Ohio Admin. Code 4725-25-01 - Telehealth communication
(A)
Definitions.
In this
chapter, the following terms have the meaning indicated:
In this chapter, the following terms
have the meaning indicated:
(1)
"Asynchronous"
means recorded data and information from health evaluations submitted for later
review.
"Telehealth services" means health
care services provided through the use of information and communication
technology by a health care professional licensed in Ohio, within the
professional's scope of practice, who is located at a site other than the site
where the patient is receiving the services or the site where another health
care professional with whom the provider of the services is formally consulting
regarding the patient is located.
(2)
"Board" means
the state vision professionals board.
"Synchronous communication technology" means audio and/or
video technology that permits two-way, interactive, real-time electronic
communication between the health care professional and the patient or between
the health care professional and the consulting health care professional
regarding the patient.
(3)
"Patient" means a consumer of telehealth
services.
"Asynchronous communication
technology", also called store and forward technology, has the same meaning as
asynchronous store and forward technologies as that term is defined in
42 C.F.R.
410.78 (effective January 1,
2022).
(4)
"Provider" means a licensed optometrist who holds a
valid therapeutic pharmaceutical certificate who provides telehealth
services.
"Remote monitoring device" means a
medical device cleared, approved, or authorized by the United States food and
drug administration for the specific purpose which the health care professional
is using it and which reliably transmits data electronically and
automatically.
(5)
"Service delivery model" means the method of
providing telehealth services.
"Health care
professional" means an optometrist licensed under Chapter 4725 of the Revised
Code.
(6)
"Site" means the patient location for receiving
telehealth services.
"Consent for telehealth
treatment" means a process of communication between a patient or, if
applicable, the patient's legal representative and the health care professional
discussing the risks and benefits of, and alternatives to, treatment through a
remote evaluation that results in the agreement to treatment that is documented
in the medical record or signed authorization for the patient to be treated
through an evaluation conducted through appropriate technology, as specified in
this rule, when the health care professional is in a location remote from the
patient.
(7)
"Stored clinical data" means video clips, sound /
audio files, photo images, electronic records, and written records that may be
available for transmission via telehealth communications.
"Formal consultation" means when a health care
professional seeks the professional opinion of another health care professional
regarding the diagnosis or treatment recommended for the patient's medical
condition presented, transfers the relevant portions of the patient's medical
record to the consulting health care professional, and documents the formal
consultation in the patient's medical record.
(8)
"Synchronous"
means services occurring via telehealth applications using real time use of
interactive audio, video or other telecommunications or electronic
technology.
"Health care facility" means a
hospital; clinic; office of a health care professional, associated group of
health care professionals, or associated group of health care professionals,
and individuals licensed under Chapters 4731. and 4725. of the Revised Code;
training institution for health care professionals; and a free clinic or other
nonprofit shelter or health care facility.
(9)
"Telehealth"
means a health care service delivered to a patient through the use of
interactive audio, video, or other telecommunications or electronic technology
from a site other than the site where the patient is located.
"Remote Site" means the location where a health care
professional provides health care services through a telehealth
system.
(10)
"Originating site" means the location where a patient
receives health care services through a telehealth system.
(11)
"Ocular Health
Emergency" is a serious, unexpected and potentially dangerous situation
requiring immediate action for an infection, sudden threat of vision loss, or
is potentially life threatening.
(B)
Service
delivery models.
A health care professional
may provide telehealth services to a patient located in a health care facility
in this state. The health care professional shall comply with all of the
following requirements:
(4)(6)
Live versus stored data refers to the actual data
transmitted during the course of telehealth services. Both live, real time and
stored clinical data may be included as part of telehealth services.
If a health care professional determines at any time
during the provision of telehealth services that a telehealth visit will not
meet the standard of care for the medical condition of the patient or if
additional in-person care is necessary, the health care professional shall see
the patient in-person within a reasonable timeframe or make the appropriate
referral to another health care professional to meet the standard of
care.
(1)
Telehealth may be delivered in a variety of ways,
including, but not limited to, those models listed in this rule.
The standard of care for a telehealth visit is the same
as the standard of care for an in-person visit.
(2)
Store and
forward model / electronic transmission is an asynchronous electronic
transmission of stored clinical data from one location to another.
