Wednesday, December 22, 2010

Prescribing in the Technological Age: Defining Legal and Ethical Guidelines

We’ve all been to the doctor and received medication. You know the drill, where based on his questions, your answers, and typically a physical exam, he determines whether or not you’re in need of medication. If that medication requires a written prescription he writes you a script and you take it to the pharmacy. This is basically the way you and I are accustomed to seeing a doctor and receiving treatment. It wasn’t long ago that similar personal experiences, like banking and dating, were based solely on this type of face to face interaction. Technology, however, has changed the way we communicate with each other and now we can conduct much of our daily lives without ever leaving the comforts of our home by using telecommunications equipment.

There’s a growing trend in healthcare to not limit patients only to seeking medical care through the traditional hospital or clinic environment. Telemedicine has offered that alternative, enabling a patient to access a physician from home or on-the-go. There are tremendous benefits to giving patients this instant access to a doctor, such as cost savings and convenience, as well as addressing medical issues as they arise and directing the patient to the most appropriate level of care. There are also some serious pitfalls to delivering care outside of the traditional scope of physician practice, where the doctor does not examine the patient in person. Some of these pitfalls have been outlined in cases, such as the Ryan Haight case, that resulted in the Ryan Haight Online Pharmacy Protection Act of 2008 making it illegal for doctors to prescribe DEA controlled substances without previously conducting an in-person exam.
The pros, cons and legal precedents of telemedicine, specifically when it comes to prescribing, are well outlined in a recently published article by the Center for Telehealth and eHealth law (CTeL). The internet based CTeL was founded in 1995 to interpret legal standards, guidelines, and definitions in telemedicine. The article, written by a law school student, articulates three different forms of internet prescribing: telemedical prescribing, e-prescribing, and internet based prescribing. To give you a broad understanding, telemedical prescribing is where a hospital or clinic has an established connection through video conferencing technology or another electronic medium where a physician in a distant location can examine a patient and make a treatment recommendation. This is becoming increasingly utilized as it can save the healthcare system money and give immediate access to a specialist where one might not be available. The second form, E-prescribing, describes the use of software that allows a doctor to enter and order a medication through an electronic database that then transmits the order to the pharmacy which can mail the prescription or where the patient can pick it up.
The main topic of the article is the third form, internet based prescribing, a broad term that encompasses all the ways a patient can access a prescription through the internet. This is rapidly becoming a hot topic for State and National Medical Boards that must react quickly to advancing trends and technologies impacting healthcare delivery. The article clearly defines prescribing based on online questionnaires as being inappropriate and discusses more widely acceptable forms. These acceptable forms of internet based prescribing, which we adhere closely to, are based on patient- doctor interaction with established guidelines and limitations, and follows protocols such as creating medical histories and records.
As technology changes and improves, so may regulatory policy on prescribing. We’ll keep you updated on this critical and evolving area of medicine.
~ Dr. Kevin Friedman
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