would permit those providers to make a diagnosis, which is outside the scope of practice of their licenses.
• It specifically allows the creation of a patient-physician rela- tionship during an initial encounter by telemedicine, which is not in accordance with the standard of care.
TMA supports TMB’s telemedicine medical services rules. Dr. Curran told the committee the TMB telemedicine rules
“are comprehensive and were adopted after thorough stake- holder input.” He added they “address the requirement of a prior patient-physician relationship, protection of privacy, adoption of protocols to prevent fraud and abuse, the use of a patient site presenter, and the delegation of tasks and activities to a patient site presenter during a patient encounter.” TMA presented the following amendments to HB 1806 to help ensure patient safety and high-quality care:
• Ensure telemedicine services meet TMB rules and the tradi- tional standard of care.
• Establish requirements for a true face-to-face consultation between a patient and a physician providing a telemedicine medical service.
• Establish a referral network and follow-up care from the physician providing the care.
• Require that patients continue to receive care from the same physi- cian who provided the telemedicine medical service.
• Establish standards for adequate physician delegation and supervi- sion of nonphysician health profes- sionals who assist in telemedicine services as distant site presenters.
• Establish the maximum number of heath care professionals to which a physician may delegate and super- vise through a telemedicine medi- cal service.
• Add language prohibiting discrimi- nation against local physicians willing to provide the same level of after-hours access whether through telephonic consultation or in-per- son visits.
Dr. Curran concluded his testimony
by saying TMA and TAFP are willing to work with the committee to de- velop a substitute to HB 1806 that en- sures telemedicine services allow safe access to care for more Texas patients. Bruce Moskow, MD, an Austin
emergency physician, testified on Sen- ate Bill 830 by Sen. Charles Schwert-
TMA online communication policy
TMA has long-standing policy covering online communication be- tween physicians and patients and guidelines for fee-based online consultations. It urges physicians to develop written electronic patient com-
munication procedures on avoiding emergency use, protecting pa- tient medical information, appropriate expectations for response times, hours of operation, patient-identifying information that should be used in all communication, types of transactions that will be permitted electronically, and quality oversight. The policy also recommends conducting online patient-physi-
cian communications over a secure network, with provisions for authentication and encryption. The physician is responsible for taking reasonable steps to authenticate the identity of correspon- dents in an electronic communication and to ensure the recipient is authorized to receive the information. In addition, TMA established guidelines for fee-based online
consultations, defined as clinical consultations “provided by a physician to a patient using the Internet or other electronic com- munications network in which the physician expects payment for the service.” To read “Guidelines for Electronic Communications (Email) with
Patients” from the Texas Medical Board and the Texas Medical Liability Trust, visit
www.texmed.org/HealthIT, scroll down, and click on E-Communication.
June 2013 TEXAS MEDICINE 21
ner, MD (R-Georgetown), on behalf of TMA and the Texas Col- lege of Emergency Physicians. Dr. Moskow said the bill would preclude the Texas Department of State Health Services from
“requiring the physical presence or physical availability of a physician” capable of rendering critical care services at a Level IV trauma facility. As drafted, SB 830 would allow telemedicine to replace the
on-site physician in the trauma teams in Level IV trauma cen- ters in counties of 50,000 or fewer residents. At press time, SB 830, HB 1806, and HB 2017 were pending
in their respective committees. For updated information on these and other bills, visit
www.texmed.org/legislature.
Telemedicine’s potential Dr. Curran says telemedicine can be particularly effective in consulting with specialists. He works as a hospitalist at East Texas Medical Center. During a shift, one of his medical part- ners’ patients came into the emergency department. The dis-
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