Practice Management

Telemedicine: Deliver Care But Protect Your Practice

By Pamela Miller, OD, FAAO, JD, FNAP

June 7, 2017

Telemedicine provides vast opportunities for providers to connect with patients and serve medical needs.

In many ways, you already are participating in aspects of it, and it is only going to increase, as technology advances and health care reform mandates better outcomes for more patients for less cost.

At the same time, telemedicine poses new challenges and largely unexplored risks to any medical practice, eyecare practices among them.

Editor’s Note: Click HERE to watch the video”Telemedicine: Should We Embrace it, and Will We Get Paid?” shot at this year’s SECO.

The ease of communication available today through not just mobile phones and e-mail, but through texting and video conferencing apps, mean patients often expect more from doctors. Many expect their doctor to be reachable even when it’s not possible for them to come into the office, or when they simply don’t feel like coming in.

But before you begin texting, e-mailing and video-conferencing with patients, think carefully about how to best provide care, and how to protect your practice from legal liability. As with all new approaches to practicing, it’s best to first consult with your state optometric board and/or your legal counsel.

Has the Patient Ever Visited Your Office?
Providing telemedicine to a patient you have previously examined, or whom you may even see every year for an annual exam, and for whom you have medical records on file, is different from providing medical advice to a patient you have never examined in-person.

A good rule of thumb is to only provide remote consultations with those patients you already have a doctor-patient relationship with. For instance, that means you may be able to safely give guidance to a patient who visits your practice annually, who woke up with red, itchy eyes, by maybe calling in a renewal of an ocular allergy medication after seeing in their records that they are long-time allergy sufferers. But not providing remote consultation and a prescription to a person whom you never examined before, who found your practice web site and e-mail online, and sent you a photo of their eyes and a description of their discomfort.

When you are consulting with a patient, whom you may have examined just a few months prior, and for whom you have records, you have a baseline understanding of their general eye health and lifestyle. That means you know whether there is an underlying condition that could be to blame for their discomfort, or if they engage in activities, such as rough manual labor, that might be the cause of the discomfort. A patient you have never examined before is a blank slate with potentially sight-threatening conditions and activities that may relate to discomfort they are experiencing.

Choose HIPAA-Secure Platform
The platform you use to communicate with patients should be HIPAA-secure, meaning it can’t just be the texting function of your personal smartphone and the texting function of the patient’s smartphone, or your Gmail account and theirs.

It should to be a platform such as the patient portal of your electronic health records, or a platform from your practice-patient communication system, such as Solutionreach, Demandforce, or another, that has been designated as HIPAA-secure.

If your patient contacts you via e-mail or texting, it presents a slightly different context. That is – the patient initiated the query via a non-HIPAA compliant method, and would typically expect your reply via the same method or mode.

The argument is that because the patient has selected the method for their inquiry and transmission of information, they expect your response via the same method. Of course, your professional discretion should govern your response. The key boils down to who initiated the communication, as well as what level or expectation of privacy your patient expects.

Document Patient Interaction
Every interaction with a patient, even those that occur outside the office, via phone, e-mail, text, Skype or video-conferencing, must be documented in the patient’s record.

For example, if a patient e-mails you via your patient portal, and you respond, double-check that your EHR automatically makes that e-mail exchange–theirs to you and your response with the dates and times of the messages–an official part of their health record.

If you keep paper-based files, print out a copy of the e-mail exchange to add to the patient’s file. You also should make sure any photos that are sent to you are included in the patient record. If the communication is sent to your personal e-mail, it is unrealistic to expect the same level of confidentiality or HIPAA protection. Again, the patient has chosen the method of communication.

Regardless of the form, or format, of communication, be sure you include any additional notes that you think are required to give a full account of the interaction, such as notes detailing a phone call you made to the patient following the e-mail exchange in which you asked the patient to visit your office if their eyes were not better within a certain time frame, or to pick up a medication you called into a pharmacy.

As always, if in doubt, consult with your state board or attorney for further clarifrication.

Pamela Miller, OD, FAAO, JD, FNAP, has a solo optometric practice in Highland, Calif. She has a law degree, holds a therapeutic license, is California State Board-certified and glaucoma-certified to prescribe eye medications, and offers comprehensive vision care, contact lenses, visual therapy and low vision services. To contact her: drpam@omnivision.com.

 

 

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