Current through Register Vol. 50, No. 9, September 20, 2024
A.
General Provisions
1. Telemedicine is a tool
and not separate field of optometry, nor does telemedicine alter the scope of
practice of Louisiana-licensed optometrists. There is no separate or different
scope of practice or standard of care applicable to those who practice
optometry via telemedicine within this state or to those optometrists located
outside Louisiana who diagnose and treat via telemedicine patients located
within this state. Accordingly, telemedicine in the field of optometry, if
employed in the appropriate manner and circumstances, can provide significant
benefits, among them increased patient access to health care.
2. The practice of optometry is deemed to
occur both where the patient is located and where the optometrist providing
professional services is located and is hereby declared to affect the public
health, safety and welfare, and is subject to regulation and control in the
public interest. It is further declared to be a matter of public interest and
concern that the practice of optometry, as defined in this chapter, rendered to
a person located in Louisiana or by an optometrist located in Louisiana be
limited to qualified persons licensed to practice optometry in the state of
Louisiana and registered as a telemedicine provider with the board.
B. Definitions. For the purpose of
this Chapter, the following terms shall have the respective meaning ascribed by
this Section.
Distant Site Provider-the provider providing
the optometric telemedicine service from a site other than the patient's
current location. A distant site provider shall hold an active Louisiana
license and must hold an active optometric license in good standing in
Louisiana and be a registered Telemedicine provider with the board.
Established Treatment Site-a location where
a patient shall present to seek optometric care where there is an optometrist
present and sufficient technology and equipment to allow for an adequate
physical evaluation as appropriate for the patient's presenting complaint. The
term requires an optometrist-patient relationship. A patient's private home is
not considered an established treatment site.
Face to Face Visit-an evaluation and/or
treatment performed on a patient where both the provider and patient are at the
same physical location or where the patient is at an established treatment
site.
Human Eye and Its Adjacent Structures-the
eye and all structures situated within the orbit, including the conjunctiva,
lids, lashes, and lachrymal system.
In-Person Evaluation-a patient evaluation
and/or treatment conducted by a provider who is at the same physical location
as the location of the patient.
Optometric Telemedicine-a health service
interaction that is delivered by a licensed optometrist acting within the scope
of his or her license between an optometrist in one physical location and a
patient located in any different physical location, accomplished via
audio-visual link, imaging, telephone, or other appropriate forms of electronic
communication and/or technology used to allow or assist the optometrist in
providing care to the patient and may require the use of advanced
telecommunications technology, other than facsimile technology, including all
of the following:
a. compressed
digital interactive video, audio, or data transmission;
b. clinical data transmission using computer
imaging by way of still image capture and store and forward;
c. other technology that facilitates access
to health care services or optometric specialty expertise.
Pharmaceutical Agents-any diagnostic and
therapeutic drug or combination of drugs that has the property of assisting in
the diagnosis, prevention, treatment, or mitigation of abnormal conditions or
symptoms of the human eye and its adjacent structures.
Provider-optometrist holding an active
Louisiana license in good standing and is a registered telemedicine provider
with the board.
C. License, Registration. An optometric
telemedicine provider must hold an active Louisiana optometric license in good
standing. Any optometric telemedicine license shall be renewed on an annual
basis provided the licensee is in good standing and shall have the same renewal
due dates as the basic optometric license.
D. Prerequisite Conditions
1. A provider must hold an active Louisiana
optometric license in good standing and be telemedicine registered.
2. Prior to utilizing optometric telemedicine
at an established treatment site the provider shall ensure that:
a. he or she has access to those portions of
the patient's medical record pertinent to the visit;
b. there exists appropriate support staff
who:
i. are trained to conduct the visit by
optometric telemedicine;
ii. are
available to implement optometrist orders, identify where medical records
generated by the visit are to be transmitted for future access, and provide or
arrange back up, follow up, and emergency care to the patient; and
iii. provide or arrange periodic testing and
maintenance of all optometric telemedicine equipment.
3. A trained and supervised health
care professional who can adequately and accurately assist with the
requirements of LAC 46:XLV.7509-7511 shall be in the examination room with the
patient at all times that the patient is receiving optometric telemedicine
services.
E. Services;
Provider-Patient Relationship; Standards of Practice; Confidentiality
1. Optometric telemedicine services provided
at an established treatment site may be used for all patient visits, including
initial evaluations to establish a proper doctorpatient relationship between a
provider and a patient.
a. a provider shall be
reasonably available onsite at the established medical site to assist with the
provision of care.
b. a provider
may delegate tasks and activities at an established treatment site to an
assistant who is properly trained and supervised or directed.
