Tag Archives: Telemedicine Guidelines Adopted by the Federation of State Medical Boards

Telemedicine: Illinois licensing issues

Telemedicine and new telehealth options are available to an increasing number of patients. In addition to hospitals and health care organizations, direct health care service providers are adopting telemedicine into their medical practices to serve and an increased number of patients. Telemedicine utilizes mobile apps and software allowing doctors and patients to meet in a virtual setting for certain types of services. In other settings, when meeting with your regular doctor, you might use mobile health care technology to bring in a specialist who would otherwise not be available due to schedules and distances. Routine doctor-patient interactions, such as follow up visits and general maintenance can be conducted using telemedicine, saving time and resources for patients who would otherwise need to drive distances to see their doctor. As more people learn of the benefits of telemedicine, there may be a patient preference to see a doctor who can see them in person or by mobile health care technology. In light of the benefits of telemedicine, there are certain legal issues arising in mobile health care. Practitioners should be aware and mindful of licensing issues.

Licensing issues involved in the practice of Telemedicine

Illinois law speaks of telemedicine within the context of the practice of medicine. Anyone practicing medicine and using telemedicine technologies must be licensed by the State of Illinois, and anyone engaging in the practice of telemedicine without an Illinois-issued medical license may be subject to penalties.[i] The general rule is that only an Illinois-licensed doctor may offer services, using telemedicine, to a patient located in Illinois. There are some exceptions to licensing rules, as it applies to patients located outside the State of Illinois.[ii]

Telemedicine does not include the following:

  1. periodic consultations between a person licensed under this Act and a person outside the State of Illinois;
  2. a second opinion provided to a person licensed under this Act; and
  3. diagnosis or treatment services provided to a patient in Illinois following care or treatment originally provided to the patient in the state in which the provider is licensed to practice medicine.

The Interstate Medical Licensure Compact[iii] was adopted into Illinois law on July 20, 2015. The Compact allows physicians to become licensed in multiple participating member states. The state where the medical practice takes place is the state where the patient is located at the time of the first physician-patient encounter, and the physician is subject to the jurisdiction of the state medical board in that state. Where a physician may become licensed in several Compact states, an unfortunate event, such as a medical malpractice lawsuit and settlement could lead to more problems for a physician, making telemedicine a potential benefit and burden.

Pitfalls of multistate licensing and practice

In the event of a malpractice settlement, the insurance provider presents the case disposition information to the National Practitioner Data Bank, the clearinghouse for state medical practice information designed to protect the public from unfit doctors moving from state to state to avoid a negative practice history. If a doctor licensed in Illinois, is also licensed in other Compact states, all the state medical licensing boards may be notified of a malpractice settlement. While Illinois may not take disciplinary action against a doctor for settling a malpractice case, there is no telling what the boards in other Compact states may decide with respect to licensure in their state. If one of the states disciplines the physician, more states may get involved and investigate for purposes of discipline.

While there are plenty of patients for doctors to serve in outlying areas in Illinois, there is an increasing interest in telemedicine among individual providers who can better reach their practice goals through mobile health care technologies. Whether staying within the Illinois boarder or practicing across state lines, there are licensing considerations that may present burdens along with the benefits of telemedicine.

Michael V. Favia and Associates, P.C., works with physicians interested in bringing telemedicine into their practice, and advises doctors and organizations about licensing as it intersects with mobile health care.

Chicago health law and litigation attorney Michael V. Favia and his associates in several locations and disciplines, advise and represent licensed physicians in all types of litigation and administrative matters involving licensing and regulatory agencies.

Michael V. Favia and Associates, P.C. represents individual physicians and health care organizations in the Chicago area with a variety of legal matters. With offices conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. For more about Michael V. Favia & Associates, please visit www.favialawfirm.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter. You can also review endorsements and recommendations for Michael V. Favia on his Avvo.com profile and on LinkedIn.

