Florida Board of Medicine Issues Telemedicine Regulations

The Florida Board of Medicine enacted new regulations governing the Standards for Telemedicine Practice. The regulations are identical for allopaths (64B8-9.0141) and osteopaths (64B15-14.0081). The new regulations went into effect March 12, 2014 and offer some additional guidance on telemedicine practice in Florida, although they are not as comprehensive as some providers may have wished. 

Highlights of the regulations are as follows:

• A valid physician-patient relationship may be established through telemedicine.  
• The regulations allow, and expressly do not prohibit, consultations between physicians, as well as the transmission and review of digital images, pathology specimens, test results, or other medical data by physicians or other qualified providers related to the care of Florida patients.
• The regulations expressly prohibit controlled substances from being prescribed through telemedicine, but make no statement with regard to prescriptions for non-controlled substances.
• The regulations explicitly recognize that telemedicine may be performed not only by a licensed Florida physician, but also by a physician assistant. 
• The regulations define the medium for telemedicine as “where patient care, treatment, or services are provided through the use of medical information exchanged from one site to another via electronic communications.” Under the regulations, telemedicine does not include the provision of health care services only through an audio only telephone, email messages, text messages, facsimile transmission, U.S. Mail or other parcel service, or any combination thereof. This definition is largely consistent with Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine published by the Federation of State Medical Boards on April 26, 2014.
• The regulations defer to the existing standard of care expectations, and do not alter existing statutory requirements on the practice of medicine and medical malpractice.
• The regulations do not apply to emergency medical services or patients with emergency medical conditions.

After the regulations were published, providers were concerned the rule precluded physicians from ordering controlled substances through the use of telemedicine for their hospitalized patients. On its face, the regulation precludes the prescribing of controlled substances through the use of telemedicine, but does not bar the use of telemedicine to order controlled substances to hospitalized patients. Accordingly, the Board of Osteopathic Medicine issued a follow-up emergency rule amending Rule 64B15-14.0081 and clarifying that the ordering of controlled substances for hospitalized patients through the use of telemedicine is not prohibited by Rule 64B15-14.0081(4). The emergency rule clarifying the regulation went into effect May 5, 2014. Unfortunately, there was no corresponding clarification issued on the allopathic physician telemedicine regulation, which creates potential confusion between the expectations for practice standards of osteopaths vs. allopaths.

The Board’s telemedicine regulations were issued during the 2014 Florida Legislative session, when a landmark telemedicine bill was in development. Although many anticipated the bill would pass, it failed to secure the necessary votes during the final day of session. The Legislature may pick up the bill again next year, but until then, the Board regulations represent the most current guidance for Florida telemedicine practitioners.