2. A distant site provider who
provides optometric telemedicine services to a patient that is not present at
an established treatment site shall ensure that a proper provider patient
relationship is established, which at a minimum includes all of the following:
a. having had at least one face-to-face
meeting at an established treatment site before engaging in optometric
telemedicine services. A face-to-face meeting is not required for new
conditions relating to an existing patient, unless the provider deems that such
a meeting is necessary to provide adequate care;
b. if an in-person initial encounter is not
possible, the optometrist must take the time and effort, and to use means and
methods appropriate under the circumstances, to gain the necessary
understanding of the patient and the patient's history, condition, and needs in
order to render a diagnosis and treatment plan that is consistent with the
standard of care.
c. establishing
that the person requesting the treatment is in fact whom he or she claims to
be.
3. Evaluation,
treatment, and consultation recommendations made in an optometric telemedicine
setting, including issuing a prescription via electronic means, shall be held
to the same standards of appropriate practice as those in traditional in-person
clinical settings.
4. Adequate
security measures shall be implemented to ensure that all patient
communications, recordings, and records remain confidential.
a. Written policies and procedures shall be
maintained when using electronic mail for provider-patient communications.
Policies shall be evaluated periodically to make sure they are up to date.
Policies and procedures shall address all of the following:
i. privacy to assure confidentiality and
integrity of patient-identifiable information;
ii. health care personnel, in addition to the
provider, who will process messages;
iii. hours of operation and
availability;
iv. types of
transactions that shall be permitted electronically;
v. required patient information to be
included in the communication, such as the patient name, identification number,
and type of transaction;
vi.
archival and retrieval;
vii.
quality oversight mechanisms.
b. All relevant provider-patient email, and
other patient-related electronic communications, shall be stored and filed in
the patient record.
c. Patients
shall be informed of alternative forms of communication for urgent
matters.
F.
Protocols; Privacy Practices
1. A provider who
uses optometric telemedicine in his or her practice shall adopt protocols to
prevent fraud and abuse through the use of optometric telemedicine.
2. Privacy Practices
a. A provider that communicates with patients
by electronic communications other than facsimile shall provide patients with
written notification of the provider's privacy practices before evaluation or
treatment.
b. The notice of privacy
practices shall include language that is consistent with federal standards
under 45 CFR Parts 160 and 164 relating to privacy of individually identifiable
health information.
c. A provider
shall make a good faith effort to obtain the patient's written acknowledgment
of the notice.
3.
Limitations of Optometric Telemedicine. A provider who uses optometric
telemedicine services, before providing services, shall give each patient
notice regarding optometric telemedicine services, including the risks and
benefits of being treated via optometric telemedicine, and how to receive
follow-up care or assistance in the event of an adverse reaction to the
treatment or in the event of an inability to communicate as a result of a
technological or equipment failure. A signed and dated notice, including an
electronic acknowledgement by the patient, establishes a presumption of
notice.
4. Necessity of In-Person
Evaluation. When, for whatever reason, the optometric telemedicine modality in
use for a particular patient encounter is unable to provide all pertinent
clinical information that a healthcare provider exercising ordinary skill and
care would deem reasonably necessary for the practice of optometry at an
acceptable level of safety and quality in the context of that particular
encounter, then the distant site provider shall make this known to the patient
and advise and counsel the patient regarding the need for the patient to obtain
an additional inperson evaluation reasonably able to meet the patient's
needs.
G. Maintenance of
Records
1. Patient records shall be maintained
for all optometric telemedicine services The provider or distance site provider
shall maintain the records created at any site where treatment or evaluation is
provided.
2. Distance site
providers shall obtain an adequate and complete medical history for the patient
before providing treatment and shall document the medical history in the
patient record.
3. Patient records
shall include copies of all relevant patient-related electronic communications,
including relevant provider-patient emails, prescriptions, laboratory and test
results, evaluations and consultations, records of past care, and instructions.
If possible, optometric telemedicine encounters that are recorded
electronically shall also be included in the patient record.
H. Exceptions
1. A licensed optometrist, who is not
licensed in Louisiana, who utilizes optometric telemedicine across state lines
in an emergency, as defined by the board, is not subject to the requirements of
this article.
2. A provider that is
contacted in an emergency is not subject to the notice and security provisions
of this rule, but is subject to those provisions should any nonemergency care
continue with the patient.
I. Limitation on Application of Chapter. This
Section shall not be construed as authorizing any optician or other person
selling eyeglasses or contact lenses on prescription as authorized above to use
any instrumentation or determine any data by performing any type of examination
or corneal evaluation necessary for the fitting of contact lenses or to use any
drugs in relation thereto.
J.
Penalties. Any person who violates this chapter is subject to criminal
prosecution for the unlicensed practice of optometry, or other action
authorized in this state to prohibit or penalize continued practice without a
license.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
37:1041-1068.
