According to the American Telemedicine Association, telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients' health status. Closely associated with telemedicine is the term "telehealth," which is often used to encompass a broader definition of remote healthcare that does not always involve clinical services. Videoconferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education and nursing call centers are all considered part of telemedicine and telehealth. Health Affairs states that Telehealth in the United States is currently affected by laws and regulations at the federal and state levels. Currently, there is no uniform legal approach to telehealth, and this continues to be a major challenge in its provision.

TMB's Standards of Care
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 Texas Medical Board’s Standards of Care

In Texas, telemedicine involves a health care provider’s medical care delivered to patients physically located at sites other than where the provider is located, with the use of technology that allows the provider to communicate with and see and hear the patients in “real” time.

A physician, physician assistant or advanced practice nurse who is supervised by and has delegated authority from a physician may treat a patient using telemedicine. Such a provider is referred to under the rules as a “distant site provider.”  All distant site providers must be licensed to practice in Texas.

In order to provide medical care via telemedicine, a distant site provider must in all cases establish a physician-patient relationship, which at a minimum includes:

  • establishing that the person requesting the treatment is in fact who the person claims to be;
  • establishing a diagnosis through the use of acceptable medical practices, including documenting and performing patient history, mental status examination, appropriate diagnostic and laboratory testing, and for medical care other than mental health services, a physical examination;
  • discussing with the patient the diagnosis and the evidence for it, the risks and benefits of various treatment options; and
  • ensuring the availability of the distant site provider or coverage of the patient for appropriate follow-up care.

In addition, the care must be provided at an appropriate location and—unless an exception applies—include the presence of qualified staff (also referred to as “patient site presenters”) to assist in the evaluation of the patient. Treatment and consultation recommendations made via telemedicine are held to the same standards of acceptable medical practices as those made in the traditional in-person clinical settings.

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Payment and Payment Parity

Even in the reimbursement fee structure, there is usually no distinction made between services provided on site and those provided through telemedicine and often no separate coding required for billing of remote services. Payment parity is the same pay for a medically necessary service whether it is delivered through telemedicine services or in-person.

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Case Studies from Texas eHealth Alliance regarding the use technology in practice settings

Glossary of frequently used telemedicine terms defined by the American Telemedicine Association

Texas Medical Association Telemedicine Activities TMA works with Texas Legislature and industry groups to ensure a regulatory framework in place that is strong enough to protect patient safety but not so restrictive that it impedes our ability to adopt innovative new patient care technologies

Texas Medical Board Frequently Asked Questions, including out of state medical licensure

Vendor Buyers Guide compiled by the American Telemedicine Association 

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TMA Updates on
Teledoc v. Texas Medical Board