The health care professional shall follow all standard
of care requirements which include but are not limited to the standard of care
requirements in paragraph (C) of this rule.
(3)
Synchronous is
a real time interaction between the provider and patient that may occur via
encrypted audio and video transmission over telecommunication links including,
but not limited to, videoconferencing.
The
health care professional may provide the telehealth services through the use of
synchronous or asynchronous communication technology provided that the standard
of care for an in-person visit can be met for the patient and the patient's
medical condition through the use of the technology selected. Telephone calls,
as a synchronous communication technology, may only be used for telehealth
services when all of the elements of a bona fide health care visit meeting the
standard of care are performed. Telephone calls that are routine or simply
involve communication of information do not constitute a telehealth
service.
(4)
That in the absence of an existing doctor-patient
relationship, a health care professional shall not provide telehealth services
which offer a prescription for glasses or contact lenses without including all
the elements of a comprehensive eye exam; however, such doctor-patient
relationship may be established by telehealth protocols.
(5)
If a patient is
experiencing a potential ocular health emergency, a health care professional
may provide telehealth services to that patient regardless of where the patient
is located.
(a)
If the
patient needs emergency care, the health care professional shall assist the
patient in obtaining emergency care by doing one of the following:
(i)
If the patient is
experiencing an ocular health emergency, alert a health care professional
located at the originating site to assist, if available;
(ii)
If the patient
is able to safely travel or be transported to the emergency department without
emergency transport services, help the patient identify the closest emergency
department and, if necessary, in the health care professional's discretion,
provide notification to the emergency department of the patient's potential
arrival;
(iii)
If the patient is unable to safely travel or be
transported to the emergency department without emergency transport services,
advise the patient to call 911 and remain on the videoconference, telephone, or
other synchronous communication technology with the patient; or
(iv)
If patient is
incapacitated, call for emergency services and remain on the videoconference,
telephone, or other synchronous communication technology with the
patient.
(b)
The health care professional shall document the
in-person visit or the referral in the patient's medical
record.
(c)
All referrals shall be made in an amount of time that
is appropriate for that patient and their condition presented.
(C)
Guidelines for the use of telehealth
A health care professional shall comply with all of the
following administrative requirements to provide telehealth services to a
patient which meet the standard of care including, but not limited to:
(1)
A provider
shall be accountable for any ethical and scope of practice requirements when
providing telehealth services.
The health care
professional shall verify the patient's identity and physical location in Ohio,
and communicate the health care professional's name and type of active Ohio
license held to the patient if the health care professional has not previously
treated the patient. This may be done verbally as long as it is documented by
the health care professional in the patient's medical record;
(2)
The scope,
nature, and standard of care of telehealth services are the same as provided in
person by the provider.
The health care
professional shall document the consent for telehealth treatment of the patient
or, if applicable, the patient's legal representative;
(3)
The quality of
electronic transmissions shall be appropriate for the provision of telehealth
services as if those services were provided in person.
The health care professional shall provide the
telehealth services in a manner that complies with the privacy and security
requirements for the patient and their protected health information required by
the law of this state and federal law. Also, the health care professional shall
ensure that any username or password information and any electronic
communications between the health care professional and the patient are
securely transmitted and stored;
(4)
A provider
shall only utilize technology with which they are competent to use as part of
their telehealth services.
The health care
professional may forward the medical record to the patient's primary care
provider, other health care provider, or to an appropriate health care provider
to whom the patient is referred as provided in paragraph (B)(4) of this
rule;
(5)
Equipment used for telehealth services shall be
maintained in appropriate operational status to provide appropriate quality of
services.
The health care professional shall
maintain a copy of the patient's medical record at the remote site and the
originating site and make the medical record of the visit available to the
patient or if applicable, the patient's legal representative, upon
request;
(6)
The provider shall be responsible for assessing the
patient's candidacy for telehealth, including behavioral, physical, and
cognitive abilities to participate in services provided via
telecommunications.
The health care
professional shall ensure that any ancillary personnel involved the provision
of telehealth services and/or located at the originating site be properly
supervised in accordance with the provisions of rule
4725-5-18 of the Administrative
Code.
