Telehealth rules in Chapters 6 and 7 became effective on June 22, 2022, and the purpose is to provide guidance to licensed practical nurses, registered nurses, and APRNs on the practitioner provider relationship, consent to telehealth visits, the use of technology, record keeping, and follow-up care. In essence, the rules provide additional guidance on the effective and safe use of telehealth technology.
According to the literature, telehealth is the use of digital information and communication technologies to access health care services remotely and manage the health care of a patient (ATA, 2019; Kruse et al., 2017; NONPF, 2018). Technologies can include computers and mobile devices, such as tablets and smartphones. This may be technology the patient use from home.
In addition, a nurse or other health care professional may provide telehealth from a primary care office or federally qualified health center, such as in rural areas. Telehealth can also be technology that the health care provider uses to improve or support health care services.
Per Iowa Administrative Code, Chapter 7.9(5), Prior to providing services through telehealth, the licensee shall first establish a practitioner-patient relationship. A practitioner-patient relationship is established when:
- The person with a health-related matter seeks assistance from the licensee
- The licensee agrees to provide services
- The person agrees to be treated, or the person’s legal guardian or legal representative agrees to the person’s being treated, by the licensee regardless of whether there has been a previous in-person encounter between the licensee and the person.
In addition, a practitioner-patient relationship can be established through an in-person encounter, consultation with another licensee or health care provider, or telehealth encounter. Some services may be provided through telehealth without first establishing a practitioner-patient relationship in the following settings or circumstances:
- Institutional settings
- Licensed or certified nursing facilities, residential care facilities, intermediate care facilities, assisted living facilities, and hospice settings
- In response to an emergency or disaster
- Informal consultations with another health care provider performed by a licensee outside of the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation
- Episodic consultations by a specialist located in another jurisdiction who provides consultation services upon request to a licensee
- A substitute licensee acting on behalf and at the designation of an absent licensee or other health care provider in the same specialty on an on-call or cross-coverage basis; -· when a sexually transmitted disease has been diagnosed in a patient, a licensee prescribes or dispenses antibiotics to the patient’s named sexual partner(s) for the treatment of the sexually transmitted disease as recommended by the U.S. Centers for Disease Control and Prevention.
A licensee who provides services through telehealth shall be held to the same standard of care as is applicable to in-person settings. A licensee shall not perform any service via telehealth unless the same standard of care can be achieved as if the service was performed in person. Prior to initiating contact with a patient for the purpose of providing services to the patient using telehealth, a licensee shall:
- Review the patient’s history and all relevant medical records
- Determine as to each unique patient encounter whether the licensee will be able to provide the same standard of care using telehealth as would be provided if the services were provided in person.
Additionally, prior to providing services via telehealth, the licensee shall obtain consent from the patient, or the patient’s legal guardian or legal representative, to receive services via telehealth.
Lastly, a licensee who provides services through telehealth to a patient physically located in Iowa must be licensed by the Iowa board of nursing. A licensee who provides services through telehealth to a patient physically located in another state shall be subject to the laws and jurisdiction of the state where the patient is physically located.
Telehealth rules and regulations may be reviewed in the following web links:
American Telemedicine Association. (ATA). (2019). Telehealth basics. Retrieved from https://www.americantelemed.org/resource/why-telemedicine/.
Iowa Administrative Code. (IAC). (2022). 6.4(152) Telehealth. Retrieved from https://www.legis.iowa.gov/docs/iac/rule/05-18-2022.655.6.4.pdf
Iowa Administrative Code. (IAC). (2022). 7.9(152) Standards of practice for telehealth. Retrieved from https://www.legis.iowa.gov/docs/iac/rule/05-18-2022.655.7.9.pdf
Kruse C. S., Krowski N., Rodriguez B., Tran L., Vela J., Brooks M. (2017). Telehealth and patient satisfaction: A systematic review and narrative analysis. BMJ Open, 7, e016242.