[i] 225 ILCS 60/49.5(b)

[ii] 225 ILCS 60/49.5(c)(1)-(3)

[iii] House Bill 3680 Enrolled, Public Act 099.0076

State licensing issues affecting telemedicine practice among several states

Before engaging in telemedicine, it is important to seek advice and counsel to avoid unauthorized practice of medicine liability.

Before engaging in telemedicine, it is important to seek advice and counsel to avoid unauthorized practice of medicine liability.

Historically, state licensing boards and organizations require health care professionals to become independently licensed by each state in which they chose to practice medicine.[i] Surely, there are metropolitan areas in our nation where several states make up a metropolitan area, particularly on the East Coast. The Chicago metropolitan area spans across state lines to include residents of Wisconsin, Illinois and Indiana, and notably, Michigan is not too far from the Chicago area and many people keep weekend lake homes there. Consider an oncologist who manages care and treatment of cancer patients, who has a lake house in New Buffalo, Michigan and a practice based in Chicago. What happens when telemedicine allows the doctor to use technology to monitor Chicago patients from his lake house in Michigan?

As technology and telemedicine offer health care professionals new options, there are new questions arising in professional licensing among the states.

Telemedicine is the use of mobile technology to perform certain routine health care services. Common applications of telemedicine include a physician with rural patients who require services that could be performed through the use of mobile technology, saving the patients the time and expense of travel to the doctor’s main office. Telemedicine also reduces the use of the office space and staff when patients are seeing the doctor from home.

Latoya Thomas, director of the State Policy Resource Center for the American Telemedicine Association commented in a recent article about the increased frequency in which states and organizations are addressing the concerns raised about the practice of telemedicine and developing appropriate laws and policies. Thomas stated, “It is something I think hospitals across the country are becoming familiar with if they haven’t already,” Thomas says, “and trying to figure out how they can comply with current standards but also prepare themselves for any new policies that might come down the pike in 2016.”

There are some “safe harbor” rules for telemedicine and states adopting policies and procedures for mobile healthcare practice.

In another scenario, an out of state patient who sees a physician in Illinois, for example, can conduct a surgical follow-up visit online; Indiana, Illinois and Ohio permit online physician follow-up with established patients[ii]. Another instance of allowed interstate telemedical practice not requiring the physician be licensed in the outlying state is the safe harbor rule of infrequent patient treatment. Minnesota has a telemedicine statute stating, “An out-of-state physician who holds a valid license to practice medicine in another state need not possess a Minnesota license-nor even register with the Minnesota Board-if she provides telemedicine services on an “irregular or infrequent basis,” which is defined as less than once per month or to fewer than ten patients annually.[iii]

There is not a uniform law directing the standard of interstate telemedical practice yet. There are Telemedicine Practice Guidelines, however, offered by the American Telemedicine Association. Some states do allow physicians in neighboring or other states to practice medicine in their state without being independently licensed, but where the out of state physician practices with the same standard of care required in the individual state.

Before engaging in telemedicine, it is important to seek advice and counsel to avoid unauthorized practice of medicine liability.

Michael V. Favia and his associates and colleagues in health care law and litigation actively follow updates in mobile health care technology and the delivery of health care services. Favia works with clients not only with matters involving the practice of medicine directly, but also with the state licensing and regulation of health care professionals. When considering telemedicine, it is important to consult with the malpractice insurance provider and find out what policies control the location of the delivery of health care services.

Michael V. Favia & Associates are available to assist nurses and healthcare professionals with professional licensing matters. With offices conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. For more about Michael V. Favia & Associates’ professional licensing work, please visit www.IL-Licensing.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter.

[i] Healthcare Dive, State licensure issues challenging telemedicine borders, by Heather Caspi, Oct. 29, 2015

[ii] The National Law Review, The Out-of-State Practice of Telemedicine: Licensure Challenges and Opportunities, Oct. 21, 2015

[iii] See HNi above

Telemedicine Guidelines Adopted by the Federation of State Medical Boards

Chicago health lawyer, Michael V. Favia recently reviewed the model policy and stated, “Physicians and health lawyers should become familiar with these rules."