(7)
A provider shall be aware of the patient's level of
comfort with the technology being used as part of the telehealth services and
only accept for treatment via telecommunications patients who can reasonably be
expected to benefit from a service delivery model in paragraph (B) of this rule
and continue with such treatment when there is reasonable expectation of
further benefit.
The health care professional
shall have access to a health care facility in the state to provide in-person
care to a patient, if necessary;
(8)
Providers
shall be held to the same standards of practice as if the telehealth services
were provided in person.
The health care
professional shall ensure that any equipment utilized during the provision of
telehealth services is maintained in appropriate operational status to provide
appropriate quality of services.
(9)
A provider
should be sensitive to cultural and linguistic variables that affect the
identification, assessment, treatment, and management of the clients.
(10) Telehealth providers shall
comply with all laws, rules, and regulations governing the maintenance of
patient records, including patient confidentiality
requirements.
(11) Notification of telehealth
services should be provided to the patient, the guardian, the caregiver, and
the multi-disciplinary team, if appropriate.
(12) A provider shall promptly refer
patients for in office care, when necessary.
(D)
Limitations of telehealth services include, but not limited
to the following:
A health care professional
shall comply with all of the following clinical requirements necessary to
provide telehealth services to a patient which meet the standard of care
including, but not limited to:
(1)
The inability to have direct, physical contact with
the patient is a primary difference between telehealth and direct in person
service delivery;
The health care professional
shall, through interaction with the patient, complete a medical evaluation that
is appropriate for the patient and the condition with which the patient
presents and that meets the minimal standards of care for an in-person
visit;
(2)
The inability to establish new provider-patient
relationships via telehealth services, except in emergency situations;
The health care professional shall establish or
confirm, as applicable, a diagnosis and treatment plan. The diagnosis and
treatment plan shall include the identification of any underlying conditions or
contraindications to the recommended treatment;
(3)
The inability
of conducting online refractions, creation or renewal of an eye glass or
contact lens prescription for a patient who has not received the appropriate in
person refractive care; and
The health care
professional shall promptly document in the patient's medical record the
patient's or, if applicable, the patient's legal representative, consent for
telehealth treatment, pertinent history, evaluation, diagnosis, treatment plan,
underlying conditions, any contraindications, and any referrals to appropriate
health care providers, including primary care providers or health care
facilities;
(4)
The quality of transmitted data may affect the
quality of services provided by the provider.
The health care professional shall provide appropriate
follow-up care or recommend follow-up care with the patient's primary care
provider, other appropriate health care provider, or health care facility in
accordance with the minimal standards of care.
(E)
Requirements
of personnel providing telehealth services.
A
health care professional shall comply with the following requirements to
provide telehealth services that involve a formal consultation with another
health care professional:
(1)
A provider of telehealth services who practices in
the state shall be licensed by the board.
The
health care professional who seeks a formal consultation shall document the
acknowledgement of the patient or if applicable, the patient's legal
representative, before seeking the telehealth services formal consultation with
the consulting health care professional;
(2)
A provider of
telehealth services shall be competent in both the type of services provided
and the methodology and equipment used to provide the service.
The consulting health care professional shall meet the
licensure or certification requirements in division (C) of section
4743.09 of the Revised Code;
and
(3)
A provider of telehealth services who resides out of
state and who provides services for Ohio residents shall be licensed by the
board.
The health care professional who seeks
a formal consultation shall send the medical records relevant to the patient's
medical condition to the consulting health care professional who shall review
the medical records of the patient relevant to the medical condition which is
the subject of the consultation before the formal consultation occurs, unless
this is not possible due to an emergency situation.
(F)
While providing
telehealth services, a health care professional may only prescribe, personally
furnish, otherwise provide, or cause to be provided a prescription drug that is
not a controlled substance to a patient through the provision of telehealth
services by complying with all requirements of this rule.
(G)
A health care
professional may provide telehealth services through the use of remote
monitoring devices for the purpose of data acquisition, patient communication,
confirmation of expected therapeutic results, confirmation of stability/or
homeostasis, and assessing changes in previously diagnosed chronic conditions,
provided that:
(1)
The patient or, if applicable, the patient's legal
representative, gives consent to the use of remote monitoring
devices;
(2)
The medical devices that enable remote monitoring have
been cleared, approved, or authorized by the United States food and drug
administration for the specific purpose for which the physician or physician
assistant are using it for the patient, and the remote monitoring devices
otherwise comply with all federal requirements.
