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The Arkansas State Medical Board on Thursday unanimously passed requirements to allow doctors to examine patients from a distant location.

The standards, known as Regulation 38, mirror Act 887 of 2015, which lays out guidelines on the use of telemedicine, board Chairman Joseph Beck said.

The board had previously adopted the standards, but a legislative committee kicked it back to the group upon getting complaints that language in the rule had changed after a June hearing.

"There was some discussion in Rules and Regs regarding whether or not the [medical] board's hearing in June was conducted properly," board attorney Kevin O'Dwyer said, referring to concerns aired by the Legislature's Rules and Regulations subcommittee. "The attorney for Rules and Regs indicated that it was, in fact, and that the regulation was conformed with the statute. However, it was suggested we hold another public hearing."

Regulation 38 will now go back to the subcommittee. If lawmakers approve it, the rule will become effective 10 days after it is sent to Arkansas' secretary of state's office, he said.

Backers of telemedicine had supported an earlier version of the rule and said that language on "store and forward technology" changed after a June 9 public hearing.

A few policymakers also complained about the change, prompting the Legislature's public health committees to send the regulation to the Rules and Regulations subcommittee without a recommendation.

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The regulation had said that "store and forward technology" did not include a patient or telemedicine company filling out a medical history form and sending it to a doctor. Such technology under the older version of the regulation included X-rays and MRIs.

Officials with Teladoc, a phone-based, health-services company headquartered in Dallas, had concerns that the "store and forward" definition neither matched those in other states nor aligned with Act 887. The law defines the phrase as "the transmission of a patient's medical information" from a health care facility to a provider.

Since June, the medical board decided to strike out the "store and forward" language, to which some telemedicine vendors objected. The board took out a paragraph with that language because it was repetitive, said David Wroten, executive vice president of the Arkansas Medical Society.

"The No. 1 thing that today's hearing did was it made clear that what the medical board did the first time around was valid," he said. "Everybody said it wasn't a substantive change, and it did not conflict with the statute. In spite of that, they decided to hold another public hearing. It's the same rule ..."

At the second public hearing, on Thursday, only one person spoke in favor of the regulation. No one spoke against it.

Robert Baratta, who represented Teladoc, relayed the company's support of the standards "after careful review."

Claudia Tucker, the company's vice president of government affairs, sent the medical board a letter, saying that the firm "agree[d] on the importance of these issues in telemedicine to have the patient's medical record and to review that record before the telemedicine visit occurs, and that process does not need to be referred to as 'store and forward technology.'"

The regulation still calls for patients and physicians to establish a proper relationship before a telemedicine visit, meaning a relationship is not established if a patient solely completes online medical history forms and forwards them to a doctor.

Doctors can treat patients they have examined at some point in person, when they have an ongoing professional or personal relationship with the patient, when they have a referral from another doctor or when they are filling in for the patient's regular doctor.

As of Sept. 6, doctors can establish a relationship through an examination conducted from a distant location through audio and visual technology.

The September change doesn't open the door for phone-based services, such as Teladoc, because the 2015 law requires patients to be in a doctor's office or another health care facility at the time of an examination conducted via telemedicine.

Information for this article was contributed by Andy Davis of the Arkansas Democrat-Gazette.

Metro on 10/07/2016

Print Headline: Board passes telemedicine rules; After 2nd public hearing, rules again go to legislative panel

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