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Historical Rule for the Texas Administrative Code

TITLE 22EXAMINING BOARDS
PART 9TEXAS STATE BOARD OF MEDICAL EXAMINERS
CHAPTER 174TELEMEDICINE
RULE §174.4Use of the Internet in Medical Practice
Repealed Date:10/17/2010

(a) Evaluation of the Patient. Physicians who utilize the Internet must ensure a proper physician-patient relationship is established that at a minimum includes:

  (1) establishing that the person requesting the treatment is in fact who the person claims to be;

  (2) establishing a diagnosis through the use of acceptable medical practices such as patient history, mental status examination, physical examination, and appropriate diagnostic and laboratory testing to establish diagnoses and identify underlying conditions and/or contra-indications to treatment recommended/provided;

  (3) discussing with the patient the diagnosis and the evidence for it, the risks and benefits of various treatment options; and

  (4) ensuring the availability of the physician or coverage of the patient for appropriate follow-up care.

(b) Treatment. Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in traditional (face-to-face) settings. An online or telephonic evaluation by questionnaire does not constitute an acceptable standard of care.

(c) State Licensure. Physicians who treat and prescribe through the Internet are practicing medicine and must possess appropriate licensure in all jurisdictions where patients reside.

(d) Electronic Communications.

  (1) Written policies and procedures must be maintained when using electronic mail for physician-patient communications. Policies must be evaluated periodically for currency. Such policies and procedures must address:

    (A) privacy to assure confidentiality and integrity of patient-identifiable information;

    (B) health care personnel, in addition to the physician, who will process messages;

    (C) hours of operation and availability;

    (D) types of transactions that will be permitted electronically;

    (E) required patient information to be included in the communication, such as patient name, identification number and type of transaction;

    (F) archival and retrieval; and

    (G) quality oversight mechanisms.

  (2) All patient-physician e-mail, as well as other patient-related electronic communications, must be stored and filed in the patient's medical record.

  (3) Patients must be informed of alternative forms of communication for urgent matters.

(e) Medical Records.

  (1) Medical records must include copies of all patient-related electronic communications, including patient-physician e-mail, prescriptions, laboratory and test results, evaluations and consultations, records of past care and instructions.

  (2) Notice of privacy practices related to the use of e-mail must be filed in the medical record.

(f) Disclosure. Physician medical practice sites must clearly disclose:

  (1) ownership of the website;

  (2) specific services provided;

  (3) office address and contact information;

  (4) licensure and qualifications of physician(s) and associated health care providers;

  (5) fees for online consultation and services and how payment is to be made;

  (6) financial interest in any information, products, or services;

  (7) appropriate uses and limitations of the site, including providing health advice and emergency health situations;

  (8) uses and response times for e-mails, electronic messages, and other communications transmitted via the site;

  (9) to whom patient health information may be disclosed and for what purpose;

  (10) rights of patients with respect to patient health information; and

  (11) information collected and any passive tracking mechanisms utilized.

(g) Accountability. Medical practice sites must provide patients with a clear mechanism to:

  (1) access, supplement, and amend patient-provided personal health information;

  (2) provide feedback regarding the site and the quality of information and services; and

  (3) register complaints, including information regarding filing a complaint with the Texas State Board of Medical Examiners as provided for in Chapter 178 of this title (relating to Complaints).

(h) Advertising/Promotion of Goods or Products. Advertising or promotion of goods or products from which the physician receives direct remuneration or incentives is prohibited.


Source Note: The provisions of this §174.4 adopted to be effective July 4, 2004, 29 TexReg 6088

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