Is it safe to receive telemedicine services from a provider licensed in another country while residing in the United States (US)?

Receiving Telemedicine Services from Providers Licensed in Other Countries While in the US

It is not safe or legally permissible to receive telemedicine services from a provider who is only licensed in another country while residing in the United States, as medical practice is considered to occur where the patient is located, requiring the physician to be licensed in that jurisdiction. 1, 2

Legal and Regulatory Framework

• Medical practice is legally considered to occur where the patient is physically located at the time of the physician-patient encounter, requiring the physician to be under the jurisdiction of the state medical board where the patient is located 1
• There have been no opinions issued by state boards that electronic diagnosis and treatment is not a form of medical practice, meaning medical licensure in the patient's state is a prerequisite to providing telemedicine services 1
• States have taken actions against out-of-state physicians for practicing medicine without a license in the patient's state, including for internet prescribing violations 1
• The Interstate Medical Licensure Compact within the US expedites licensure across participating states, but this does not extend to international providers 1, 2

Patient Safety Concerns with International Telemedicine

• Without proper licensing and regulatory oversight, patients have limited legal recourse in cases of malpractice when using providers from other countries 2
• International telemedicine faces additional barriers including linguistic differences between patients and remote providers, which may lead to miscommunication and medical errors 2
• Technological limitations such as inadequate bandwidth for high-resolution images or videoconferencing may compromise diagnostic accuracy when services cross international borders 2
• Different standards for patient confidentiality and data security between countries may put patient information at risk 1

Technical and Security Considerations

• Patient confidentiality requires secure transmission and storage of electronic data and media, which becomes more challenging across international boundaries with different data protection standards 1, 2
• Each telemedicine encounter should begin with confirmation of provider and patient identities, including possible display of photo identification 1
• The provider is responsible for ensuring secure transmission and storage of electronic data, which may be difficult to enforce with international providers 1

Potential Limited Exceptions

• Medical consultation (as opposed to diagnosis and treatment) may have somewhat less clear requirements, but still generally requires appropriate licensure 1
• Educational opportunities through international telemedicine as a "university without borders" may be possible in certain structured programs, but this is different from direct patient care 3

Practical Recommendations

• Patients seeking telemedicine care should prioritize providers licensed in their state to ensure legal compliance and recourse in case of malpractice 2
• If seeking specialized expertise from international providers, this should be done through established programs where the international provider collaborates with a locally licensed physician 2, 3
• For patients requiring care while traveling internationally, connecting with US-licensed providers through US-based telemedicine platforms may be preferable to seeking care from local providers unfamiliar with your medical history 4

Future Developments

• Some have advocated for regional or national approaches to licensure in response to the growth of telemedicine, but these efforts have not yet extended to international practice 1, 5
• The TELE-MED Act proposals would allow providers licensed in one state to provide telemedicine to Medicare patients in different states, but this legislation has not been enacted and would not address international practice 1, 2
• As telemedicine continues to evolve, international agreements similar to the Interstate Medical Licensure Compact could potentially develop, but currently do not exist 5, 6