I read with interest "Legal Considerations in Telehealth and Telemedicine" (Legal Clinic, September). Our facility is located in an Illinois city that borders Wisconsin. Illinois is not a compact state. One question that has come up is, what should be done about patients who live in Illinois but winter or vacation in another state and call for assistance, advice, or refilling of medications? Are they considered a resident of the state they are visiting or of Illinois?

Sharon Peterson, BSN, RN

Rockford, IL

Author Edie Brous responds: The question that must be addressed is: Where is the provider practicing? Most states require physicians to be licensed in the state in which the patient is located. It doesn't matter what state the patient claims as a residence-it matters where the patient is actually located at the time care is delivered. The National Council of State Boards of Nursing also considers nursing practice to be where the patient is located. A nurse in Florida, for example, cannot take orders from an Illinois physician unless the physician is also licensed to practice in Florida.

There are a number of other potential issues in this scenario:

* Patients who winter out of state might not have full insurance coverage while out of their resident state. Some plans might also require face-to-face encounters for reimbursement.

* If patients spend a great deal of time in another state each year, there can be a question as to which state is the primary residence. This can affect insurance coverage.

* It can be difficult for providers to adhere to the standards of care if patients are asking for long-distance care. Refilling of medications might require an assessment of laboratory results, for example, or advice and assistance might require an actual physical examination. Pharmacies might not fill prescriptions written by providers not licensed in the state where the pharmacy is located.

Laws have not kept up with technology, and until they do, the best practice might be to refer those patients to a local provider while they are out of state and carefully coordinate the care.