Medical Board Committee Advances Relaxed Telemedicine Rules

Patients in Arkansas could establish a relationship with a doctor through a real-time audiovisual visit instead of an in-person visit under proposed regulations described by the State Medical Board Telemedicine Advisory Committee Wednesday.

Under previous regulations and a law passed by the Legislature this year, patients cannot be treated virtually unless they have already had an in-person visit with that doctor.

Arkansas’ rules are among the most restrictive in the nation, says Teladoc, which contracts with doctors to provide telemedicine services to employees of large employers. For a fee, employees can contact a physician online from their home to be treated remotely for routine elements. It operates in 49 other states but left Arkansas rather than subject its physicians to possible disciplinary action.

The law, however, included a provision that allows the Arkansas State Medical Board to broaden the definition of telemedicine and the times when it can be used. The Telemedicine Advisory Committee is drafting a rule that will be presented to the board. Walmart and some employers along with ERIC, a national group representing large employers, have written letters in support of broadening the definition of telemedicine.

The committee came to a consensus on allowing the relationship to be established as long as the patient provides a detailed medical complaint to the physician and gives informed consent, and as long as the physician agrees to accept responsibility for the patient’s care. The physician must be licensed by the state but is not required to be located in the state.

The committee agreed that the initial relationship should be established only through real-time audiovisual communication. Attorney Kevin O’Dwyer, who is helping draft the regulations, said afterwards that it remains to be seen exactly how “audiovisual” will be defined.

The committee is still tweaking the rules before presenting them to the State Medical Board. It will host a public hearing at 2 p.m. Nov. 4 to solicit input from patients, medical providers, insurance companies and telemedicine companies. Eventually, the draft recommendations will be presented to the full board.

The committee agreed that telemedicine-based physicians cannot prescribe controlled substances. However, prescriptions for other drugs can be issued.

The committee also agreed that physicians should be required to record a patient’s history during the initial contact. Physicians also must provide a record of the encounter to the patient and send a copy to the patient’s primary care provider if the patient allows. If necessary, physicians should refer patients to an appropriate local provider, such as an emergency room or family doctor.

The committee agreed that, for patients under age 18, the relationship requires the consent of a parent or guardian.

Rep. Stephen Magie, D-Conway, a member of the committee and an ophthalmologist, said afterwards that the use of telemedicine will continue to evolve. He pointed to its potential use in rural, medically underserved areas.

“Telemedicine is not new,” he said. “We’ve practiced telemedicine for years, but the technology that’s available now for patients to access and communicate with primary care doctors or speciality doctors is so exciting, it’s so great at this point in time that the board has to address this. I mean, it’s the wave of the future for medicine.”