Notes
Promulgated Under: 119.03
Statutory Authority: 119.03, 4725.09, 4725.44
Rule Amplifies: 4725.12, 4725.25
Prior Effective Dates: 04/20/2020 (Emer.), 01/14/2021, 07/02/2023
Promulgated Under: 119.03
Statutory Authority: 119.03, 4725.09, 4725.44
Rule Amplifies: 4725.12, 4725.25
Prior Effective Dates: 04/20/2020 (Emer.), 01/14/2021
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(A) Definitions. In this chapter, the following terms have the meaning indicated:
In this chapter, the following terms have the meaning indicated:
(1) "Asynchronous" means recorded data and information from health evaluations submitted for later review. "Telehealth services" means health care services provided through the use of information and communication technology by a health care professional licensed in Ohio, within the professional's scope of practice, who is located at a site other than the site where the patient is receiving the services or the site where another health care professional with whom the provider of the services is formally consulting regarding the patient is located.
(2) "Board" means the state vision professionals board. "Synchronous communication technology" means audio and/or video technology that permits two-way, interactive, real-time electronic communication between the health care professional and the patient or between the health care professional and the consulting health care professional regarding the patient.
(3) "Patient" means a consumer of telehealth services. "Asynchronous communication technology", also called store and forward technology, has the same meaning as asynchronous store and forward technologies as that term is defined in 42 C.F.R. 410.78 (effective January 1, 2022).
(4) "Provider" means a licensed optometrist who holds a valid therapeutic pharmaceutical certificate who provides telehealth services. "Remote monitoring device" means a medical device cleared, approved, or authorized by the United States food and drug administration for the specific purpose which the health care professional is using it and which reliably transmits data electronically and automatically.
(5) "Service delivery model" means the method of providing telehealth services. "Health care professional" means an optometrist licensed under Chapter 4725 of the Revised Code.
(6) "Site" means the patient location for receiving telehealth services. "Consent for telehealth treatment" means a process of communication between a patient or, if applicable, the patient's legal representative and the health care professional discussing the risks and benefits of, and alternatives to, treatment through a remote evaluation that results in the agreement to treatment that is documented in the medical record or signed authorization for the patient to be treated through an evaluation conducted through appropriate technology, as specified in this rule, when the health care professional is in a location remote from the patient.
(7) "Stored clinical data" means video clips, sound / audio files, photo images, electronic records, and written records that may be available for transmission via telehealth communications. "Formal consultation" means when a health care professional seeks the professional opinion of another health care professional regarding the diagnosis or treatment recommended for the patient's medical condition presented, transfers the relevant portions of the patient's medical record to the consulting health care professional, and documents the formal consultation in the patient's medical record.
(8) "Synchronous" means services occurring via telehealth applications using real time use of interactive audio, video or other telecommunications or electronic technology. "Health care facility" means a hospital; clinic; office of a health care professional, associated group of health care professionals, or associated group of health care professionals, and individuals licensed under Chapters 4731. and 4725. of the Revised Code; training institution for health care professionals; and a free clinic or other nonprofit shelter or health care facility.
(9) "Telehealth" means a health care service delivered to a patient through the use of interactive audio, video, or other telecommunications or electronic technology from a site other than the site where the patient is located. "Remote Site" means the location where a health care professional provides health care services through a telehealth system.
(10) "Originating site" means the location where a patient receives health care services through a telehealth system.
(11) "Ocular Health Emergency" is a serious, unexpected and potentially dangerous situation requiring immediate action for an infection, sudden threat of vision loss, or is potentially life threatening.
(B) Service delivery models. A health care professional may provide telehealth services to a patient located in a health care facility in this state. The health care professional shall comply with all of the following requirements: (4)(6) Live versus stored data refers to the actual data transmitted during the course of telehealth services. Both live, real time and stored clinical data may be included as part of telehealth services. If a health care professional determines at any time during the provision of telehealth services that a telehealth visit will not meet the standard of care for the medical condition of the patient or if additional in-person care is necessary, the health care professional shall see the patient in-person within a reasonable timeframe or make the appropriate referral to another health care professional to meet the standard of care.
