Indiana Telehealth Prescribing: Establishing a Valid Provider-Patient Relationship

Indiana has established a comprehensive framework for the practice of telehealth, including specific provisions for establishing a valid provider-patient relationship, which is a critical prerequisite for prescribing medications. These regulations are designed to ensure patient safety and maintain the standard of care, even when services are delivered remotely. Healthcare providers and organizations leveraging telehealth in Indiana must adhere strictly to these requirements to remain compliant.

The Foundation: Indiana's Telehealth Law

Indiana's permanent telehealth legislation, primarily codified in Indiana Code (IC) § 25-1-9.5, defines telehealth and outlines the conditions under which it can be practiced. A key aspect of this law is the emphasis on the establishment of a valid provider-patient relationship. Without this relationship, prescribing, especially for controlled substances, is generally prohibited.

Defining the Provider-Patient Relationship for Telehealth

According to IC § 25-1-9.5-4, a practitioner-patient relationship may be established through telehealth if certain conditions are met. This section is crucial for understanding the boundaries of telehealth practice in the state. The law states that a valid relationship can be established if:

1. A face-to-face examination of the patient is performed by the practitioner before the issuance of a prescription. For telehealth, this typically means a real-time, two-way audio-visual interaction that is sufficient to allow the practitioner to conduct an appropriate examination and form a diagnosis and treatment plan consistent with the standard of care for an in-person encounter.
2. The practitioner has a pre-existing relationship with the patient, meaning they have previously conducted an in-person examination or have an ongoing treatment relationship that was initially established in person.
3. The practitioner is providing services in an emergency situation where an in-person examination is not feasible.
4. The practitioner is providing consultation services at the request of another practitioner who has an existing relationship with the patient.

For the vast majority of direct-to-consumer telehealth services, the primary method for establishing this relationship will be through a real-time, two-way audio-visual interaction. This means that asynchronous methods (e.g., questionnaires, text-only exchanges) or audio-only interactions are generally insufficient for establishing an initial provider-patient relationship for prescribing purposes, unless a pre-existing relationship or specific exception applies. The examination conducted via telehealth must be