Long-distance medical exams passed by panel

Gives doctors more flexibility

Arkansas doctors will have more flexibility — although not as much as some employers and telemedicine companies would like — to examine patients from a distant location under a rule change approved by a legislative committee Tuesday.

The change approved by the Legislative Council’s Rules and Regulations Subcommittee, and on June 9 by the state Medical Board, is an amendment to the Medical Board’s Regulation 2.8, which details how “a proper physician/patient relationship” can be established.

The amendment will allow such a relationship to be an examination conducted from a distant location through audio and visual technology.

Currently, doctors can only treat patients they have examined at some point in person, when they have an ongoing professional or personal relationship with the patient, when they have a referral from another doctor or when they are filling in for the patient’s regular doctor.

The change won’t open the door for phone-based services offered by companies such as Dallas-based Teladoc, however. That’s because Act 887 of 2015 requires a patient to be in a doctor’s office or other health care facility at the time of an examination conducted via telemedicine.

The Rules and Regulations Subcommittee did not take action on a related proposal, Regulation 38, which was also approved by the Medical Board on June 9 and sets standards on the use of telemedicine.

Some employers and telemedicine companies oppose how that regulation defines “store-and-forward technology.”

According to the proposed rule, such technology does not include a patient or a telemedicine company completing a medical history form and sending it to a physician.

Instead, the regulation says store-and-forward technology includes images such as X-rays and MRIs.

The telemedicine proponents had supported an earlier draft of the regulations and complained that the language on “store-and-forward technology” was changed after a June 9 public hearing.

After some lawmakers complained about the change, the Legislature’s public health committees sent the regulations to the Rules and Regulations Subcommittee without a recommendation.

Kevin O’Dwyer, an attorney for the Medical Board, has said Regulation 38 would not prohibit patients from filling out online medical history forms. Those forms just wouldn’t be considered “store-and-forward technology,” he said.

But Claudia Tucker, vice president of government affairs at Teladoc, said the proposed definition of “store-and-forward technology” conflicts with how the term is used in other states and with Act 887.

The law defines the term as “the transmission of a patient’s medical information” from a health care facility to a provider.

David Wroten, executive vice president of the Arkansas Medical Society, said companies in other states have pushed for laws allowing for a doctor-patient relationship to be established through store-and-forward technology and phone conversations, which the Medical Society opposes.

“The idea that you could have that encounter and somehow write a prescription for some drug for a patient who you’ve never seen in your life doesn’t sound like very good medicine to us,” Wroten said.

Regulation 38 will go back to the Medical Board for a second public hearing that will be held in October, O’Dwyer said.