1. Kenneth B Simons, MD Chair, WI MEB Chair, FSMB SMART Workgroup

2. Telemedicine --- the practice of medicine using electronic communications, information technology or other means between a licensee in one location, and a patient in another location with or without an intervening healthcare provider. Generally, telemedicine is not an audio only, telephone conversation, e-mail/instant messaging conversation or fax. It typically involves the application of secure videoconferencing or store and forward technology to provide or support healthcare delivery by replicating the interaction of a traditional in person encounter between a provider and a patient Telemedicine Technologies – devices and technologies enabling secure electronic communications and information exchange between a licensee in one location and a patient in another location with or without an intervening healthcare provider Definitions

3. Welfare of patients comes first Maintain acceptable & appropriate standards of practice Adhere to recognized ethical codes governing medical profession Properly supervise non-physician clinicians Protect patient confidentiality First Principles

4. When does it begin? Fundamental to the provision of acceptable medical care Physicians must recognize the obligations, responsibilities and patient rights associated with establishing and maintaining the relationship Thus with telemedicine technologies: 1.Fully verify and authenticate the location and to the extent possible, the requesting patient 2.Disclose and validate provider’s identity and applicable credentials 3.Obtain appropriate consents after disclosures re: delivery models, rx methods or limitations regarding the use of telemedicine technologies Establishing the Physician-Patient Relationship

5. A physician must be licensed by, or under the jurisdiction of, the medical board of the state where the patient is located. Licensure

6. Documented medical evaluation and history c/w patient presentation to establish dx and id underlying conditions and/or contra-indications to rx recommended/provided MUST be obtained prior to providing rx, including issuing prescriptions Rx and consultation recommendations in an online setting will be held to the same standards as a traditional F2F (in person) setting Rx (including issuing prescriptions) based solely on an online questionnaire does not constitute an acceptable standard of care Evaluation and Treatment of the Patient

7. Appropriately includes: Identification of the patient, the physician and physician’s credentials Types of transmissions permitted using telemedicine technologies Patient agrees that the physician determines whether or not the condition being dx’d or rx’d is appropriate for telemedicine Details on security measures taken with use of telemedicine technologies Hold harmless clause for information lost due to technical failures Requirement for express patient consent to forward pt. identifiable data to a third party Informed Consent

8. Referrals for Emergency Services Medical Records Privacy and Security of Pt. Records & Exchange of Information Disclosures and Functionality on Online Services Making Available Telemedicine Technologies Parity of Professional and Ethical Standards Continuity of Care