“Telehealth” is the universal term for the broad array of current telemedicine applications. As per Section 2290.5 of the California Business and Professions Code, it is defined as “… the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at a distant site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.”
As per Assembly Bill 415 — passed 2011 — “telemedicine” is defined as “… the ability of physicians and patients to connect via technology other than through virtual interactive physician/patient capabilities, especially enabling rural and out-of-area patients to be seen by specialists remotely.” However, patients are still expected to have a full examination by a recommended physician, outlined by the Compassionate Use Act of 1996.
California is currently one of five states — including Connecticut, Maine, Massachusetts, and New York — that does not require an in-person physical examination to establish a bonafide patient-physician relationship. Instead, healthcare providers may not only establish patient relationships through telemedicine, but they may also prescribe non-controlled substances — prescribing “dangerous drugs or devices” via telemedicine, is only permitted if an in-person examination is conducted first.
All healthcare professionals — including but not limited to, physicians, nurses, dentists, chiropractors, speech pathologists, registered dietitians, occupational therapists, and licensed midwives — licensed under Division 2 of California’s Healing Arts statute, may legally provide telemedicine care to patients. And, unless deemed inappropriate by a healthcare provider, any patient is eligible to receive remote care, upon giving informed consent.
California regulations, permit telemedicine services to include: “store-and-forward” fax, email and secure messaging; real-time videoconferencing; telephonic communications; and remote patient monitoring (RPM).
As per Chapter 404, all health care practitioners providing telemedicine services, are required to first obtain either a patient’s written or verbal informed consent, prior to commencing service.
All out-of-state health care practitioners intending to provide telemedicine services, to patients geographically situated in the state of California, must first obtain a valid medical license, from the California Medical Board, prior to commencing service — however, physician-to-physician (P2P) exemptions apply.
California is one of 16 states across the United States to have an informed consent policy for telemedicine.
On January 1, 2016, a new law in California went into effect that established standards for doctors who write recommendations for the use of medical marijuana. In a nutshell, the law states that no one can either prescribe, furnish, dispense, or cause to be prescribed, furnished or dispensed, “dangerous drugs or devices” on the Internet without an “appropriate prior examination.”
What this means for California medical marijuana telemedicine was not completely clear. It could be interpreted as prohibiting doctors from using telemedicine to recommend medical cannabis. Or it could be interpreted as allowing telemedicine recommendations as long as the state considered telemedicine doctor-patient examinations as an “appropriate prior examination.” There will likely be many tweaks to this new law in the next year to make it as clear as possible as to whether telemedicine will continue to be allowed in the state.
Physicians offering California medical marijuana telemedicine services are required to be licensed in the state and ensure that patient medical information remains private. They are required to carry all the duties related to practicing medicine whether they provide their services on a face-to-face basis or via telemedicine.