Professions and Occupations
CHAPTER 60. Provisions Applicable to Telehealth and Telemedicine
For purposes of this chapter:
(1) “Distant site” means a site at which a health-care provider legally allowed to practice in Delaware is located while providing health-care services by means of telemedicine.
(2) “Health-care provider” means any person authorized to deliver clinical health-care services by telemedicine and participate in telehealth pursuant to this chapter and regulations promulgated by the respective professional boards listed in § 6002 of this title.
(3) “Originating site” means a site in Delaware at which a patient is located at the time health-care services are provided to the patient by means of telemedicine or telehealth. Notwithstanding any other provision of law, insurers and providers may agree to alternative siting arrangements deemed appropriate by the parties.
(4) “Store and forward transfer” means the synchronous or asychronous transmission of a patient’s medical information either to or from an originating site or to or from the provider at the distant site, but does not require the patient being present nor must it be in real time.
(5) “Telehealth” means the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.
(6) “Telemedicine” means a form, or subset, of telehealth, which includes the delivery of clinical health-care services by means of real time 2-way audio (including audio-only conversations, if the patient is not able to access the appropriate broadband service or other technology necessary to establish an audio and visual connection), visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which facilitates the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care.83 Del. Laws, c. 52, § 4; 83 Del. Laws, c. 283, § 29;
(a) Health-care providers licensed by the following professional licensing boards existing under this title are authorized to deliver health-care services by telehealth and telemedicine subject to the provisions of this chapter:
(1) The Board of Podiatry created pursuant to Chapter 5 of this title.
(2) The Board of Chiropractic created pursuant to Chapter 7 of this title.
(3) The Board of Medical Licensure and Discipline created pursuant Chapter 17 of this title.
(4) The State Board of Dentistry and Dental Hygiene created pursuant to Chapter 11 of this title.
(5) The Delaware Board of Nursing created pursuant to Chapter 19 of this title.
(6) The Board of Occupational Therapy Practice created pursuant to Chapter 20 of this title.
(7) The Board of Examiners in Optometry created pursuant to Chapter 21 of this title.
(8) The Board of Pharmacy created pursuant to Chapter 25 of this title.
(9) The Board of Mental Health and Chemical Dependency Professionals created pursuant to Chapter 30 of this title.
(10) The Board of Examiners of Psychologists created pursuant to Chapter 35 of this title.
(11) The State Board of Dietetics/Nutrition created pursuant to Chapter 38 of this title.
(12) The Board of Social Work Examiners created pursuant to Chapter 39 of this title.
(b) A professional licensing board listed in subsection (a) of this section may promulgate or revise rules applicable to health-care providers under the professional licensing board’s jurisdiction to facilitate the provision of telehealth and telemedicine services consistent with this chapter.
(c) A health-care provider licensed in a state that has not adopted an interstate compact applicable to the health-care provider may only provide telehealth under this chapter if the health-care provider obtains an interstate telehealth registration from the Division of Professional Regulation. A health-care provider is eligible for an interstate telehealth registration only if all of the following requirements are continuously met:
(1) The health-care provider holds a valid, active license issued by another state’s licensing authority or board.
(2) The health-care provider is licensed in good standing in all states in which the health-care provider is licensed.
(3) The health-care provider is not the subject of an administrative complaint which is currently pending before another state’s licensing authority or board.
(4) The health-care provider is not currently under investigation by another state’s licensing authority or board, or any authority in this State.
(d) A health-care provider who obtains an interstate telehealth registration under subsection (c) of this section consents and agrees to be subject to all of the following:
(1) The law of this State regarding the health-care provider’s profession in this State, including all provisions of Title 11, Title 16, and this title, and all regulations of this State.
(2) The judicial system of this State, which includes consenting and agreeing to be subject to the personal jurisdiction of the courts of this State under Chapter 31 of Title 10.
(3) All profession conduct rules and standards incorporated into the practice act for the health-care provider’s profession.
(4) The jurisdiction of the applicable licensing board in this State, including the board’s complaint, investigation, and hearing process. Any discipline imposed by a licensing board in this State may be reported to the applicable National Practitioner Database, as well as to every jurisdiction in which the health-care provider holds a license.83 Del. Laws, c. 52, § 4; 83 Del. Laws, c. 484, § 1;
(a) Except for the instances listed in this chapter, health-care providers may not deliver health-care services by telehealth and telemedicine in the absence of a health-care provider-patient relationship. A health-care provider-patient relationship may be established either in-person or through telehealth and telemedicine but must include all of the following:
(1) Thorough verification and authentication of the location and, to the extent possible, identity of the patient.
