Telehealth Practitioner-Patient Relationship: Building Trust in Virtual Care

As telehealth becomes a central component of modern healthcare, establishing and maintaining a compliant practitioner-patient relationship in the virtual setting is more important than ever. However, this relationship is governed by complex legal and regulatory frameworks that ensure quality of care, patient safety, and privacy.

In the realm of telemedicine, each state has its own laws and regulations regarding the establishment of a practitioner-patient relationship. While all states allow physicians to form such relationships via telemedicine, there may be certain variations and conditions to consider. Some states impose specific requirements on the patient's location, or the modalities used for establishing the relationship. To gain a better understanding, it is advisable to review the specific laws and regulations of each state.

According to the American Medical Association (AMA), a valid practitioner-patient relationship should be established before delivering telemedicine services. This can be achieved through one of the following methods:

  • If an in-person encounter is typically required for the service in question, a face-to-face examination may be necessary before commencing telemedicine services.

  • Another option is to have a consultation with a physician who already has an ongoing practitioner-patient relationship with the individual seeking telemedicine services. The physician who has established the relationship must agree to supervise the patient's care.

  • The establishment of a practitioner-patient relationship can also align with evidence-based clinical practice guidelines on telemedicine developed by prominent medical specialty societies. These guidelines, often created by societies like radiology and pathology, outline the standards for establishing such relationships.

Existing Policies: Defining the Virtual Care Relationship

Establishing the Practitioner-Patient Relationship in Telehealth

In telehealth, the establishment of a practitioner-patient relationship is foundational to delivering care. In most states, this relationship must be formally established before any diagnosis or treatment can occur. The rules for establishing this relationship vary by state, and providers must adhere to different requirements based on the services they offer.

Most states require:

  • Initial Consultations: A synchronous video or audio visit to establish the practitioner-patient relationship before prescribing medication or initiating treatment.

  • Patient Consent: Obtaining informed consent to ensure that the patient fully understands the nature of telehealth services.

  • Documentation: Proper record-keeping of the virtual visit to ensure that it complies with state regulations for continuity of care.

Informed Consent for Telehealth Services

Many states mandate that healthcare providers obtain explicit patient consent before engaging in telehealth visits. This involves explaining the potential risks, benefits, and limitations of telehealth and ensuring patients understand how it differs from in-person visits. Our resources detail state-by-state consent requirements to ensure compliance and provide best practices for enhancing patient understanding in virtual care environments.

Prescribing Laws and Practitioner-Patient Relationships

Federal and state laws place significant emphasis on how controlled substances can be prescribed via telehealth. Under the Ryan Haight Act, an in-person visit is typically required before a practitioner can prescribe controlled substances, though temporary COVID-19 waivers have allowed virtual prescribing under certain conditions. Our resources cover:

  • Conditions under which telehealth providers can prescribe medications, both for controlled and non-controlled substances.

  • The use of e-prescriptions and compliance with state-specific telehealth prescribing laws.

  • Policies around prescribing for chronic disease management, mental health, and pain management.

Continuity of Care in Telehealth

Maintaining continuity of care through telehealth is essential to fostering long-term relationships with patients. Current policies encourage healthcare providers to integrate telehealth visits with in-person care when needed and to maintain comprehensive records of telehealth encounters. Providers must also ensure appropriate follow-up, referrals, and coordination with other care teams to ensure ongoing patient support.

Supporting Quality Relationships in Virtual Care

The telehealth practitioner-patient relationship is the cornerstone of effective and safe virtual care. As policies evolve, healthcare providers must stay informed about how they can deliver high-quality, compliant care while fostering trust and maintaining long-term relationships with their patients. Our Telehealth Practitioner-Patient Relationship Center offers resources to help you:

  • Understand existing laws and requirements for establishing and maintaining telehealth relationships.

  • Stay up to date on evolving telehealth prescribing laws and cross-state relationship rules.

  • Access best practices for patient engagement, consent, and documentation in the virtual care environment.