(1) Telehealth may be delivered in a variety of ways, including, but not limited to, those models listed in this rule. The standard of care for a telehealth visit is the same as the standard of care for an in-person visit.
(2) Store and forward model / electronic transmission is an asynchronous electronic transmission of stored clinical data from one location to another. The health care professional shall follow all standard of care requirements which include but are not limited to the standard of care requirements in paragraph (C) of this rule.
(3) Synchronous is a real time interaction between the provider and patient that may occur via encrypted audio and video transmission over telecommunication links including, but not limited to, videoconferencing. The health care professional may provide the telehealth services through the use of synchronous or asynchronous communication technology provided that the standard of care for an in-person visit can be met for the patient and the patient's medical condition through the use of the technology selected. Telephone calls, as a synchronous communication technology, may only be used for telehealth services when all of the elements of a bona fide health care visit meeting the standard of care are performed. Telephone calls that are routine or simply involve communication of information do not constitute a telehealth service.
(4) That in the absence of an existing doctor-patient relationship, a health care professional shall not provide telehealth services which offer a prescription for glasses or contact lenses without including all the elements of a comprehensive eye exam; however, such doctor-patient relationship may be established by telehealth protocols.
(5) If a patient is experiencing a potential ocular health emergency, a health care professional may provide telehealth services to that patient regardless of where the patient is located.
(a) If the patient needs emergency care, the health care professional shall assist the patient in obtaining emergency care by doing one of the following:
(i) If the patient is experiencing an ocular health emergency, alert a health care professional located at the originating site to assist, if available;
(ii) If the patient is able to safely travel or be transported to the emergency department without emergency transport services, help the patient identify the closest emergency department and, if necessary, in the health care professional's discretion, provide notification to the emergency department of the patient's potential arrival;
(iii) If the patient is unable to safely travel or be transported to the emergency department without emergency transport services, advise the patient to call 911 and remain on the videoconference, telephone, or other synchronous communication technology with the patient; or
(iv) If patient is incapacitated, call for emergency services and remain on the videoconference, telephone, or other synchronous communication technology with the patient.
(b) The health care professional shall document the in-person visit or the referral in the patient's medical record.
(c) All referrals shall be made in an amount of time that is appropriate for that patient and their condition presented.
(C) Guidelines for the use of telehealth A health care professional shall comply with all of the following administrative requirements to provide telehealth services to a patient which meet the standard of care including, but not limited to:
(1) A provider shall be accountable for any ethical and scope of practice requirements when providing telehealth services. The health care professional shall verify the patient's identity and physical location in Ohio, and communicate the health care professional's name and type of active Ohio license held to the patient if the health care professional has not previously treated the patient. This may be done verbally as long as it is documented by the health care professional in the patient's medical record;
(2) The scope, nature, and standard of care of telehealth services are the same as provided in person by the provider. The health care professional shall document the consent for telehealth treatment of the patient or, if applicable, the patient's legal representative;
(3) The quality of electronic transmissions shall be appropriate for the provision of telehealth services as if those services were provided in person. The health care professional shall provide the telehealth services in a manner that complies with the privacy and security requirements for the patient and their protected health information required by the law of this state and federal law. Also, the health care professional shall ensure that any username or password information and any electronic communications between the health care professional and the patient are securely transmitted and stored;
(4) A provider shall only utilize technology with which they are competent to use as part of their telehealth services. The health care professional may forward the medical record to the patient's primary care provider, other health care provider, or to an appropriate health care provider to whom the patient is referred as provided in paragraph (B)(4) of this rule;
(5) Equipment used for telehealth services shall be maintained in appropriate operational status to provide appropriate quality of services. The health care professional shall maintain a copy of the patient's medical record at the remote site and the originating site and make the medical record of the visit available to the patient or if applicable, the patient's legal representative, upon request;
(6) The provider shall be responsible for assessing the patient's candidacy for telehealth, including behavioral, physical, and cognitive abilities to participate in services provided via telecommunications. The health care professional shall ensure that any ancillary personnel involved the provision of telehealth services and/or located at the originating site be properly supervised in accordance with the provisions of rule 4725-5-18 of the Administrative Code.
