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INTRODUCTION

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The Practice of Medicine via Telehealth Technologies

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The practice of medicine via telehealth carries with it myriad opportunities as well as unique challenges. One area of particular attention is legal and regulatory compliance. No longer may health care providers follow only the law of their single “home” state as they expand to offer services to patients located across the country and the world. Just as telehealth requires its own tailored clinical approaches, so, too, does it require specific legal solutions and business structures designed to fully harness the promise of telehealth while remaining compliant with the complex universe of state and federal laws. This chapter addresses some of the key legal and regulatory issues in telehealth.

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Telehealth and State Licensing
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It is widely understood and accepted that in order to practice medicine, an individual must have a license. Licensing is a state law issue, and medical boards have jurisdiction over physician licensing. For telehealth services, licensing rules and applicable state medical practice laws are based not on the location of the physician, but rather the location of the patient at the time of the consult. For example, a physician licensed in New York and providing telehealth services to a patient located in Florida must have a license to practice medicine in Florida (or otherwise meet a licensure exception).

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With the development of telehealth practices sweeping across geographic boundaries, licensure has become more of an impediment than it has been in the past. Patients want access to the best specialists, regardless of where they are located. They already have the technology to receive those consults. However, licensure remains a requirement and, for many, an administrative burden (although not insurmountable).

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Attempts are underway to help streamline medical licensing. The most notable is the Federation of State Medical Board's Interstate Licensing Compact. This offers a uniform, fast-track option for a physician to obtain multiple licenses in the participating compact states. Thus far (October 2016), 17 states have passed laws to join the compact. States also offer a number of exceptions to licensure, allowing a doctor licensed in one state to deliver care (typically on a limited basis) to patients in the state where the doctor is not licensed. Some exceptions include medical emergencies and disasters, neighboring/border states, follow-up care, free “curbside” informal consults, and peer-to-peer consultations. Although certain exceptions exist in every state, they vary significantly, and providers should carefully understand the requirements or else risk unlicensed practice of medicine.

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Telehealth and the Standard of Care
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Fundamental to the practice of medicine, whether in person or via telehealth, is to meet the standard of care and deliver high-quality services. To that end, providers should adhere to the same standard of care in telehealth settings as they would when delivering care in person. Thus, labs, vitals, physicals, and any other information obtained ...

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