AOA Board of Trustees adopts Oct. 16 recommendations of its Telehealth Council, which consulted leaders in the technology platform, artificial intelligence, and eye health and vision care in a nearly yearlong reimagination of the 2017 AOA policy.
The new position statement replaces the board’s 2017 policy statement and represents a yearlong look by the AOA Telehealth Council and input from leaders in eye and vision care, artificial intelligence, telehealth platforms and doctors. The new position paper includes AOA’s stance on telemedicine, criteria for ensuring high-quality telemedicine in optometry, legal and privacy considerations, a section on the essentialness of the doctor-patient relationship, as well as reaffirmation of the in-person, comprehensive eye exam as optometry’s “gold standard” of care.
“In-person, comprehensive eye exams will continue to be the gold standard,” says Teri K. Geist, O.D., board liaison to the Telehealth Council. “However, for the sake of our patients, doctors of optometry must take an active role in the evolution of telemedicine technology and use.
“That means we help define how this technology-based care is optimally developed and implemented,” says Dr. Geist, who thanked the council for its work. “Then we must embrace improved patient access and outcomes, while fighting against care that is substandard and puts patients at risk.”
CRITERIA FOR ENSURING HIGH QUALITY TELEMEDICINE IN OPTOMETRY
Important criteria must be met to ensure that telemedicine in optometry meets the existing standard of care, is of high-quality, contributes to care coordination, protects and promotes the doctor-patient relationship, complies with state licensure and other legal requirements, maintains patient choice and transparency, and protects patient privacy.
- The standard of care for eye, health, and vision services must remain the same regardless of whether services are provided in-person, remotely via telehealth, or through any combination thereof. Doctors may not waive this obligation or require patients to waive their right to receive the standard of care. Further, a payor may not require either the doctor or patient waive the right to receive the standard of care.
- Fundamental elements of the doctor-patient relationship must be established and maintained. Physicians must act as advocates on behalf of the patient and are obligated to discuss necessary and appropriate treatment alternatives, and in good faith to fully inform the patient of all treatment options.
- Physicians must ensure all protected health and other personal information is held in confidence.
- Patients consent to receive telemedicine in optometry and understand their right to choose (at any point in the care continuum) in-person eye, health, and vision services provided by a doctor of optometry. Telemedicine in optometry must be provided consistent with and in compliance with existing laws and regulations of practice in the respective jurisdiction.
- In-person care, provided by a doctor of optometry, is the gold standard for the delivery of a comprehensive eye exam and for the prescription of glasses or contact lenses.
- The use of remote patient monitoring may be appropriate for data acquisition, patient communication, confirmation of expected therapeutic results, confirmation of stability/or homeostasis, and assessing changes in previously diagnosed chronic conditions.
- The use of telemedicine in optometry may in certain circumstances be appropriate for establishing a doctor-patient relationship for an initial diagnosis. Telemedicine in optometry should not be used to replace partial or entire categories of care available in-person where the doctor-patient relationship is strengthened through personal face-to-face interactions.
- Unless otherwise permitted by law or regulation, doctors of optometry delivering telemedicine in optometry must be licensed in the state in which the patient receives care and must abide by that state’s licensure laws and regulations.
- Patients must be made aware of the limitations of telemedicine in optometry. Doctors of optometry delivering eye, health, and vision services via telemedicine in optometry must, when clinically appropriate, promptly provide in-person care or refer the patient for an in-person visit with a doctor of optometry or refer to another qualified physician for diagnosis and/or care. Referrals must adhere to the same standard of care with regard to the timeframe for appropriate referral.
- The patient’s relevant health history must be collected as part of telemedicine in optometry. Appropriate health records should be available to the doctor of optometry prior to or at the time of the telehealth encounter. Doctors of optometry should have a good understanding of the culture, health care infrastructure, and patient resources available at the originating site. The provision of eye, health, and vision services delivered by telemedicine in optometry must be properly documented. These health records should, when appropriate, be available at the remote site and at the originating site and electronically or physically available to the patient.
- The provision of eye, health, and vision services delivered via telemedicine in optometry should adhere to the in-person standard of care with regard to care coordination with the patient’s additional health care practitioners. This coordination is especially important to ensure that information regarding diagnoses, test results, and medication changes are available to the care team, when one exists.
- In the absence of an existing doctor-patient relationship, services which, remote or otherwise, offer a prescription for glasses or contact lenses without a comprehensive eye exam, including all the elements of a comprehensive exam would not meet the current standard of care and as such cannot be delivered independently by telemedicine in optometry. Any doctor of optometry who offers a prescription under such circumstances would be in violation of their ethical obligations and duty of care.
To read in detail about 2020 position statement on Telemedicine visit AOA Policy Statement.
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Resources: American Optometric Association