Chicago health lawyer, Michael V. Favia recently reviewed the model policy and stated, “Physicians and health lawyers should become familiar with these rules.”
Photo (C) Lavine: LTC Insurance

Imagine you have a cold or sore throat, something minor but you know you need to see a doctor to get the prescription you want to get better. Sometimes it is too difficult and our schedules are so demanding that it makes more sense to handle routine medical appointments using technology instead of driving to the doctor’s office or hospital. Imagine how much productivity time at work is lost due to employees being out of work seeking medical attention. There is a new technology in town, at a hospital or doctor’s office near you and it is called telemedicine.

Mayo Clinic is one of the hospitals taking advantage of telemedicine and technology to treat patients all over who seek the advice of a specialist at watch this video and see a demonstration of how it all works at Mayo when they use telemedicine.

Telemedicine is defined by the American Telemedicine Association (ATA) as “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.” Telemedicine may include services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology.[1]

Insurance companies, employers, hospital administrations all like the idea of telemedicine because the doctors can see more patients and there is a decreased burden on staff and hospital administration. Watch this interesting video demonstrating how telemedicine works. By going online and making an appointment with a doctor, the patient will be connected with their doctor or a license Doctor in their state. As you can imagine there are several concerns about law and policy regarding telecommunications and the practice of medicine when not conducted live and in person. The Federation of state medical boards House of Delegates recently adopted a model policy for the appropriate use of telemedicine technology, the “FSMB Telemedicine Policy.” A FSMB press release states that telemedicine, “provides much needed guidance and a basic roadmap that state boards can use to ensure that patients are protected from harm in a fast-changing health care delivery environment.”

Read the Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine. Chicago health lawyer, Michael V. Favia recently reviewed the model policy and stated, “Physicians and health lawyers should become familiar with these rules.[2]

Here is a summary as published in the recent article in the JD Supra Business Advisor,[3] “The FSMB Telemedicine Policy includes the following guidelines for the “appropriate use of telemedicine technologies in a medical practice:”

  • physician must be licensed or under the jurisdiction of the medical board of the state where the patient is located;
  • physician must take appropriate steps to establish a physician-patient relationship;
  • there must be a documented medical evaluation before providing treatment to the patient;
  • patient must provide informed consent for the use of telemedicine technologies;
  • patient should have the ability to seek, “with relative ease,” follow-up care from the physician who provided care through telemedicine;
  • physician must have an emergency plan in place if referral to an acute care facility or emergency room is appropriate for the patient;
  • patient’s medical records should be accessible and documented for the physician and patient in accordance with all requirements for medical records;
  • physician should “meet or exceed” federal and state privacy requirements, including HIPAA;
  • online services used by a physician should make specific disclosures including fee arrangements and physician contact information; and
  • steps need to be taken to ensure the prescribing physician upholds patient safety in the absence of an in-person examination, including confirming the identity of the patient.”

If you have any questions about the model policy and how health lawyers and physicians can take the proper steps to learn and integrate the policy into their practice you may contact Michael V. Favia for more information by calling (773) 631-4580.

If you are interested in learning more about Michael V. Favia & Associates, serving Chicago and its suburban communities, please visit the Favia Law Firm website for resources and articles of interest. To contact the firm to speak to a lawyer about a healthcare-related concern, you may dial (773) 631-4580. For more information about the firm’s practice areas, you can also visit the firm’s Facebook and Twitter sites. Please “LIke” and “Follow” respectively to keep in touch!

[1] JD Supra Business Advisor, State Medical Board Association Adopts Telemedicine Guidelines. By Bruce D. Armon and Karilynn Baus, May 9, 2014.

[2] Michael V. Favia is the principal of The Law Firm of Michael V. Favia & Associates in Chicago.

[3] See FN 1 above.