medical history and images to an ID physician. The patient then receives a recommendation for treatment or direct care from the ID physician. ISSUES FOR CONSIDERATION Licensure, Credentialing, and Privileging Synchronous telemedicine requires the equivalent licensing, credentialing, and privileging as required for direct patient contact. In the United States, ID telemedicine services using interactive technologies are restricted to jurisdictions where the provider is permitted, by law, to practice. In other words, ID physicians delivering telemedicine services must be licensed in the state in which the patient is physically located (ie, the originating site) at the time of consultation and must abide by that state’s rules and regulations for maintenance of licensure and medical practice laws. IDSA supports efforts by state medical boards to facilitate and lower burdens for physicians to obtain licenses in multiple states. The Joint Commission (TJC) has established credentialing and privileging requirements for the provision of medical services using telemedicine. Under the TJC Telemedicine Requirements, practitioners who render care using live interactive systems are subject to credentialing and privileging at the distant site (location of the provider) when they are providing direct care to the patient. Practitioners who render care using asynchronous systems are viewed by TJC as “consultants” and may not be required to be credentialed at the originating site. The originating site may use the credentialing and privileging information from the distant site if all the following requirements are met: (1) the distant site is TJC-accredited; (2) the practitioner is privileged at the distant site for those services that are provided at the originating site; and (3) the originating site has evidence of an internal review of the practitioner’s performance of these privileges and sends to the distant site information that is useful to assess the practitioner’s quality of care, treatment, and services for use in privileging and performance management. Physicians who wish to provide asynchronous (store-and-forward) consultations across state lines should limit such consultations to states in which they are legally permitted to provide care. Information of issues of consideration regarding reimbursement may be found in the Supplementary Materials. Scope of Service, Quality of Care, and Documentation If experts are involved in designing and maintaining each aspect of a telehealth or telemedicine program, with evidence-based protocols, excellent communication between team members, and frequent program evaluation and quality assurance measures, an outstanding program may be designed and implemented. Vital core concepts include the following: obtaining the correct equipment and technology, providing high-quality clinical care in a timely fashion, assuring strict patient confidentiality, striving for high patient and provider satisfaction, appropriately creating and storing medical records, communicating with other care providers at the originating site, designing a sustainable business model (including reimbursement considerations), and—for some programs—high-quality teaching and research. Specific considerations include: • Patients or referring physicians seeking ID telemedicine services should have a choice of ID physicians and must have access, in advance, to the licensure and board certification qualifications of the clinician providing care. The delivery of ID telemedicine services must be consistent with state scopeof-practice laws. • The patient’s relevant medical history should be collected as part of the provision of ID telemedicine services. Ideally, appropriate medical records should be available to the consulting ID physicians prior to or at the time of the telemedicine encounter. Consulting ID physicians should have a good understanding of the culture, medical records, policies and procedures, healthcare infrastructure, and patient resources available at the site from which consultations are originating. • The provision of ID telemedicine services must be properly documented. These medical records should be available at both the originating (location of the patient) and distant (location of the provider) sites. •