The provision of ID telemedicine services should include care coordination with the patient’s existing primary care physician or medical home, and existing ID physician(s) if Downloaded from https://academic.oup.com/cid/article/64/3/237/2912592 by guest on 03 December 2021 240 • CID 2017:64 (1 February) • Siddiqui et al one exists. This should include, at a minimum, identifying the patient’s existing primary care physician in the telemedicine record, and providing a copy of the medical record to active members of the treatment team. This is vitally important so that information about diagnoses, test results, and medication changes are available to the existing care team. • Organizations and clinicians providing ID telemedicine services should have an active training and quality assurance program for both the distant and receiving sites. Each organization should also maintain documentation on how the program protects patient privacy, promotes high-quality clinical continuity of care, and facilitates care coordination for patients who may require subsequent in-person evaluations or procedures. • Organizations and clinicians participating in ID telemedicine services should have protocols for local referrals (in the patient’s geographic area) for urgent and emergency services. • The physician–patient relationship: a. For ID telemedicine services where a referring provider ultimately manages the patient (including the prescription of medications), the consulting ID physician is not required to have a preexisting, valid patient–physician relationship. It is optimal, however, if the patient has available access to in-person follow-up with a local, board-certified ID physician if needed. b. For direct-to-patient ID telemedicine services, IDSA believes that the consulting ID physician must either: ○ Have an existing physician–patient relationship (having previously seen the patient in person); ○ Create a physician–patient relationship through the use of a live-interactive face-to-face consultation at the initial visit; or ○ Be a part of an integrated health delivery system where the patient already receives care, in which the consulting ID physician has access to the patient’s existing medical record and can coordinate follow-up care. • The use of direct-to-patient ID telemedicine services raises several additional issues (and all of the above criteria still apply): a. Physicians must exercise caution regarding direct prescribing for patients via electronic communications or asynchronous telemedicine evaluations. Most states have regulations that discourage or prohibit practitioners from prescribing for patients whom they have not seen faceto-face. In many cases, the wording of these regulations is such that a live interactive teleconsultation would meet the requirements for a “face-to-face examination.” The Federation of State Medical Boards established a National Clearinghouse on Internet Prescribing located at Internet Prescribing Overview by State (http://www.fsmb. Table.pdf). The Clearinghouse includes a state-by-state breakdown of jurisdiction, regulations, and actions related to the regulation of Internet prescribing. b. ID physicians providing direct-to-patient ID telemedicine services must make every effort to collect accurate, complete, and quality clinical information. When appropriate, the ID physician may wish to contact the primary care provider(s) or other specialists to obtain additional corroborating information. Privacy and Confidentiality Clinicians who practice telemedicine should ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, as amended, and its stated rules and regulations. While synchronous or asynchronous transmissions over the integrated services digital network infrastructure are often thought to be secure, depending on the access interface, internet protocol (IP) transmissions should be encrypted when transmitted over the public internet to ensure security. IP encryption in other settings such as private or semi-private networks is also highly recommended. To ensure patient confidentiality, HIPAA requires 128- bit encryption and password authentication [18]. The handling of medical records, faxes, and communications is subject to the same