The Medical Board occasionally receives inquiries for information and advice from physicians who have been contacted by recruiters or who have seen advertisements for various telemedicine positions and providers. The Board recognizes that telemedicine is a useful tool with evolving technology that, if employed appropriately, may provide important benefits to patients. However, physicians should protect themselves by thoroughly evaluating a telemedicine provider and proposed means of delivering care before agreeing to treat patients via telemedicine.
Here are several important considerations:
How are you being contacted?
Your point of contact may not be the actual owner of the telemedicine service. A recruiting company, email contact or advertisement may provide vague or incorrect answers to your questions. Affirmatively determine who actually owns the telemedicine service. The owner of the telemedicine practice may be an out-of-state non-physician, which could raise concerns about illegal or unethical business arrangements.
Have an attorney experienced in North Carolina health care law review all contracts and documents.
Confirm that the means you will be using to provide patient care remotely is acceptable and in accord with North Carolina law and Medical Board policies.
If you will be providing telemedicine patient care in more than one state be aware of the multiple state license domino effect.
Many practitioners who primarily practice telemedicine hold medical licenses in multiple states. If an individual is disciplined by a medical board in one state, it often rapidly triggers a series of medical board investigations in all states where a physician is licensed. It’s possible to be disciplined by other state medical boards for conduct in a different state, even if you have not provided any patient care—via telemedicine or face-to-face—in those other states.
Physicians practicing via telemedicine will be held to the same standard of care as licensees employing more traditional inperson medical care.
You will be held to the standard of care applicable to the type of care you are providing. There is no watered down or special standard of care for telemedicine practice. If you are providing primary or family medicine type care you will be held to the standard of care expected of a family medicine physician seeing the patient in person. A failure to conform to the appropriate standard of care may subject the physician to discipline by the Board.
Physicians using telemedicine to provide care to patients located in North Carolina must provide an appropriate examination prior to diagnosing or treating the patient.
Obviously, the examination will not be exactly the same as an exam conducted in person. However, the examination must be substantially equivalent to one that would be conducted in person and allow the practitioner to gather all needed information to make a diagnosis.
Physicians using telemedicine should have some means of verifying that the person seeking treatment is in fact who they claim to be.
For example, it is not appropriate to prescribe antibiotics to a wife who does a telemedicine consultation on behalf of her husband. In some cases the Board is familiar with telemedicine practitioners have prescribed in the name of the patient they are speaking to knowing that the medication is intended for another party. This is clearly substandard practice.
Licensees using telemedicine must ensure the availability of appropriate follow-up care and maintain a complete medical record.
Records must be available to the patient and to other treating health care providers.
Prescribing controlled substances by means of telemedicine is an invitation to disaster.
Don’t do it.
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View the North Carolina Medical Board’s official position statement on Telemedicine.
