Telemedicine is the exchange of medical information from one location to another using electronic communication, which improves patient health status. Telemedicine has multiple applications and can be used for different services, which includes wireless tools, email, two-way video, smartphones, and other methods of telecommunications technology.

The Health Resources Services Administration defines telehealth as the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications. Telehealth is different from telemedicine because it refers to a broader scope of remote healthcare services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.

The Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) defines telehealth as the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, and public health and health administration. Technologies include videoconferencing, the internet, store- and-forward imaging, streaming media, and landline and wireless communications. Telehealth services may be provided, for example, through audio, text messaging, or video communication technology, including videoconferencing software. For purposes of reimbursement, certain payors, including Medicare and Medicaid, may impose restrictions on the types of technologies that can be used. Those restrictions do not limit the scope of the HIPAA Notification of Enforcement Discretion regarding COVID-19 and remote telehealth communications.

FAQs Archive

Q: Under the student immunization disclosure provisions at 45 CFR 164.512(b)(1)(vi), is a health care provider permitted to disclose proof of a child’s immunization to a school that is not subject to a school entry law with respect to the information?

No, 45 CFR 164.512(b) (1)(vi) of the Privacy Rule permits the disclosure of proof of immunization about a student or prospective student only to a school that is required by State or other law to have such information prior to admitting the student. In the limited case where a school is not subject to a school entry law but seeks proof of immunization of students, a covered health care provider may either provide the proof of immunization to the parent of the student (or student, if applicable) to give to the school, or obtain the parent’s (or student’s, if applicable) written authorization to provide the requested information directly to the school.

Q: If a state law requires a covered health care provider to disclose proof of a student’s immunizations directly to a school without the affirmative permission of a parent or guardian, must the health care provider also obtain the agreement of a parent or guardian in accordance with 45 CFR 164.512(b)(1)(vi) of the Privacy Rule prior to making the disclosure?

No. The Privacy Rule permits a covered entity to use or disclose protected health information to the extent that such use or disclosure is required by law and the use or disclosure complies with and is limited to the relevant requirements of that law. See 45 CFR 164.512(a) . In such cases, the covered entity is not required to also meet the conditions of 45 CFR 164.512(b) (1)(vi) in making the required by law disclosure.

Q: Must a health care provider obtain a parent’s agreement before each disclosure of proof of a child’s immunization to a school that is required by a school entry law to have such information?

In most cases, it is anticipated that a health care provider will obtain agreement for the disclosure of proof of immunization to a school at the time a particular disclosure is needed. For example, a parent may call and request that a covered health care provider send proof of his or her child’s immunizations to an elementary school before the child is to begin school. If that child moves to a different school and is unable to transfer the immunization records to the new school, the parent may then need to request that the health care provider send the child’s records directly to the new school. However, in some circumstances the scope of the agreement may vary based on the needs of the parent and the school. For example, a parent may agree to the health care provider making multiple disclosures over a period of time, such as where updates are required by a school when a series of vaccinations have been completed.

Q: Where a parent requests that a health care provider disclose proof of his child’s immunizations to a school so the school can legally admit the child, does the Privacy Rule limit to whom at the school the provider may send the records?

No. It is expected that in most cases a school has designated an administrative official or employee, such as a school nurse, to receive and maintain proof of student immunizations to comply with applicable law. Given the designated person may vary from school to school, the Privacy Rule permits the health care provider to make the disclosure to whoever at the school is identified in the parent’s request or school’s instructions to the parent.