Telehealth In The Practice Of Optometry

(1) Definitions (a) Healthcare Provider, as used in this rule, means an optometrist acting within the scope of a valid license and a graduate or a student as defined in T.C.A. § 63-1-155. (b) Emergency as referenced in T.C.A. § 63-1-155 – A situation or condition where failure to provide immediate treatment poses a threat of loss of sight to a person. For the purposes hereof, routine visual care shall not be an emergency. (c) In-person – A patient encounter conducted by a healthcare provider who is at the same physical location as the location of the patient. GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02 (d) Patient Encounter – The rendering of a documented healthcare provider opinion concerning evaluation, diagnosis, and/or treatment of a patient whether the healthcare provider is physically present in the same room, in a remote location within the state, or across state lines. (e) Telehealth – Shall be defined as provided in T.C.A. § 63-1-155. (2) Establishment of a Healthcare Provider-Patient Relationship. A healthcare provider shall not render telehealth services, ophthalmic prescribing and eye health services, advice and/or care without: (a) Fully verifying, to the extent possible, the requesting patient’s identity; (b) Disclosing the healthcare provider’s identity and applicable credential(s) to the patient; and (c) Obtaining appropriate consents from requesting patients after disclosures regarding the delivery models and treatment methods or limitations, including any special informed consents regarding telehealth. (3) The Appropriate Use of Telehealth in Optometric Practice (a) Policy Statement – The Tennessee Board of Optometry has developed these rules to educate healthcare providers as to the appropriate use of telehealth in the practice of optometry. The Tennessee Board of Optometry is committed to ensuring patient access to the convenience and benefits afforded by telehealth, while promoting the responsible practice of optometry by a healthcare provider. These rules shall not be construed to alter the scope of practice of any healthcare provider or authorize the delivery of eye health and vision services in a setting, or in a manner, not otherwise authorized by Tennessee law. (b) Authority to practice telehealth is outlined in T.C.A. § 63-1-155. The patient shall be physically located in Tennessee. (c) Informed Consent 1. Evidence documenting appropriate patient informed consent for the use of telehealth shall be obtained and maintained. Documentation of informed consent that is signed and dated, including electronic acknowledgment or signature of the patient, establishes a presumption of informed consent. Appropriate informed consent should include the following terms: (i) Identification of the patient, the healthcare provider and the healthcare provider’s credentials; (ii) Types of transmissions permitted using telehealth; (iii) Necessity of in-person patient encounter. When, for whatever reason, the telehealth modality in use for a particular patient encounter is unable to provide all pertinent clinical information that a healthcare provider exercising ordinary skill and care would deem reasonably necessary for the practice of optometry at an acceptable level of safety and quality in the context of that particular encounter, then the distant site healthcare provider shall make this known to the patient and advise and counsel the patient regarding the need for the patient to obtain an additional in-person patient encounter reasonably able to meet the patient’s needs; GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02 (iv) Limitations of telehealth. A provider who uses telehealth, before providing services, shall give each patient notice regarding telehealth services, including the risks and benefits of being treated via telehealth, and how to receive follow-up care or assistance in the event of an adverse reaction to the treatment or in the event of an inability to communicate as a result of a technological or equipment failure; and (v) Details on security measures taken with the use of telehealth, such as encrypting data, password protected screen savers and data files, or utilizing other reliable authentication techniques, as well as potential risks to privacy notwithstanding such measures. (d) Continuity of Care. Patients should be able to seek, with relative ease, follow-up care or information from the healthcare provider who conducts a telehealth encounter. Healthcare providers solely providing services using telehealth with no existing healthcare provider-patient relationship prior to the encounter, shall make documentation of the encounter available. Subject to the patient’s request and consent, documentation of the telehealth encounter shall be made available to any identified care provider within a reasonable time after the telehealth encounter. (e) Optometric Records. The patient’s optometric record should include, if applicable, copies of all patient-related electronic communications, including healthcare provider- patient communication(s), prescriptions, laboratory and test results, evaluations and consultations, records of past care, and instructions obtained or produced in connection with the utilization of telehealth. Informed consents obtained in connection with an encounter involving telehealth should also be filed in the patient’s examination record. The patient record established during the use of telehealth shall be accessible and documented for both the healthcare provider and the patient, consistent with T.C.A. §§ 63-8-101, et seq. (f) Privacy and Security of Patient Records and Exchange of Information 1. Healthcare providers shall meet or exceed applicable federal and state legal requirements of optometric patient encounters/health information privacy, including compliance with the Health Insurance Portability and Accountability Act (HIPAA) and State of Tennessee privacy, confidentiality, security, and optometric record retention rules. 2. Healthcare providers shall ensure that sufficient privacy and security measures shall be in place and documented to assure confidentiality and integrity of patient-identifiable information. (g) Prescribing 1. Telehealth, when prescribing medications and ophthalmic materials may be contemplated, shall require a healthcare provider to implement measures to uphold patient safety in the absence of a traditional in-person patient encounter. Such measures shall guarantee that the identity of the patient and provider is clearly established and that detailed documentation for the clinical patient encounter and resulting prescription is both enforced and independently kept. 2. Prescribing medications, in-person or via telehealth, is at the professional discretion of the healthcare provider based on licensure. The indication, appropriateness, and safety considerations for each telehealth visit prescription shall be evaluated by the healthcare provider in accordance with current GENERAL RULES GOVERNING THE PRACTICE OF OPTOMETRY CHAPTER 1045-02 standards of practice and consequently carry the same professional accountability as prescriptions delivered during an in-person patient encounter. However, where such measures are upheld, and the appropriate clinical consideration is carried out and documented, healthcare providers may exercise their judgment and prescribe medications as part of telehealth encounters. 3. For telehealth ophthalmic prescriptions, the same requirements exist as for fixed fee in-person services as outlined in Tenn. Comp. R. & Regs. 1045-02-.08.