In the majority of the states in the United States, it is legal to see patients this way. Some states do require that the initial visit be done with the patient and the doctor physically in the same room. Our legal department will let you know how you have to do things in your particular state(s) of practice.
Contact us regarding where you are licensed and where you want to practice. We will let you know the specifics regarding telemedicine in your area.
A good portion of the AIMS test is based on your visual observation and on asking the patient questions. Here is the AIMS test: The chair to be used in this examination should be a hard, firm one without arms.
• Ask the patient whether there is anything in his or her mouth (such as gum or candy) and, if so, to remove it.
• Ask about the current condition of the patient's teeth. Ask if he or she wears dentures. Ask whether teeth or dentures bother the patient now.
• Ask whether the patient notices any movements in his or her mouth, face, hands, or feet. If yes, ask the patient to describe them and to indicate to what extent they currently bother the patient or interfere with activities.
• Have the patient sit in chair with hands on knees, legs slightly apart, and feet flat on floor. (Look at the entire body for movements while the patient is in this position.)
• Ask the patient to sit with hands hanging unsupported -- if male, between his legs, if female and wearing a dress, hanging over her knees. (Observe hands and other body areas).
• Ask the patient to open his or her mouth. (Observe the tongue at rest within the mouth.) Do this twice.
• Ask the patient to protrude his or her tongue. (Observe abnormalities of tongue movement.) Do this twice.
• Ask the patient to tap his or her thumb with each finger as rapidly as possible for 10 to 15 seconds, first with right hand, then with left hand. (Observe facial and leg movements.)
• Flex and extend the patient's left and right arms, one at a time.
• Ask the patient to stand up. (Observe the patient in profile. Observe all body areas again, hips included.)
• Ask the patient to extend both arms out in front, palms down. (Observe trunk, legs, and mouth.)
• Have the patient walk a few paces, turn, and walk back to the chair. (Observe hands and gait.) Do this twice.
As you can see, the only one that requires the patient be touched is #9. At a county facility or community mental health clinic or hospital, you can train local staff to do #9 for you during the AIMS exam.
Sara Gibson, MD, Medical Director of Telemedicine, Northern AZ Regional Behavioral Health Authority, has a telemedicine AIMS demo online. Looking for the AIMS Test Demo? Click Here and Go to Slide 26.
At a county facility or community mental health clinic or hospital, you can train local staff to test the patient for cogwheel rigidity for you during the AIMS exam.
With any problem, you can start with us. If it's something we can deal with, then we will. If it's something that would fall under your own business expense, then we'll tell you. We provide the interface between you and the patients and a significant amount of support to make sure that interface works exceptionally well. However, if you need paper for your fax machine, a light bulb for your office, a CME course, to renew your medical license or DEA certificate, a new microphone for your computer, a new computer, a vacation in the Bahamas, etc., these are the kinds of expenses that fall to you.
Make sure the technology doesn't get in your way. The connection between you and your patient should be spot on. Be the best doctor you can be. Don't focus on the technology. Follow our 'Basic Telepsychiatry Etiquette." Link
The contract mandates adherence to specific Standards of Practice. We routinely survey patients regarding their satisfaction with the care they are receiving. We routinely review random patient charts for quality of the note and make sure you are meeting the billing guidelines of the local entity. We routinely check everybody's National Practitioner Identifier Database record. We process complaints from the patients and from the contracted entity staff and work with providers to resolve issues.
No. It's your business, and so they are your expenses that you get to count off on your taxes as a business expense.
The only restriction is that you do not use the infrastructure provided by us to make a profit on patients not contracted with us. There are proprietary components, trademarks, patents, etc., related to what we do, and it would be illegal to use these for yourself or to use them to start a company to compete with us.
