The Practice Of Telehealth Or Telemedicine

No person shall engage in the practice of chiropractic remotely using information transmitted electronically or through other means, on a patient within the state of Tennessee unless duly licensed by the Board in accordance with the provisions of the current statutes and rules. Unless specifically set out in this rule, this rule is not intended to and does not supersede any pre-existing federal or state statutes or rules and is not meant to alter or amend the applicable standard of care in any particular healthcare field or to amend any requirement for the establishment of a chiropractic physician-patient relationship. (1) Definitions - (a) Facilitator - The facilitator is an individual often affiliated with a local system of care or a parent or legal guardian of the patient. The facilitator must be physically present with the patient and is responsible for verifying the identity and location of the patient and for the origination, collection and transmission of data in the form of images or clinical data to the chiropractic physician performing the evaluation remotely. (b) Medical interpretation - The performance of a medical interpretation by a chiropractic physician is the rendering of a diagnosis regarding a particular patient by patient history, observation, examination of radiologic imaging studies, advanced imaging, laboratory reports (including, but not limited to urine, blood, saliva and hair) or medical records requested by another physician or licensed health care provider. (c) Patient encounter - The rendering of a documented medical opinion concerning evaluation, diagnosis, and/or treatment of a patient whether the chiropractic physician is physically present in the same room, in a remote location within the state or across state lines. (d) Chiropractic physician-patient relationship - A chiropractic physician-patient relationship is created by mutual consent and mutual communication, except in an emergency, between the patient and the chiropractic physician. The consent by the patient may be expressed or implied consent; however, the chiropractic physician-patient relationship is not created simply by the receipt of patient health information by a provider unless a prior chiropractic physician-patient relationship exists. The duties and obligations created by the relationship do not arise until the healthcare provider: 1. Affirmatively undertakes to diagnose or treat the patient; or 2. Affirmatively participates in the diagnosis or treatment. GENERAL RULES GOVERNING CHIROPRACTIC EXAMINERS CHAPTER 0260-02 (e) Store-and-forward technology - Defined by T.C.A.§ 63-1-155. (2) Effect of License - The issuance by the Board of a license to practice chiropractic subjects the licensee to the jurisdiction of the Board in all matters set forth in the Chiropractic Practice Act and implementing rules and regulations, including all matters related to discipline. The licensee agrees to produce patient medical records and materials as requested by the Board and to appear before the Board upon receipt of notice from the Board commanding such appearance. Failure of the licensee to appear and/or to produce records or materials as requested, after appropriate notice, shall constitute grounds to suspend or revoke the license at the Board’s discretion. (3) Chiropractic physicians who are contractually obligated to provide and/or deliver chiropractic services in Tennessee must be licensed to practice chiropractic in Tennessee, regardless of whether such services are in exchange for direct compensation. (4) A chiropractic physician licensed in Tennessee may engage in the practice of telehealth “telemedicine” under the following circumstances: (a) Except as provided under paragraphs six (6) and seven (7) of this rule, the patient encounter to establish or maintain the chiropractic physician-patient relationship via telehealth/telemedicine between the chiropractic physician in a remote location and the patient in Tennessee may occur with or without the use of a facilitator so long as such encounter is consistent with parts 1. and 2. of this rule: 1. If no facilitator is present: (i) The patient must utilize adequately sophisticated technology to enable the remote provider to verify the patient’s identity and location with an appropriate level of confidence; (ii) The patient must transmit all relevant health information at the level of store-and-forward technology or secure video conferencing; and (iii) The remote provider must disclose his or her name, current and primary practice location, chiropractic degree and recognized specialty area, if any, and all additional information required pursuant to T.C.A. § 63-1-109. 2. If a facilitator is present: (i) The facilitator must personally verify the identity of the patient; however, all relevant health information must be transmitted to the remote provider using at least the level of store-and-forward technology. The facilitator and the patient may interact with the provider at the remote location via secure video conferencing or store-and-forward technology; (ii) The facilitator must identify himself, his role, and his title to the patient and the remote chiropractic physician; and (iii) The remote chiropractic physician must disclose his name, current and primary practice location, chiropractic degree and recognized specialty area, if any, and all additional information required pursuant to T.C.A. § 63- 1-109. GENERAL RULES GOVERNING CHIROPRACTIC EXAMINERS CHAPTER 0260-02 (b) For patient encounters conducted via telehealth/telemedicine, the chiropractic physician should have appropriate patient record(s) or be able to obtain such information during the telehealth/telemedicine encounter. (c) The chiropractic physician engaging in telehealth/telemedicine is responsible for ensuring that the medical record contains all pertinent data and information gleaned from the encounter. A chiropractic physician conducting a patient encounter via telehealth/telemedicine must so document in the patient record and must state the technology used. All records for Tennessee patients are subject to inspection pursuant to T.C.A. § 63-1-117. (d) If the information transmitted through electronic or other means as part of a patient’s encounter is not of sufficient quality or does not contain adequate information for the chiropractic physician to form an opinion, the chiropractic physician must declare that he cannot form an opinion to make an adequate diagnosis and must request direct referral for inspection and actual physical examination, request additional data, or recommend the patient be evaluated by the patient’s primary physician or other local health care provider. (5) A chiropractic physician licensed by the Board may, if requested to do so by another chiropractic physician licensed by the Board, engage in medical interpretation as defined in these rules and render an opinion based on data which is transmitted electronically. In such cases, the chiropractic physician providing the medical interpretation need not examine the patient and need not have the complete medical record accessible, unless the interpreting chiropractic physician believes that additional information is necessary. Any opinion rendered by such interpreting chiropractic physician must be reduced to writing which includes the name and electronic signature of the interpreting chiropractic physician. (6) No patient seeking care via telehealth/telemedicine who is under the age of eighteen (18) years of age can be treated unless there is a facilitator present, except as otherwise authorized by law. (7) No person shall engage in the practice of chiropractic on patients in this state, hold himself out as qualified to do the same, or use any title, word, or abbreviation to indicate to or induce others to believe that he is licensed to do the same, unless he is licensed to practice chiropractic in this state.