As of 2017, Washington state started to focus more on the development of telemedicine services. The turning point was the update of the state's parity law that helped with reimbursement policies immensely and made telehealth services transparent, easy, and available.

The COVID-19 pandemic proved that telemedicine is the future of healthcare, especially in the USA. The country was struggling to treat and care for all the patients even before the outbreak, but recent events have shown just how inadequate the system is.

Telehealth may offer solutions for creating a more efficient and democratic healthcare system by decreasing per-capita expenditures that seem to be going through the roof lately. The Evergreen State is leading the way by encouraging and supporting telemedicine practitioners.

Telemedicine—What it’s all about

With the rapid development of technology and new communication channels, it was a question of time before healthcare would feel the impact. Aside from the improvements in the way we perform surgeries and handle diagnosis, the innovation started affecting even the traditional medical appointments and the doctor-patient relationship.

Telemedicine is the provision of healthcare in which the provider is at one location and the patient at another. They use digital communication channels, such as video and audio calls, text messages, emails, and chat.

The scope of telehealth services is vast and includes diagnosis, providing instructions, primary care, and issuing prescriptions. Psychiatry and psychotherapy were the first branches to use communication technology, but many other medical professionals jumped on the bandwagon. Telemedicine allows healthcare providers to:

• Treat more patients
• Improve patient experience
• Lower the costs of care

It is crucial to understand that telemedicine is not a new discipline or an alternative method of treatment. It is a tool in medical practice. All standards of in-person, traditional patient care still apply. The below chart sums up the scope and the benefits of telemedicine.

Telemedicine and telehealth

These two terms seem to overlap in many aspects. There are no clear definitions on the federal or international level that would explain the difference between telemedicine and telehealth. Each state defines these terms according to its rules and regulations.

Most states agree that telehealth is a broader term that includes non-clinical practices such as healthcare education and prevention, while telemedicine refers to clinical services only. Some states view them as synonymous and allow both terms to be used to denote remote patient care.

Washington is among these states, and you can use both terms—telemedicine and telehealth—when promoting or registering your practice.

Washington state telemedicine laws and requirements

The Evergreen State expects telemedicine practitioners to respect the federal law and meet the same standards that apply to traditional practice. This means that practitioners must be HIPAA (Health Insurance Portability and Accountability Act) compliant every step of the way. Putting the safety of the patient first, the state officials came up with strict and fair legislation. Every aspect of telemedicine is covered, which allows medical professionals to understand their obligations and act accordingly.

The Medical Quality Assurance Commission (MQAC) developed a comprehensive guide, which is immensely helpful in understanding what to do and how when establishing a telemedicine practice. The same goes for healthcare providers who are looking for ways to incorporate it into their existing business.

Telehealth practitioners in Washington state should adhere to the following guidelines:

1. Possess the necessary licenses and permits
2. Provide the required standard of care

Telemedicine licensing in Washington

Every medical professional practicing telemedicine in the Evergreen State has to have a license that is valid in Washington. It is essential to understand that the service “takes place” at the residence of the patient and not the practitioner. If the patient is outside of Washington, the doctor must be allowed to practice medicine there.

This doesn’t apply to follow-ups. If the patient received treatment or diagnosis in Washington and changed their residence after the initial meeting, the physician is allowed to continue treating them. The same rules apply for patients who are away on business or personal trips.

Telemedicine practitioners who are not Washington residents must have the appropriate license to practice in the Evergreen State. The only exception is a follow-up to previously established doctor-patient relationships.

The good news is that Washington joined the Interstate Medical Licensure Compact, which makes obtaining interstate licenses and permits easier.

Standard of care

The Medical Quality Assurance Commission gives a detailed description of what standards have to be met for a provider to practice telemedicine and telehealth in Washington. The idea was to keep the quality of care on the same level as for in-person services. All technical, clinical, and ethical requirements stay the same regardless of the tool used in providing healthcare.

Any violation of these rules will result in disciplinary measures that are the same as for traditional practice. Strict regulations protect the rights of both patients and practitioners. Confidentiality, medical liability, and malpractice are all thoroughly explained and regulated, and MQAC has done an excellent job of providing transparent and comprehensive guidelines. Every telehealth practitioner must:

1. Establish a proper doctor-patient relationship
2. Get informed consent from the patient
3. Set treatment parameters
4. Keep appropriate medical records
5. Issue prescriptions according to the regulations

Doctor-patient relationship

With new ways to practice medicine emerging, the relationship between the physician and patient has been undergoing some changes lately. Even without in-person contact, a face-to-face meeting is required to establish a relationship.

This implies that an email, an online questionnaire, or a text message do not qualify, and a video call has to be the first point of contact. 

Informed consent

A telemedicine encounter should only begin once the practitioner has obtained and documented informed consent from the patient. Considering the special nature of telemedicine, the informed consent should state:

1. The identity and location of the patient
2. The medical professional's credentials
3. The description of the technology used to enable the service (its capabilities as well as limitations)
4. The written agreement that telehealth tools are appropriate for the treatment by both parties

Although not all telemedicine services require informed consent in Washington, we strongly advise you to get it from every patient.

