient’s treating physician.
- Once the telemedicine session is established, the physician must agree to accept responsibility for the care of the patient.
- The physician must agree to provide or arrange for follow-up care if necessary.
- Store-and-forward technology is permitted.
Arkansas, one of the lowest-ranked states in the American Telemedicine Association’s annual telemedicine report cards, is one of only a handful of states still requiring face-to-face visits before a telemedicine session. Mississippi and Alabama are eyeing legislation, while Texas medical officials face a court challenge from Teladoc over their interpretation of the rules.