When you’re stepping into telemedicine, you’re entering a world where healthcare meets technology—and that intersection comes with its own set of rules. You’ll need to navigate federal regulations, state licensing requirements, and professional standards that can vary dramatically depending on where you practice and where your patients are located.
The most fundamental rule? You must be licensed in the state where your patient is physically located during the consultation. This means if you’re in California treating a patient vacationing in Florida, you need a Florida license. It’s not about where you are—it’s about where they are.
Patient Authentication and Verification
When looking at the rules for telemedicine providers and your practice, you first need to know who you’re treating. This isn’t just good practice; it’s a requirement. You’ll want to verify patient identity through multiple data points: full name, date of birth, address, and sometimes additional identifiers like the last four digits of their Social Security number.
Document everything. Create a clear record of how you verified the patient’s identity and location. Some providers use photo identification verification, while others rely on existing patient portals with established credentials.
Establishing the Provider-Patient Relationship
Here’s where things get interesting. Some states require an initial in-person visit before you can provide telemedicine services, while others allow you to establish the relationship entirely through virtual means. You’ll need to check your state’s specific requirements, but generally, you should:
- Conduct a thorough virtual examination appropriate to the patient’s presenting complaint
- Review relevant medical history
- Clearly explain the limitations of telemedicine
- Obtain informed consent for virtual care
The key is to ensure that you can provide the same standard of care as you would in person. If you can’t adequately assess or treat the patient virtually, you need to refer them for in-person care.
Documentation and Record Keeping
Your documentation standards don’t change just because the visit is virtual. Every telemedicine encounter requires the same level of detail you’d provide for an in-person visit. Include the date, time, duration of the consultation, technology platform used, and any technical issues encountered.
You should also document the patient’s location and your own location during the visit. Some states require this information for licensing compliance. Store all records according to your usual retention policies and ensure they’re accessible for continuity of care.
Prescribing Medications: Navigate Carefully
This is where many providers feel uncertain, and rightfully so. The rules around prescribing via telemedicine are complex and constantly evolving. Generally, you can prescribe non-controlled substances if you’ve established a proper provider-patient relationship and conducted an appropriate examination.
Controlled substances are trickier. The DEA has specific requirements, and many states have additional restrictions. During public health emergencies, rules may be relaxed, but don’t assume—verify current regulations.
Never prescribe medications you haven’t personally evaluated the patient for, and always check for drug interactions and allergies just as you would in person.
Technology and Privacy Compliance
Your telemedicine platform must be HIPAA-compliant. Consumer video services like Skype or FaceTime generally don’t meet these requirements. You need:
- End-to-end encryption
- Business associate agreements with technology vendors
- Secure data storage and transmission
- Patient access controls
Emergency Protocols Matter
You must have clear protocols for handling medical emergencies during virtual visits. Know how to quickly connect patients with local emergency services, and always document your emergency response procedures.
Remember, telemedicine is a tool to extend your reach and improve access to care. When used appropriately and within regulatory boundaries, it can transform how you serve your patients while maintaining the quality and safety they deserve.