The Maine Board of Licensure in Medicine enacted new guidelines governing the practice of telemedicine and the use of technology to deliver health care services. Effective June 2014, Maine’s guidelines expand upon prior Board advisory rules and policies. The guidelines, which are flexible and forward-thinking to protect patient safety while allowing for health innovation, represent the Board’s overall approach to telemedicine practice in Maine.
Regrettably, the Maine guidelines appear to use the terms “face-to-face” and “in-person” interchangeably, and not always with consistency. This may cause some confusion among telemedicine providers, so it is essential to review Maine’s guidelines in their overall context to best understand the intent. Other states continue to adopt a more standardized approach by using “in-person” to mean when the provider and patient are physically located in the same room, and recognizing that a “face-to-face” consult may occur via telemedicine interactive audio and video.
- Maine License Required: A Maine medical license is required for the practice of telemedicine with patients located in Maine, as the practice of medicine occurs at the location of the patient.
- Practice Standards: The same standards of practice for physician interaction, treatment, recommendations, and prescribing apply, regardless of whether the physician provides services via telemedicine or traditional in-person encounters. The telemedicine interaction must include all the recognized components of a patient-physician encounter required to establish a diagnosis and treatment.
- In-Person Examinations: Maine does not require an in-person examination prior to the telemedicine encounter. A valid doctor-patient relationship may be created via telemedicine. However, physicians offering primary care via telemedicine, other than acute episodic care, are required to conduct a “face-to-face” visit with their patient at least once a year.
- Remote Prescribing: Under the guidance, physicians may conduct remote prescribing without the need for an in-person exam. Remote prescribing is at the discretion of the prescribing physician and is held to equivalent standards for in-person encounters. Where proper measures are followed, and the appropriate clinical consideration is carried out and documented, physicians may exercise their judgment and prescribe medication as part of telemedicine encounters. Providers may not engage in internet prescribing. The guidance is silent on remote prescribing of controlled substances.
- Accessibility of Medical Records: Medical records are expected to satisfy Maine’s medical record standards and confidentiality rules, and must be maintained at the distant site. Records must be accessible to local health care providers and facilities upon request.
- Informed Consent: Maine’s consent requirements are more onerous than other states. Patient consent to the use of telemedicine technologies must be obtained, and should include:
- Patient and physician identification
- Types of telemedicine interactions/transmissions permissible such as prescriptions, refills, education, diagnosis, and appointment scheduling
- Security measures taken with use of telemedicine such as password protection, encryption and notification of potential risk to privacy and sensitive information even with such measures
- Possibility of transmission failure or loss of information due to technical reasons
- Information regarding emergency care and after-hours contacts
- Emergency Care: The physician providing services through telemedicine is required to provide to the patient with an emergency plan when a hospital emergency department or an acute care facility is needed. A plan of next steps to be taken by the patient must be provided to the patient by the physician providing telemedicine care when that care indicates the need for an acute care facility or hospital emergency department, including after-hours emergency treatment instructions.
- Technology Considerations: The guidelines require telemedicine to use either real-time audio and visual communications, or store & forward technology, provided the technology offers the same information to the provider as if the encounter had occurred in person. The technology must also verify the identity and location of the patient, and disclose the physician’s identity and credentials.
- Other Communications: Audio only, telephone conversation, e-mail/instant messaging or fax are not acceptable methods for the practice of medicine in Maine with the following exceptions:
- Providers covering their own practice or that of another licensee where an established patient-physician relationship exists.
- Providers who initiate treatment of a patient/partner for sexually transmitted disease.
- Distant site provider who provides consultation to a licensee who has primary responsibility for the care and treatment of the patient.
States continue to develop guidelines and policies governing the practice of telemedicine. Maine’s telemedicine guidelines permit physicians using technology to provide virtual care in a broad and meaningful manner. Providers in Maine are already taking advantage of telemedicine, making quality health care more readily accessible to those living in rural areas.