Psychiatrists

State of Washington Medical Quality Assurance Commission

Appropriate Use of Telemedicine MD2014-03

“A. Licensure: A practitioner using Telemedicine to practice medicine on patients in

Washington must be licensed to practice medicine in Washington.

1. This includes practitioners who treat or prescribe to Washington patients through

online service sites.

2. The licensure exemption in RCW 18.71.030(6) does not apply to Telemedicine

practice. RCW 18.71.030(6) exempts from the licensing requirement “The practice of

medicine by any practitioner licensed by another state or territory in which he or she

resides, provided that such practitioner shall not open an office or appoint a place of

meeting patients or receiving calls within this state.” As the legislature created this

exemption in 1909, it clearly was not designed to apply to Telemedicine. Our state

supreme court has stated that this exemption “merely permits out-of-state

physicians temporarily within the state, but without an office or similar professional 

connections, to practice their calling while in Washington.”2 The Commission

interprets this exemption as applying to physicians who are physically in the state

and treating patients in-person, but on a temporary basis, such as a physician for a

sports team visiting the state. The Commission’s interpretation is consistent with the

statement by the state supreme court and with the Commission’s mission to protect

the public. The Commission must have the ability to prevent unqualified physicians

from practicing in our state and to take disciplinary action against practitioners who

commit unprofessional conduct or are impaired.”

“B. Standard of Care: Practitioners using Telemedicine will be held to the same standard of

care as practitioners engaging in more traditional in-person care delivery, including the

requirement to meet all technical, clinical, confidentiality and ethical standards required

by law. Failure to conform to the standard of care, whether rendered in person or via

Telemedicine, may subject the practitionerto potential discipline by the Commission.

Some elements of the standard of care as applied to Telemedicine include:

1. Practitioner-Patient Relationship: When practicing Telemedicine, a practitioner

must establish a practitioner-patient relationship with the patient. The absence

of in-person contact does not eliminate this requirement. Patient completion of

a questionnaire does not, by itself, establish a practitioner-patient relationship,

and therefore treatment, including prescriptions, based solely on a questionnaire

does not constitute an acceptable standard of care.

2. Informed Consent: As with medical care involving in-person contact, a

practitioner should obtain and document appropriate informed consent for

Telemedicine encounters. Because of the unique characteristics of Telemedicine,

it is best practice for the informed consent to include:

1. Reasonable understanding by all parties of the enabling technologies

utilized, their capabilities and limitations, and a mutual agreement that

they are appropriate for the circumstances;

1. The credentials of the practitioner.
2. Patient Evaluation: An appropriate history and evaluation of the patient must

precede the rendering of any care, including provision of prescriptions. Not all

patient situations will be appropriate for Telemedicine. Since, by definition,

Telemedicine does not involve in-person contact between practitioner and

patient, if circumstances require in-person contact, an appropriate surrogate

examiner acceptable to the Telemedicine practitioner and the patient must be

present, with the patient, to provide necessary in-person observations, or the

Telemedicine practitioner should advise the patient to be seen by a practitioner

in-person. Evaluating the adequacy and significance of any surrogate

examination remains the responsibility of the Telemedicine practitioner.”

Refer to the source provided for all requirements and limitations.

Permission for the Temporary Practice of Clinicians Licensed Outside the State

We are not aware of any permission that allows for services delivered by out-of-state providers.