Telemedicine

The Washington Medical Commission has been developing its Telemedicine guidelines and standards for practitioners over the course of the last decade, and most recently put forward its November 19, 2021 Notice of Adoption of Policy POL2021—02, superseding MD2014-03 and PPOL2018-01, which touches on issues with Artificial Intelligence [AI] at the very end.

The same standard of care is owed the patient, regardless of whether telemedicine is utilized.  The practitioner should verify the identity of the patient.  Where the standard of care does not require an initial in-person encounter, the practitioner-patient relationship may be established when the practitioner agrees to undertake diagnosis or treatment of the patient and the patient agrees to the same.

Prior to issuing any prescriptions, the practitioner “should interview the patient to collect the relevant medical history,” at the very least, sufficient for the diagnosis and treatment.  It is within the practitioner’s judgment to determine whether it is medically necessary to perform a physical examination.  Beware, though, that “[a]n on-line questionnaire does not constitute an acceptable medical interview for the provision of treatment, including issuance of prescriptions, by a practitioner.  The standard of care requires direct interaction with a licensed practitioner.”  [Emphasis added]. 

However, in its definition of telemedicine, the WMC includes “a mode of delivering healthcare services using telecommunications technologies by a practitioner to a patient” when they are in different physical locations to “include[s] real-time interactive services, store-and-forward technologies, and remote monitoring.”  Store-and-forward technologies can include electronic mail or other texting portals.

But the practitioner should be wary of only relying on the definitions portion at the risk of disregarding the precise requirement of a “direct interaction” before issuing a prescription via telehealth, to meet the standard of care.