La. Admin. Code tit. 46 § LI-509

Current through Register Vol. 50, No. 9, September 20, 2024

Section LI-509 - Optometric Telemedicine

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.

La. Admin. Code tit. 46, § LI-509

Promulgated by the Department of Health, Board of Optometry, LR 48299 (2/1/2022).

AUTHORITY NOTE: Promulgated in accordance with R.S. 37:1041-1068.