Board of Medicine

A Policy Statement on Telemedicine

Approved by the Iowa Board on April 10, 1996

This policy statement is not a legally binding opinion of the board, but is only intended to provide guidance to the public. The board may make formal policy only through administrative rules, declaratory orders or contested case decisions.

At a recent meeting, the Iowa Board of Medical Examiners reviewed your inquiry relating to the licensure requirements for out-of-state physicians performing diagnoses through electronic means. It is the board’s policy to require any physician who participates in the diagnosis and treatment of a patient situated in Iowa to obtain licensure. However, there is a provision in the board’s authorizing statute which permits physicians not licensed in Iowa to provide medical consultation and services which are “incidental” to the care of patients. Medical reports used for “primary diagnostic purposes” are generally not considered incidental and thus are seldom exempted under this provision.

The board is aware that Iowa licensees sometimes make arrangements with firms in other states for a limited range of diagnostic laboratory services. Questions about whether the medical directors and other physicians practicing in these firms require an Iowa license are usually determined on a case-by-case basis after considering the scope and range of services provided and the extent to which they become the basis for patient care. The board strongly feels that for the sake of accountability, it is both prudent and in the best interest of all concerned for out-of-state physicians who provide primary diagnostic services or who otherwise provide a documented medical opinion that affects the diagnosis and treatment of a patient to obtain Iowa licensure.

The board also recognized that with the recent advances in telemedicine, a growing number of its licensees are considering the financial benefits of pursuing such arrangements with out-of-state firms. In weighing their options, the board cautions Iowa physicians to adhere to the rules governing the practice of medicine in the state, particularly those relating to the proper delegation of care. Out-of-state physicians should also be made aware that state law mandates that the unauthorized practice of medicine in Iowa is a felony. Although the board cannot sanction a physician not licensed in this state for an inaccurate reading of an x-ray or a missed diagnosis, it can and will take the appropriate action against the Iowa physician who relied on the diagnosis and who is ultimately responsible and thus accountable for the patient’s care.

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