Telemedicine generally involves using secure videoconferencing or other appropriate technology to replicate the interaction of an in-person encounter. The practice of medicine 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, work, education, or vacation 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. Although not specifically addressed by a statutory exemption, the Oregon Medical Board has chosen not to enforce the licensure requirement for the out of state physician or physician assistant to provide this temporary or intermittent continuity of care. The patient needs are best served by having the physician or physician assistant who knows the patient and has access to the patient's medical records provide this follow up care.
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.
How to Conduct a Visit
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 licensee, beyond that authorized by law. Licensees 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 licensee is expected to maintain an appropriate provider-patient relationship. At each telemedicine encounter, the licensee 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.
- For treatment and consultation recommendations, a licensee is expected to 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.
- A licensee is expected to provide for an acceptable 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.
- When referral to an acute care facility or Emergency Department is necessary for the safety of the patient, a licensee is expected to immediately direct the patient to the appropriate level of care. Licensees should have a formal written protocol to facilitate such acute referrals.
- A licensee is expected to 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.
- When using online services to provide care via telemedicine, a licensee is expected to be transparent in:
- Specific services provided;
- Contact information for licensee;
- Licensure and qualifications;
- Fees for services and how payment is to be made;
- Financial interests, other than fees charged, in any information, products, or services provided by a licensee;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.
- Online services used by licensees to provide care via telemedicine should 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.
- Online services must have accurate and transparent information about the website owner/operator, location, and contact information, including a domain name that accurately reflects the identity. When providing links to other sites, licensees should be aware of the implied endorsement of the information, services or products offered from such sites.