The new telemedicine law went into effect July 1. The legislation (House Enrolled Act 1263), authored by Rep. Cindy Kirchhofer (R-Indianapolis), was enthusiastically supported by the Indiana Chamber because it increases access to care and potentially could reduce costs. Prior to the bill’s passage, Indiana was one of only four states that had not adopted telemedicine legislation.
Telemedicine is defined as the delivery of health care services using electronic communication and information technology, including: secure videoconferencing; interactive audio – using store and forward technology; or remote patient monitoring technology between a provider in one location and a patient in another location. Physicians, physician assistants who have authority to prescribe, licensed advanced practice nurses who have authority to prescribe and optometrists are all authorized to utilize telemedicine.
To provide the telemedicine service, a provider must have established a patient-provider relationship. In that patient-provider relationship, the provider, at a minimum, must obtain the patient’s name and contact info and location; disclose the provider’s name and title; obtain informed consent; obtain the patient’s medical history and other information to establish a diagnosis; discuss that diagnosis with the patient along with the evidence for and risks and benefits of various treatment options including when it is advisable to seek in-person care. The provider must also create and maintain a medical record for the patient and notify the patient’s primary care physician; issue proper instructions for appropriate and follow-up care and provide a telemedicine visit summary to the patient, including any prescriptions.
The law allows for a provider to issue a prescription through telemedicine even if the patient has not seen the provider in person previously as long as: the provider has satisfied the applicable standard of care in treating the patient; the issuance of a prescription is within the provider’s scope of practice; and the prescription is neither a controlled substance nor an abortion-inducing drug. At this time, the law prohibits ophthalmic devices such as glasses, contact lenses or low-vision devices.
An out-of-state provider may conduct telemedicine business in Indiana but must certify to the Indiana Professional Licensing Agency that it agrees to be subjected to the jurisdiction of the courts of law of Indiana and all substantive and procedural laws concerning a claim against the provider.
There was concern during session about liability in providing telemedicine services. Therefore, the General Assembly included a provision that if a provider provides telemedicine services then that provider would be held to the same standards of care as if the health service was provided in an in-person setting.
Regarding the aforementioned prohibition against providing eye glasses and contact lenses, the Indiana Chamber has recently been in discussion with a company that would like to have that provision changed during the next legislative session. This company says it has the capability, via the Internet, of providing a refractive eye exam as accurate as one completed in the doctor’s office. The way the law stands currently, this telemedicine company (based upon its business model) would be prohibited from conducting any business in Indiana.