Telemedicine

Telemedicine generally involves using secure videoconferencing or other appropriate technology to replicate the interaction of an in-person encounter. The practice of medicine, podiatry, or acupuncture occurs at the patient's location when technology is used to provide care. The provider must possess appropriate licensure in all jurisdictions where the patient receives care. Therefore, with a few exceptions provided in ORS 677.060 and 677.137 and detailed below, providers practicing via telemedicine on patients located in Oregon must be licensed in Oregon.

A physician or physician assistant licensed in another state may provide care via telemedicine without obtaining Oregon licensure if they have an established provider-patient relationship with a person who is in Oregon temporarily for the purpose of business, education, vacation, or work and who requires the direct medical treatment by that physician or physician assistant as provided in ORS 677.060 or 677.137.

A physician or physician assistant licensed in another state may consult directly with another physician or physician assistant licensed in Oregon if they do not undertake the primary responsibility for diagnosing or rendering treatment to a patient located in Oregon as provided in ORS 677.060 or 677.137.

A physician or physician assistant licensed in another state may provide temporary or intermittent follow up care via telemedicine without obtaining Oregon licensure if they have an established provider-patient relationship with a person located in Oregon as described in ORS 677.060 or 677.137. The OMB understands that the patient's needs are often best served by allowing continuity of care with the physician or physician assistant who knows the patient and has access to the patient's medical records provide follow up care under these circumstances.

A physician, physician assistant, or acupuncturist licensed in Oregon with an Active status license may be temporarily located outside of Oregon to provide care via telemedicine for a patient located in Oregon.

The Board recognizes that delivery of services through telemedicine conveys potential benefits and potential challenges for patients, and that the delivery method does not alter the scope of practice, the professional obligations, the setting, or the manner of practice of any provider, beyond that authorized by law. Physicians, physician assistants, and acupuncturists are always obligated to maintain the highest degree of professionalism, place the welfare of patients first, meet the same standards of professional practice and ethical conduct, and protect patient confidentiality. As such, some situations and presentations are appropriate to provide care via telemedicine, while some are not.

A physician, PA, or acupuncturist is expected to:

• Maintain an appropriate provider-patient relationship. At each telemedicine encounter, the provider should:
• Verify the location and identity of the patient,
• Provide the identity and credentials of the provider to the patient, and
• Obtain appropriate informed consents from the patient after disclosures regarding the limitations of telemedicine.
• Document relevant clinical history and evaluation of the patient's presentation. Treatment based solely on an online questionnaire without individualized review and assessment does not constitute an acceptable standard of care.
• Provide continuity of care for patients, including follow-up care, information, and documentation of care provided to the patient or suitably identified care providers of the patient.
• Immediately direct the patient to the appropriate level of care when referral to acute or emergency care is necessary for the safety of the patient.
• Meet or exceed applicable federal and state legal requirements of medical/health information privacy, including compliance with the Health Insurance Portability and Accountability Act (HIPAA) and state privacy, confidentiality, security, and medical retention rules. Written policies and procedures should be maintained at the same standard as in-person encounters for documentation, maintenance, and transmission of the records.
• Be transparent in:
• Specific services provided;
• Contact information;
• Licensure and qualifications;
• Fees for services and how payment is to be made;
• Financial interests;¹
  
• Appropriate uses and limitations of the site, including emergency health situations;
• Uses and response times for e-mails, electronic messages and other communications transmitted via telemedicine technologies;
• To whom patient health information may be disclosed and for what purpose;
• Rights of patients with respect to patient health information; and
• Information collected and any passive tracking mechanisms utilized.
• Provide patients a clear mechanism to:
• Access, supplement, and amend patient-provided personal health information;
• Provide feedback regarding the site and the quality of information and services; and
• Register complaints, including information regarding filing a complaint with the Oregon Medical Board.

 

 

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The Oregon Medical Board holds providers to recognized standards of ethics of the medical profession, specifically for this philosophy: American Medical Association's Code of Medical Ethics: Opinion 1.2.12 Ethical Practice in Telemedicine; American Association of Physician Assistants' Guidelines for Ethical Conduct for the PA Profession: The PA and Patient; and Oregon Association of Acupuncturists' Code of Ethics: 1.2 Communication with Patients.

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1. A health practitioner must inform patients when referring the patient to a facility in which the health practitioner or an immediate family member has a financial interest. See ORS 441.098.