Current through Register Vol. 49, No. 9, September, 2024
XIV. Telemedicine (Ark. Code Ann. §
17-103-309)
A. Definitions:
1. "Distant site" means the location of the
healthcare professional delivering services through telemedicine at the time
the services are provided. Ark. Code Ann. §
17-80-402(1).
2. "Originating site" means a site at which a
patient is located at the time healthcare services are provided to him or her
by means of telemedicine. Ark. Code Ann. §
17-80-402(2).
3. "Remote patient monitoring" means the use
of synchronous or asynchronous electronic information and communication
technology to collect personal health information and medical data from a
patient at an originating site that is transmitted to a healthcare professional
at a distant site for use in the treatment and management of medical conditions
that require frequent monitoring. Ark. Code Ann. & §
17-80-402(5).
4. "Store-and-forward technology" means the
asynchronous transmission of a patient's medical information from a healthcare
professional at an originating site to a healthcare professional at a distant
site. Ark. Code Ann. §
17-80-402(6).
5. "Telemedicine" means the use of electronic
information and communication technology to deliver healthcare services,
including without limitation the assessment, diagnosis, consultation,
treatment, education, care management, and self-management of a patient.
Telemedicine includes store-and-forward technology and remote patient
monitoring. Ark. Code Ann. §
17-80-402(7).
B. Establishing a Social
Worker/Client Relationship:
A social worker/client relationship must be established in
accordance with Ark. Code Ann. §§
17-80-402
& 403 and Rule XIV before the delivery of services via telemedicine. A
client completing a psychosocial history online and forwarding it to a social
worker is not sufficient to establish the relationship, nor does it qualify as
store-and-forward technology. A social worker exhibits gross negligence if he
or she provides and/or recommends any form of treatment via telemedicine
without first establishing a proper social worker/client relationship.
C. Minimum Requirements for a
Social Worker/Client Relationship:
For the purpose of this Rule, a proper social worker/client
relationship, at a minimum requires that:
1. The social worker performs an "in person"
psychosocial assessment of the client adequate to establish a diagnosis and
develop a treatment plan, OR
2. The
social worker performs a face to face psychosocial assessment using real time
audio and visual telemedicine technology that provides information at least
equal to such information as would have been obtained by an in-person
psychosocial assessment, OR
3. The
social worker knows the client and the client's general psychosocial issues
through a previously established professional relationship; AND
4. Appropriate follow-up be provided or
arranged, when necessary.
D. When a Social Worker/Client Relationship
is Deemed to Exist:
For the purpose of this Rule, a proper social worker/client
relationship is deemed to exist in the following situations:
1. When treatment is provided in consultation
with, or upon referral by, another provider or treatment team who has an
ongoing relationship with the client, and who has agreed to supervise the
client's treatment, including follow up care.
2. On-call or cross-coverage situations
arranged by the client's treating provider or treatment team.
E. Exceptions:
Recognizing a social worker's duty to adhere to the applicable
standard of care and to comply with mandatory reporting laws, the following
situations are excluded from the requirement of this rule by Ark. Code Ann.
§
17-80-403(a)(2):
1. Emergency situations where the life
or health of the client is in danger or imminent danger.
2. Simply providing information of a generic
nature not meant to be specific to an individual client.
F. Professional Relationship Exceptions:
Under Ark. Code Ann. §
17-80-403(c),
"Professional relationship" does not include a relationship between a social
worker and a client established only by the following:
1. An internet questionnaire;
2. An email message;
3. Patient-generated medical
history;
4. Audio-only
communication, including without limitation interactive audio;
5. Text messaging;
6. A facsimile machine; or
7. Any combination thereof.
G. Requirements for Services
Provided Via Telemedicine:
The following requirements apply to all services provided by
social workers using telemedicine:
1.
The practice of counseling via telemedicine shall be held to the same standards
of care as traditional in-person encounters.
2. The social worker must obtain a detailed
explanation of the client's complaint from the client or the client's treating
provider or treatment team.
3. If a
decision is made to provide treatment, the social worker must agree to accept
responsibility for the care of the client.
4. If follow-up care is indicated, the social
worker must agree to provide or arrange for such follow-up care.
5. The social worker must keep a documented
treatment record, including, but not limited to psychosocial history.
6. At the client's request, the social worker
must make available to the client an electronic or hardcopy version of the
client's treatment record documenting the encounter. Additionally, unless the
client declines to consent, the social worker must forward a copy of the record
of the encounter to the client's regular treating provider or treatment team if
that provider or treatment team is not the same social worker delivering the
service via telemedicine.
7.
Services must be delivered in a transparent manner, including providing access
to information identifying the social worker's licensure and other relevant
certifications, as well as client financial responsibilities, in advance of the
encounter.
8. If the client, at the
recommendation of the social worker, needs to be seen in person, the social
worker must arrange to see the client in person or direct the client to their
regular treating provider or treatment team or other appropriate provider if
the client does not have a treating provider or treatment team. Such
recommendation shall be documented in the client's treatment record.
9. Social workers who deliver services
through telemedicine must establish protocols for referrals for emergency
services.
H. Scope of
Practice:
Social workers may practice social work via telemedicine within
the definitions found in Ark. Code Ann. §
17-103-103.
I. Confidentiality:
Social workers who use technology to facilitate supervision,
consultation, or other confidential meetings shall use appropriate precautions
to protect the confidentiality of those communications. Precautions to protect
confidentiality depend on the type of technology being used, and may isnclude
using passwords, firewalls, encryption, and antivirus software; using
electronic service providers that rely on standards of security for data that
are transmitted and stored; and ensuring a private setting when using their
electronic devices. See NASW, ASWB, CSWE, & CSWA Standards for Technology
in Social Work Practice.
