What key issues should healthcare professionals be aware of when providing telehealth services?

Telehealth has expanded the availability of medical and mental health treatment to individuals in areas where providers are not easily accessible, to those who have health issues that make in-person treatment often difficult, and to those who simply like the convenience of seeing a provider via telehealth. While the use of telehealth has increased significantly, any healthcare professional engaged in telehealth should be aware of some key issues.

 

• Professional practice occurs where the patient/client is located. 

For almost all healthcare professionals, most states define the practice of the profession as occurring where the patient or client is located.  This means that the provider who is providing telehealth services to an individual must be licensed in the state in which the individual receiving the service is located.   Providing telehealth services without being licensed in the state where the patient/client is located is practicing without a license in that state.   For many local healthcare practices, this is often not an issue unless the patient lives over a state border or is seeking services while out of their home state. However, there has also been an increase in multi-state practices providing services to patients/clients in several different states; this has been especially true in the area of mental health.  Providers working for such multi-state businesses should ensure that they are not assigned to see patients/clients in states in which they do not hold a license.  Do not rely solely on representations from multi-state practices that they have “okayed” a provider’s practice in a state in which the provider does not hold a license or have submitted an application on the provider’s behalf.  A provider should always perform their own due diligence and ensure that they are indeed legally able to provide services in a state.  

 

• The standard of care required does not change.

The standard of care that a provider must uphold in an in-person encounter with a patient/client does not change simply because the encounter is via telehealth.  Providers must ensure that any services provided via telehealth are appropriate for a telehealth encounter; if the service provided would not be able to be appropriately performed via telehealth modalities, the patient must be seen in person. Providers must ensure that appropriate records are kept of the encounter as would be with an in-person encounter. Additionally, providers must ensure that any telehealth platform they utilize is HIPAA complaint.

 

• States vary in the scope of services that can be provided via telehealth and through which modality telehealth may be performed.

Many states have adopted statutes and regulations related to telehealth and the requirements for telehealth vary widely between states.  Some states, such as Nevada, allow telehealth to be conducted by either synchronous or asynchronous interactions and allows for audio only interactions (there are some additional requirements if insurance is to be billed in some cases).  In other states however, for example New Mexico, real-time audio-visual interactions are required.  Providers must not assume that telehealth requirements are the same in every state.  Additionally, providers should understand if there are limitations on what services can be provided through telehealth.  Can certain assessments be completed remotely? Can controlled substances be renewed via telehealth?  Providers must understand the limitations that may be placed on them by various states in which they wish to practice telehealth.   

While telehealth is becoming more prolific across healthcare, one size definitely does not fit all.  Understanding the requirements and limitations imposed by different states on the practice of telehealth is crucial for those providing care and treatment in this fashion.