The North Dakota Board of Medicine issued proposed regulations designed to move the Peace Garden State to the list of telemedicine-friendly states. The rules properly focus on the quality of care delivered, rather than the technical means through which it is delivered, aligning well with telemedicine practice rules articulated by other state medical boards. The Board held a public hearing on the proposed rules last month and has solicited comments, all of which will be discussed and reviewed at the Board’s November 20 meeting. The last time the Board issued guidance on telemedicine was March 2014.
Health care providers, hospitals, and start-up companies offering telemedicine services in North Dakota can review these proposed rules and sculpt their service offerings accordingly.
Providers should focus on these top five takeaways designed to protect patient quality and safety while fostering innovation and new care approaches:
North Dakota’s definition of telemedicine includes direct interactive patient encounters as well as asynchronous store-and-forward technologies and remote monitoring. Certain types of telemedicine utilizing asynchronous store-and-forward technology or electronic monitoring, such as tele-radiology or ICU monitoring, do not necessarily require an independent examination of the patient to be performed. However, an examination or evaluation that consists only of a static online questionnaire or an audio conversation will not be considered to meet the standard of care.
The proposed regulations also include two provisions not commonly seen in other state medical board telemedicine rules.
Ability to refer patients. North Dakota expects licensees to have the ability to make appropriate referrals of those patients not appropriate for diagnosis or complete treatment through telemedicine. This includes patients in need of emergent care or complementary in-person care. Providers should have procedures in place for when a physician determines the telemedicine encounter will not suffice and a referral to in-person care or emergent care is necessary.
Telemedicine and physician assistants. The proposed rule discusses the use of PAs for telemedicine practice, a topic gaining attention due to the complexity of physician supervision required (direct, indirect, etc.) and the vast differences among state laws in this regard. Under the proposed rules, “[a] physician assistant practicing telemedicine from another state is subject to the rules regarding physician supervision, except that supervision may be by a North Dakota licensed physician who is practicing telemedicine in North Dakota from the same state as the physician assistant, and need not be by a North Dakota licensed physician who is physically located in North Dakota.” It appears the intent is to require both the PA and the supervising physician to be licensed in North Dakota, and we believe the final rules will likely clarify or confirm this interpretation.
We will continue to monitor the proposed rules for when the final version is published.
For more information on telemedicine, telehealth, virtual care and other health innovations, including the team, publications, and other materials, visit Foley’s Telemedicine Practice.