Telemedicine treatment parameters in Washington

Following common sense and professional standards, telemedicine practitioners should understand the limitations of the digital tools they use, as well as of their expertise. This means that they have to evaluate the patient’s condition and determine whether telemedicine is an adequate way to provide the correct diagnosis and treat them.

With all its benefits, telehealth is not always enough to provide responsible medical care. Certain conditions require traditional care. The physician must refer the patient to an appropriate institution if telemedicine doesn’t suffice in treating them.

Medical records

Telemedicine appointments and treatment must be properly recorded, and the data should be available on request. All medical records should be clear and precise. Each encounter, regardless of the communication channel, is subject to these rules.

It is also mandatory to file all test results, scans, prescriptions, and instructions, along with any documents from other specialists. The patient's medical history prior to the telemedicine treatment should also be added if it is available. 

Telemedicine prescriptions in Washington

Telemedicine providers can prescribe medication to patients at their discretion. The same strict standards apply as in traditional practice, so practitioners must prescribe drugs responsibly, especially in the case of DEA-controlled substances.

MQAC encourages the use of e-Prescription services to minimize potential errors and ensure patient safety. The practitioner should also refrain from recommending specific pharmacies. The establishment from which the medication is to be obtained should be the choice of the patient.

The benefits of practicing telemedicine in Washington

Telemedicine gained popularity for a reason, and that goes far beyond the Evergreen State. It revolutionized the way doctors diagnose and treat patients. Healthcare is now available to patients who have limited access to medical facilities.

Residents from rural or remote areas benefit the most from telemedicine services. Even in urban areas, where life is often hectic, people are turning to telehealth because it is convenient and time-efficient.

When it comes to practitioners, the benefits are significant. Telemedicine allows them to:

• Expand the practice by seeing more patients or offering additional services
• Reduce the time wasted on administration by redirecting resources to medical issues
• Improve the visibility of documents and ease of access through the use of simple yet practical telehealth tools

In the wake of the COVID-19 pandemic, telemedicine can provide support to the healthcare system that struggles to stay afloat. In the long run, telehealth can contribute to the overall health of the population.

The challenges of practicing telemedicine in the Evergreen State

With excellent legislation and precise guidelines on how to practice telemedicine in check, practitioners from Washington are in a much better position than their colleagues from some other states. The challenges still exist, so make sure you focus on the following:

• Choose the right digital platform
• Ensure the continuity of care
• Ensure data security and privacy

Choosing the right partner

Opting for the right partner to provide your telemedicine platform is essential in establishing a successful business. Your telemedicine solution should have an appealing and user-friendly interface, integrate with your practice management system, and provide secure communication channels. Having reliable technical support is also essential.

We at Curogram offer comprehensive solutions that will allow you to focus on patients instead of dealing with IT issues.

Contingency plans

Telemedicine is not a suitable option for all patients. It is up to the practitioner to determine whether a particular person or condition is eligible for telehealth.

In case the service is appropriate, and they begin the treatment, each healthcare provider must have an emergency backup plan if the patient's condition deteriorates, and they need hospitalization. Such protocols should have precise guidelines. If the practitioner offers telemedicine services only, they must refer the patient to other appropriate institutions in time.

Data protection

Doctor-patient confidentiality and information privacy are as important in telemedicine as they are in traditional practice. Data protection is one of the biggest concerns in telehealth. Telemedicine tools require non-medical personnel to be involved, and they might even have access to electronic patient data (ePHI) transmitted through the platform. 

It is vital to make sure that encryption and password protection are in check because any violations can be damaging to your patients’ data and your practice. Your telemedicine platform must guarantee that all information is secure and can’t be accessed by third parties.

Telemedicine reimbursement in Washington

Washington state started regulating almost every aspect of reimbursement for telehealth services by updating the telemedicine parity law in 2017. This means that all health insurance providers should cover live video and store-and-forward services.

WA Medicaid only reimburses for telemedicine services provided over a live video call. This state-federal partnership also covers:

• Prenatal genetic counseling
• Treatment of autism 
• Behavior analysis
• Teledentistry
• Teledermatology
• Remote patient monitoring 

According to WA regulations, the reimbursement rates for telehealth should match those for traditional in-person services. This goes for private insurers, Medicaid beneficiaries, and employee health plan users.

Additional tips

Since telemedicine depends on digital communication, it is vital to have a well-organized online presentation. Your patients should be able to navigate your site easily, and the required information should be clearly visible and precise. You should state the following on your website:

1. Available services
2. Contact details of the physicians
3. All medical personnel credentials, licenses, and permits
4. Fees and payment methods
5. Any additional costs
6. Clear instructions on how to navigate the site and tools
7. Estimated response time for all communication channels available
8. Any third parties that can have access to patients’ information 
9. Patients’ rights and the ways to exercise them

Another crucial tool in modern medicine are electronic health records (EHRs) that make it easier to track patient medical records. The platform you choose for telemedicine must be able to integrate with your EHR. This will eliminate the need for manual entry and save time for patient care.

Curogram integrates with any EHR and is an excellent solution for any telehealth practice.

Telemedicine by State

Don’t see your state? We just haven’t written about it yet! Stay tuned on our blog or check out our article on telemedicine reimbursement by state.