What DCs Should Know about Telemedicine

With telemedicine becoming an increasingly popular way to communicate with and treat patients, what are the implications for Doctors of Chiropractic?

Posted in Risk Management on Wednesday, October 9, 2019

As new technology is utilized, developed and expanded, and reimbursement is becoming more common, how can DCs adapt to these changes in caring for their patients? 

Moving from Hands-On to Online

The job of a chiropractor is very hands-on, so the amount of work a provider can do via telemedicine is limited. In the chiropractic world, telemedicine is intended to enhance rather than replace in-person care. Knowing that each state has their own regulations and requirements to check and keep in mind, the following are a few possible options for DCs for practicing telemedicine:

• Talk with a patient about their symptoms
• Check in with the patient on their progress
• Provide radiology services
• Consult with patients regarding nutrition and supplementation

Not So Fast: What to Know Before Venturing Down the Electronic Highway

All states have created their own rules and regulations, or a “position statement” regarding telemedicine, so before you decide to venture down this electronic highway, it is important to know your state’s requirements as well as the requirements where your patient resides. All DCs must be licensed in the state in which they practice. It is also important to remember, that the standard of care is the same whether you are seeing the patient in person or via telemedicine.

The Federation of State Medical Board’s (FSMB) definition of telemedicine includes the statement that, “[Telemedicine] typically involves the application of secure videoconferencing or store-and-forward technology to provide/support healthcare delivery by replicating the interaction of a traditional encounter in person between a provider and a patient.” This statement is important because it clarifies that normal telephone and electronic communications between a provider and patient do not constitute telemedicine.

You Need to Know: The Risks Associated with Telemedicine

Important risks to be aware of in telemedicine, just like in-person visits, are in documentation. In addition to documenting the interaction as you would an in-person visit, when using telemedicine, the documentation should include:

• All providers and staff involved in the telemedicine visit. As the patient may have other individuals with them during the visit, document those individuals by name along with their relationship.
• Where the patient is located. Whether this is the patient’s home or a long-term care facility, document where the patient resides. Document the state where you reside in the patient’s record as well.
• If the patient resides in multiple states. The general rule of thumb is that you must be licensed in the state where the patient is located. While many states are addressing this issue, check with your counsel regarding situations such as this so you know the landscape.
• When the conversation starts and ends. Make sure your documentation includes when your conversation started and ended in your notes in order to provide a thorough tracking of your conversation and history with the patient.
• Patient medical history. Just as you would in person, check the patient’s medical history before offering any advice or treatment options.

Don’t Get Too Comfortable: Things to Keep in Mind

In addition to a specific informed consent procedure, there is a finesse required for telemedicine to be effective and profitable.

• For the doctor/staff: It is important that the provider be as professional during a telemedicine conference as they are when seeing the patient in person.
  • This means your appearance and demeanor convey the professionalism you want to demonstrate to your patient so you can ensure their trust in your ability.
  • Staff involved should be appropriately licensed and trained in the use of the telemedicine equipment.
• The surroundings: Be sure the space allocated for telemedicine is private and large enough to recognize the potential need for any additional equipment/staff necessary for your virtual visit.
  • Like your personal appearance, your surroundings should reflect your professionalism.

With the future of telemedicine and its implications on the future of healthcare, consider researching your state’s requirements for practicing telemedicine. It could provide greater benefits for your patients and your practice.