Best Practices for Telehealth Medicine
Use a HIPAA-compliant video platform with a signed business associates agreement—platforms like Skype that lack this agreement are non-compliant and have resulted in medical board sanctions. 1
Platform Selection and Technical Setup
The platform must meet HIPAA Omnibus Rule requirements through a formal business associates agreement with the vendor 1. A 2014 case in Oklahoma resulted in a physician receiving 2 years of probation for using non-compliant platforms for telepsychiatry 1.
Key technical considerations include:
- Ensure stable network connectivity with backup plans for unstable connections 2
- Address IT security and privacy issues proactively 2
- Set up appropriate telehealth environments that optimize visualization and minimize distractions 2
Pre-Visit Preparation
Before the encounter:
- Verify patient identity using multiple identifiers (name, date of birth, patient identification number) 3
- Obtain and document informed consent specifically for telehealth services 3, 4
- Confirm the patient's physical location for licensure and emergency response purposes 1
- Test technology with the patient beforehand to address access barriers 2
Conducting the Visit
History Taking and Communication
- Build rapport and trust early in the encounter, as this requires enhanced effort in virtual settings 2
- Use nonmanual communication methods effectively (verbal cues, facial expressions) 2
- Address patient or caregiver skepticism about telehealth through education 2
- Conduct history taking to the same standard as in-person visits 1
Visual Examination
- Enhance observation and assessment skills specific to video limitations 2
- Request patient positioning and lighting adjustments to optimize visualization 2
- Recognize when physical examination limitations necessitate in-person evaluation 1
Documentation Requirements
Document consistently:
- Date of service 3
- Patient identification number 3
- Communication method used 3
- Patient informed consent 3
- Diagnosis and clinical impression 3
- Evaluation results and recommendations 3
- Any technical issues encountered 3
Documentation should meet the same standards as in-person encounters and support billing/reimbursement requirements 1, 3.
Electronic Prescribing
Apply the same prescribing standards as face-to-face encounters—telemedicine must not be held to different standards unless medically justified. 1 Legal challenges in telemedicine have primarily involved alleged illegalities in prescribing drugs over the Internet rather than negligent care delivery 1.
When In-Person Visits Are Required
An in-person visit is necessary when:
- Physical examination findings are essential for diagnosis or management and cannot be adequately assessed virtually
- Safety concerns arise that require hands-on evaluation
- The clinical situation exceeds the limitations of remote assessment 2, 5
Do not mandate arbitrary requirements like telepresenters at every visit unless clinically indicated—this creates unnecessary barriers without medical justification. 1
Liability Protection
Verify that medical liability insurance explicitly covers telemedicine services, as policies vary by state and carrier 1. Physicians providing telehealth have the same duty of care as in-person encounters 1.
Common Pitfalls to Avoid
- Using consumer-grade platforms without business associates agreements 1
- Failing to verify patient location for licensure compliance 1
- Inadequate documentation of consent and encounter details 3
- Not having contingency plans for technology failures 2
- Assuming all clinical scenarios are appropriate for telehealth without assessing examination limitations 1