(2) Disclosure and validation of the provider’s identity and credentials.
(3) Receipt of appropriate consent from a patient after disclosure regarding the delivery model and treatment method or limitations, including informed consent regarding the use of telemedicine technologies as required by paragraph (a)(5) of this section.
(4) Establishment of a diagnosis through the use of acceptable medical practices, such as patient history, mental status examination, physical examination (unless not warranted by the patient’s mental condition), and appropriate diagnostic and laboratory testing to establish diagnoses, as well as identification of underlying conditions or contraindications, or both, for treatment recommended or provided.
(5) Discussion with the patient of any diagnosis and supporting evidence as well as risks and benefits of various treatment options.
(6) The availability of a distant site provider or other coverage of the patient for appropriate follow-up care.
(7) A written visit summary provided to the patient.
(b) Health-care services delivered by telehealth and telemedicine may be synchronous or asynchronous using store-and-forward technology. Telehealth and telemedicine services may be used to establish a provider-patient relationship only if the provider determines that the provider is able to meet the same standard of care as if the health-care services were being provided in-person.
(c) Treatment and consultation recommendations delivered by telehealth and telemedicine shall be subject to the same standards of appropriate practice as those in traditional (in-person encounter) settings. In the absence of a proper health-care provider-patient relationship, health-care providers are prohibited from issuing prescriptions solely in response to an internet questionnaire, an internet consult, or a telephone consult.83 Del. Laws, c. 52, § 4; 83 Del. Laws, c. 484, § 1;
(a) A health-care provider using telemedicine and telehealth technologies to deliver health-care services to a patient must, prior to diagnosis and treatment, do at least 1 of the following:
(1) Provide an appropriate examination in-person.
(2) Require another Delaware-licensed health-care provider be present at the originating site with the patient at the time of the diagnosis.
(3) Make a diagnosis using audio or visual communication.
(4) Meet the standard of service required by applicable professional societies in guidelines developed for establishing a health-care provider-patient relationship as part of an evidenced-based clinical practice in telemedicine.
(b) After a health-care provider-patient relationship is properly established in accordance with this section, subsequent treatment of the same patient by the same health-care provider need not satisfy the limitations of this section.
(c) A health-care provider treating a patient through telemedicine and telehealth must maintain complete records of the patient’s care and follow all applicable state and federal statutes and regulations for recordkeeping, confidentiality, and disclosure to the patient.
(d) Telehealth and telemedicine services shall include, if required by the applicable professional board listed in § 6002(a) of this title, use of the Delaware Health Information Network (DHIN) in connection with the practice.
(e) Nothing in this section shall be construed to limit the practice of radiology or pathology.83 Del. Laws, c. 52, § 4;
(a) Telehealth and telemedicine may be practiced without a health-care provider-patient relationship during:
(1) Informal consultation performed by a health-care provider outside the context of a contractual relationship and on an irregular or infrequent basis without the expectation or exchange of direct or indirect compensation.
(2) Furnishing of assistance by a health-care provider in case of an emergency or disaster when circumstances do not permit the establishment of a health-care provider-patient relationship prior to the provision of care if no charge is made for the medical assistance.
(3) Episodic consultation by a specialist located in another jurisdiction who provides such consultation services at the request of a licensed health-care professional.
(4) Circumstances which make it impractical for a patient to consult with the health-care provider in-person prior to the delivery of telemedicine services.
(b) A mental health provider, behavioral health provider, or social worker licensed in another jurisdiction who would be authorized to deliver health-care services by telehealth or telemedicine under this chapter if licensed in this State pursuant to Chapter 30 (Mental Health and Chemical Dependency Professionals), Chapter 35 (Psychologists), or Chapter 38 (Social Workers) of this title may provide treatment to Delaware residents through telehealth and telemedicine services. The Division of Professional Regulation shall require any out-of-state health-care provider practicing in this State pursuant to this section to complete a Medical Request Form and comply with any other registration requirements the Division of Professional Regulation may establish.83 Del. Laws, c. 52, § 4;