Your state can answer your telemedicine questions

Once your medical executive committee decides that your facility will participate in a telemedicine program, it can decide what services to use from distant sites, says Hugh Greeley, founder of The Greeley Company in Marblehead, MA. According to Sheff, your telemedicine policies must specify whether you are an originating site, a distant site, or both. Incorporate the following into your policies:

The JCAHO allows facilities to rely on the credentialing and privileging information from the distant site as long as that site is also JCAHO accredited, says Sheff. This will save time for originating sites, since distant sites complete the same credentialing process.

TIP: If you plan to rely on the distant site's information, you must have a written contract stating that, says Sheff.

Be careful about relying too heavily on the credentialing and privileging process at the distant site, says Scott Edelstein, MPA, JD, a partner with the health law department of McDermott, Will and Emery in Los Angeles.

If the originating site relies on the distant site's credentialing information and the distant site was negligent in their process, the originating site could potentially be liable as well, he says.

To comply with JCAHO standards, you only need to verify that the distant site also has JCAHO accreditation. However, meeting the standards might not protect your facility from malpractice action, says Edelstein.

"I don't think the JCAHO standards [on telemedicine and credentialing] provide organizations with a lot of protection from malpractice action," he says.

Verify state license requirements
States have different requirements for practitioner licenses. This is a concern for organizations that contract with telemedicine providers in states other than their own, says Edelstein.

For example, some states require full licensure in the state where the patient is located, unless the telemedicine practitioner is responding to an emergency, or the practitioner simply consults with the physician in a different state, says Edelstein.

States with limited licensure agreements allow telemedicine practitioners to provide services out-of-state if they complete a special registration process.

TIP: Verify with officials in your state what types of licenses your telemedicine practitioners require.

Organizations that use telemedicine practitioners need to consider the Health Insurance Portability and Accountability Act of 1996 (HIPAA) when sharing credentialing information with distant sites. Many credential files contain protected health information that organizations might not be allowed to share, says Edelstein.

For example, if patients complain about a particular practitioner and the care they received, that complaint would be in the credentialing file.

Under HIPAA, there are only three acceptable situations under which you may disclose this information to a distant site, says Edelstein:

1. Create a limited data set use agreement, although many organizations do not like to use these agreements because they are too restrictive.

2. Remove information that identifies the patient from the credential file. That way, the two hospitals can freely share information in the credential file.

3. Create an organized health care arrangement between your two sites. HIPAA permits organizations to share information in this kind of arrangement, says Edelstein.

TIP: Consult with your legal counsel and HIPAA privacy officer to determine what option is best for your facility when sharing information for telemedicine purposes.

Editor's note: Our expert comments were adapted from the recent HCPro audioconference, "Telemedicine: Credentialing, JCAHO standards, and other hot issues for hospitals." Go to www.hcmarketplace.com/Prod.cfm?id=1979 <http://www.hcmarketplace.com/Prod.cfm?id=1979> to order a tape of the audioconference.