(7) A provider shall be aware of the patient's level of comfort with the technology being used as part of the telehealth services and only accept for treatment via telecommunications patients who can reasonably be expected to benefit from a service delivery model in paragraph (B) of this rule and continue with such treatment when there is reasonable expectation of further benefit. The health care professional shall have access to a health care facility in the state to provide in-person care to a patient, if necessary;
(8) Providers shall be held to the same standards of practice as if the telehealth services were provided in person. The health care professional shall ensure that any equipment utilized during the provision of telehealth services is maintained in appropriate operational status to provide appropriate quality of services.
(9) A provider should be sensitive to cultural and linguistic variables that affect the identification, assessment, treatment, and management of the clients.
(10) Telehealth providers shall comply with all laws, rules, and regulations governing the maintenance of patient records, including patient confidentiality requirements.
(11) Notification of telehealth services should be provided to the patient, the guardian, the caregiver, and the multi-disciplinary team, if appropriate.
(12) A provider shall promptly refer patients for in office care, when necessary.
(D) Limitations of telehealth services include, but not limited to the following: A health care professional shall comply with all of the following clinical requirements necessary to provide telehealth services to a patient which meet the standard of care including, but not limited to:
(1) The inability to have direct, physical contact with the patient is a primary difference between telehealth and direct in person service delivery; The health care professional shall, through interaction with the patient, complete a medical evaluation that is appropriate for the patient and the condition with which the patient presents and that meets the minimal standards of care for an in-person visit;
(2) The inability to establish new provider-patient relationships via telehealth services, except in emergency situations; The health care professional shall establish or confirm, as applicable, a diagnosis and treatment plan. The diagnosis and treatment plan shall include the identification of any underlying conditions or contraindications to the recommended treatment;
(3) The inability of conducting online refractions, creation or renewal of an eye glass or contact lens prescription for a patient who has not received the appropriate in person refractive care; and The health care professional shall promptly document in the patient's medical record the patient's or, if applicable, the patient's legal representative, consent for telehealth treatment, pertinent history, evaluation, diagnosis, treatment plan, underlying conditions, any contraindications, and any referrals to appropriate health care providers, including primary care providers or health care facilities;
(4) The quality of transmitted data may affect the quality of services provided by the provider. The health care professional shall provide appropriate follow-up care or recommend follow-up care with the patient's primary care provider, other appropriate health care provider, or health care facility in accordance with the minimal standards of care.
(E) Requirements of personnel providing telehealth services. A health care professional shall comply with the following requirements to provide telehealth services that involve a formal consultation with another health care professional:
(1) A provider of telehealth services who practices in the state shall be licensed by the board. The health care professional who seeks a formal consultation shall document the acknowledgement of the patient or if applicable, the patient's legal representative, before seeking the telehealth services formal consultation with the consulting health care professional;
(2) A provider of telehealth services shall be competent in both the type of services provided and the methodology and equipment used to provide the service. The consulting health care professional shall meet the licensure or certification requirements in division (C) of section 4743.09 of the Revised Code; and
(3) A provider of telehealth services who resides out of state and who provides services for Ohio residents shall be licensed by the board. The health care professional who seeks a formal consultation shall send the medical records relevant to the patient's medical condition to the consulting health care professional who shall review the medical records of the patient relevant to the medical condition which is the subject of the consultation before the formal consultation occurs, unless this is not possible due to an emergency situation.
(F) While providing telehealth services, a health care professional may only prescribe, personally furnish, otherwise provide, or cause to be provided a prescription drug that is not a controlled substance to a patient through the provision of telehealth services by complying with all requirements of this rule.
(G) A health care professional may provide telehealth services through the use of remote monitoring devices for the purpose of data acquisition, patient communication, confirmation of expected therapeutic results, confirmation of stability/or homeostasis, and assessing changes in previously diagnosed chronic conditions, provided that:
(1) The patient or, if applicable, the patient's legal representative, gives consent to the use of remote monitoring devices;
(2) The medical devices that enable remote monitoring have been cleared, approved, or authorized by the United States food and drug administration for the specific purpose for which the physician or physician assistant are using it for the patient, and the remote monitoring devices otherwise comply with all federal requirements.
Notes
Promulgated Under: 119.03
Statutory Authority: 119.03, 4725.09, 4725.44
Rule Amplifies: 4725.12, 4725.25
Prior Effective Dates: 04/20/2020 (Emer.), 01/14/2021