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The advancements and continued development of medical and communications technology offer
opportunities for improving the delivery and accessibility of health care, particularly in the area of telehealth, which includes the practice of physical therapy using electronic communication, information technology, or other means of interaction between a healthcare provider in one location and a patient in another location with or without an intervening healthcare provider.
The Colorado State Physical Therapy Board ("Board") recognizes that using telehealth technologies in the delivery of physical therapy offers potential benefits in the provision of care. However, in fulfilling its duty to protect the public, the Board must also consider patient safety concerns in adapting rules and policies historically intended for the in-person provision of medical care to new delivery models involving telehealth technologies.
The Board is committed to assuring patient access to the convenience and benefits afforded by telehealth technologies, while promoting the responsible practice of physical therapy by providers. The Board has developed a policy to educate licensees as to the appropriate use of telehealth technologies in the delivery of physical therapy services directly to patients. This policy does not set a standard of care, do not alter generally accepted standards of practice, the scope of practice of any health care provider, or authorize the delivery of health care services in a setting, or in a manner, not otherwise authorized by law.
It is the expectation of the Board that providers of care, electronically or otherwise, maintain the highest degree of professionalism and should:
This policy does not apply to the use of telehealth technologies when solely providing consulting
services to another provider who maintains the primary provider-patient relationship with the patient, the subject of the consultation.
For the purpose of this policy, the following terms are defined as:
1. "Telehealth" means a mode of delivery of health care services through telecommunications systems, including information, electronic, and communication technologies, to facilitate the assessment, diagnosis, consultation, intervention, education, care management, or self-management of a person's health care while the person is located at an originating site and the provider is located at a distant site. The term includes synchronous interactions and store and forward transfers.
2. This guideline defines "telehealth" for purposes of compliance with the Physical Therapists Practice Act, Telehealth may be defined differently in different statutory contexts, including but not limited to, insurance requirements or reimbursement.
"TELEHEALTH TECHNOLOGIES" means technologies and devices enabling secure electronic
communications and information exchange between a licensee in one location and a patient in another location with or without an intervening healthcare provider.
"DISTANT SITE" means a site at which a provider is located while providing health care services by means of telehealth.
"ORIGINATING SITE" means a site at which a patient is located at the time health care services are provided to him or her by means of telehealth.
"SYNCHRONOUS INTERACTION" means a real-time interaction between a patient located at the originating site and a provider located at a distant site.
ASYNCHRONOUS INTERACTION means an interaction between providers that occurs between an originating site and distant site while the patient is not present or the electronic transfer of a patient’s medical information (also known as Store and Forward).
"PROVIDER" means a licensee regulated by the Colorado Physical Therapy Board.
Providers who evaluate or treat through telehealth technologies are practicing physical therapy. The practice of physical therapy occurs where the patient is located at the time telehealth technologies are used. Therefore, a provider must be licensed to practice physical therapy in the state of Colorado in order to evaluate or treat patients located in Colorado utilizing telehealth technologies or otherwise.
Establishment of a Provider-Patient Relationship
Provider-patient relationships may be established using telehealth technologies, so long as the relationship is established in conformance with generally accepted standards of practice.
Appropriate informed consent should be obtained for a telehealth encounter including those elements required by law and generally accepted standards of practice.
Continuity of Care
Physical Therapists should adhere to generally accepted standards of practice as it relates to continuity and coordination of care.
Referrals for Emergency Services
An emergency plan should be established by the provider in case of an emergency.
The health records should include, if applicable, copies of all patient-related electronic
communications, including patient-provider communication, prescriptions, laboratory and test results, evaluations and consultations, records of past care, and instructions obtained or produced in connection with the utilization of telehealth technologies. Informed consents obtained in connection with an encounter involving telehealth technologies should also be filed in the health record.
Privacy and Security of Patient Records & Exchange of Information
Providers should meet or exceed applicable federal and state legal requirements of
medical/health information privacy, including compliance with the Health Insurance Portability and Accountability Act (HIPAA) and state privacy, confidentiality, security, and medical record retention rules.
Written policies and procedures should be maintained at the same standard as traditional in-person encounters for documentation, maintenance, and transmission of the records of the encounter using telehealth technologies.
Disclosures and Functionality for Providing Online Services
Disclosures and advertising should be made in accordance with state and federal law.
Parity of Professional and Ethical Standards
There should be parity of ethical and professional standards applied to all aspects of a Provider’s practice. A provider's professional discretion as to the diagnoses, scope of care, or intervention
should not be limited or influenced by non-clinical considerations of telehealth technologies, and provider remuneration or intervention recommendations should not be materially based on the delivery of patient-desired outcomes or the utilization of telehealth technologies.
Colorado State Physical Therapy Board Policy
The Appropriate Use of Telehealth Technologies in the Practice of Physical Therapy
Date issued: July 20, 2018 as guidelines modified to policy July 19, 2019