Telemedicine in Puerto Rico: what it is and how a professional is certified

The Department of Health distinguishes three modalities. Synchronous teleconsultation, which it calls face to face, takes place in real time between the health professional and the person requesting the service. Asynchronous consultation takes place by sending clinical information — by email or text message — with advice given afterwards. And remote monitoring supports self-care at a distance through electronic equipment and systems, for example vital-signs monitoring platforms. Services may be delivered through audio files, text messages or video communication technologies such as a videoconferencing program; the Department warns that, for reimbursement purposes, some payers such as Medicare and Medicaid may impose restrictions on the types of technology that can be used. On privacy, the Department notes that digital platforms have been adjusted for compliance with the Health Insurance Portability and Accountability Act (HIPAA), which allows a secure and reliable connection between medical staff and patients.

For the patient there is no published requirement: telemedicine is a mode of care, not a benefit you apply for. For the professional, the Department of Health is explicit: every health professional wishing to offer services through telehealth and telemedicine must obtain a certification from ORCPS and from the Medical Licensing and Discipline Board. The requirements the portal publishes for certification are four. Submitting an application to the JLDM, duly sworn before a notary public and presented on the document the Board provides for that purpose; applications submitted from other United States jurisdictions must be accompanied by the authentication of that jurisdiction’s County Clerk. Holding a licence issued by the JLDM authorizing practice as a Physician or Physician-Surgeon in Puerto Rico. Being duly licensed in the federal jurisdiction where the person to be served is located. And submitting the original Criminal Record Certificate issued by the Puerto Rico Police, issued 30 days ago or less.

• An application filed with the Medical Licensing and Discipline Board, sworn before a notary public, on the document the Board provides.Verified against the official source
• A current licence issued by the JLDM authorizing practice as a Physician or Physician-Surgeon in Puerto Rico.Verified against the official source
• Being duly licensed in the federal jurisdiction where the person to be served is located.Verified against the official source
• If the application is submitted from another United States jurisdiction: authentication by that jurisdiction’s County Clerk.Verified against the official source

• Original Criminal Record Certificate issued by the Puerto Rico Police, issued 30 days ago or less.
• A copy of the current Physician or Physician-Surgeon licence in Puerto Rico.
• Evidence of being licensed in the patient’s jurisdiction.

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   Step 1: If you are a patient: telemedicine is regulated

   Telemedicine and telehealth in Puerto Rico have their legal basis in Ley Núm. 168 of 1 August 2018, as amended, known as the Act for the Use of Telemedicine in Puerto Rico. And the Department of Health says every health professional wishing to offer services that way must obtain a certification from ORCPS and from the Medical Licensing and Discipline Board. Asking about that certification is reasonable.

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   Step 2: Know which modality you are being offered

   Synchronous is the real-time, face-to-face teleconsultation. Asynchronous is the one done by sending clinical information by email or text message, with advice given afterwards. And remote monitoring is the use of electronic equipment and systems — for example vital-signs monitoring platforms — to support self-care at a distance. They are different things and it is worth knowing which one applies to you.

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   Step 3: On privacy, there are rules and there is practice

   The Department notes that digital platforms have been adjusted to comply with HIPAA, which allows a secure connection between medical staff and patients. And it asks the professional for three concrete things: to establish security measures protecting the patient’s health information; to take into account the physical environment of both parties, providing privacy, good signal reception and noise control; and to inform and document whether other people will be on the call, on both the professional’s and the patient’s side — and the patient must consent to it, with consent documented. If there is someone else in the room and you were not told, that last rule is yours.

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   Step 4: If you are a professional: get the criminal record certificate first

   The Department requires submitting the original Criminal Record Certificate issued by the Puerto Rico Police, issued 30 days ago or less. Thirty days is a narrow margin when you also have to swear before a notary and, where applicable, authenticate before a County Clerk. Get it early in the process, but not so early that it expires: the window is short by design.

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   Step 5: Check you hold both licences, not one

   This is the requirement most people overlook. You must hold a licence issued by the Medical Licensing and Discipline Board authorizing practice as a Physician or Physician-Surgeon in Puerto Rico. And you must also be duly licensed in the federal jurisdiction where the person to be served is located. The Puerto Rico licence does not travel with the patient: if your patient is in another state, you need that state’s licence too.

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   Step 6: Swear before a notary, and authenticate if filing from outside

   The application is filed with the Medical Licensing and Discipline Board, duly sworn before a notary public, and on the document the Board provides for that purpose — not in a format of your own. And the Department adds a rule for those filing from outside: applications submitted from other United States jurisdictions must be accompanied by the authentication of that jurisdiction’s County Clerk.

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   Step 7: Count on ORCPS as well as the Board

   The Department says the certification comes from the Office for the Regulation and Certification of Health Professionals (ORCPS) and from the Medical Licensing and Discipline Board. They are two offices of the same Department. If you have already been through ORCPS for your ordinary health professional recertification, this is a different process: the telemedicine certification is separate, and this site covers ordinary recertification in its own guide.

The application is filed with the Department of Health’s Medical Licensing and Discipline Board (JLDM), on the document the Board provides, sworn before a notary. The certification is issued by the Office for the Regulation and Certification of Health Professionals (ORCPS) and the JLDM. The Department of Health’s telemedicine and telehealth information portal has two entrances, one for the citizen and one for the professional seeking certification.

• Believing the Puerto Rico licence is enough: you must also be licensed where the patient is located.
• Submitting a criminal record certificate issued more than 30 days ago.
• Filing the application without swearing it before a notary public.
• Using your own format instead of the document the Board provides.
• Filing from another United States jurisdiction without the County Clerk’s authentication.
• Confusing this certification with the ordinary health professional recertification before ORCPS.
• As a patient, not asking whether other people will be on the call, when consent must be documented.

These are the government pages this guide is based on.

• Departamento de Salud de Puerto Rico

  Salud

  www.salud.pr.gov