Iowa Board of Medicine proposes disciplinary standards for telemedicine practice in Iowa – Part 2 of 7  posts on the proposed rule, October 16 – 24, 2014.

“Telemedicine” defined

Proposed rule 653-13.11(1) is available on the IBM’s website at, or directly through this link.

Summary. The proposed rule addresses technologies covered and not covered by its reach. Telemedicine is the practice of medicine using electronic audio-visual communications and information technologies or other means between a physician licensee in one location and a patient in another location with or without an intervening health care provider. Telemedicine is not the provision of medical services only through an audio-only telephone, email message, fax, postal mail, or combinations thereof. “Telemedicine technologies” is separately defined as mechanisms enabling secure electronic communications and information exchanges between a physician licensee in one location and a patient in another location with or without an intervening health care provider. In proposed rule 653-13.11(16), the IBM recognizes three current categories of telemedicine technologies: store and forward, remote monitoring, and real-time interactive services. 

Considerations. These definitions, read in tandem, seemingly take in a wide range of electronically-delivered medical services. Many Iowa physicians may now or soon in the future be providing medical services via telemedicine as so defined. Do these definitions capture too wide of a field of potential physician-patient exchanges for purposes of this regulations? Are each of the many comprehensive requirements (i.e.,standards) imposed upon physicians in the proposed rule appropriate to each of these many exchanges? Should the definitions of “telemedicine” and/or“telemedicine technologies” be narrowed or more focused in this round of telemedicine rulemaking to avoid an overly broad application of the rule’s requirements as well as to assure that physicians know which standards apply to them in each of the various telemedicine exchanges anticipated by the rule’s definition?

An overriding concern in reviewing the IBM’s proposed telemedicine rule in its entirety is that physicians are held responsible,subject to licensee discipline, to a very wide range of expectations associated with telemedicine delivery of medical services, yet in certain contexts,physician may have little control over those elements. In that regard, lumping various types of telemedicine exchanges together and imposing broadly stated requirements or standards upon physicians for each form of telemedicine delivery may create confusion and, in some instances, may impose unrealistic expectations on the physician licensee.

Physicians who “use” telemedicine.

Summary. The standards proposed by the rule apply to physician licensees who “use” telemedicine.

Considerations.  “Use” is not defined. The rule appears to be primarily directed to those physicians who actually provide medical services utilizing telemedicine technologies. It is not clear the extent to which physicians who refer patients for telemedicine services also might be subject to the rule’s standard, if at all. It is important that physicians involved in telemedicine delivery of care, whether in referring a patient or in actually providing the medical service via telemedicine, understand the extent to which the rule’s provisions apply or do not apply to them.

Note. Later discussion through these postings will note that certain requirements and prohibitions set forth in this proposed rule are not specifically limited in their applicability to physicians using telemedicine but, rather, address all physicians within the rule’s broad telemedicine reach.

Iowa medical license required.

Proposed rule 653-13.11(3)

Summary. A physician who uses telemedicine in the diagnosis and treatment of a patient located in Iowa shall hold an active Iowa medical license.

Considerations. This requirement enforces licensure policy of the IBM in place since 1996 and is consistent with the IBM’s position that the practice of medicine is where the patient is located, not where the physician is located. That 1996 telemedicine policy statement notes that under the IBM’s licensure rules, an out-of-state physician may provide medical consultation services “incidental” to the care of patients without obtaining full Iowa medical licensure; however, medical reports used for primary diagnostic purposes generally are not “incidental.”

The proposed rule is silent on the continued effectiveness of the 1996 telemedicine policy statement on licensure. It may be helpful to clarify the extent to which other licensure provisions, such as “incident to” exceptions and provisional licensure, may be available to out-of-state physicians providing medical services via telemedicine.

The October 20, 2014 posting will address the proposed rule’s requirement that a physician-patient relationship be established prior to providing medical services via telemedicine.

See our page dedicated to Telemedicine for all related articles, including our most current post.