As discussed in our previous
Update, the State Medical Board of Ohio proposed a new rule in April 2016 outlining the standards
for a physician's prescribing of drugs to patients based only
upon a remote encounter. Specifically, the proposed rule would
allow a physician to prescribe a noncontrolled substance to a
patient based on a telemedicine encounter if the physician uses
"appropriate technology" that is "sufficient"
for the physician to conduct the evaluation as if it had occurred
in person. The Board received comments on the proposed rule from
various stakeholders, made minor modifications, and submitted a Business Impact Analysis describing the
purpose and impact of the proposed rule. While the rule's use
of phrases like "appropriate technology" is vague, the
Board clarified parts of the proposed rule in its Business Impact
Analysis. For example, although there is no "real-time"
element incorporated into the proposed rule, the Board's
commentary indicates that store and forward may be appropriate only
in the context of a provider-to-provider consultation and not for
direct patient care. The commentary also suggests that an
"examination via questionnaire" is not sufficient. In
addition, several comments indicate than an audio-only encounter is
not sufficient to meet the medical evaluation requirement in the
proposed rule. Interestingly, the commentary specifically notes
that the proposed rule does not apply to nurse practitioners or
physician assistants, and the medical board expects to issue a
separate rule to apply similar requirements to physician
assistants. It is unclear as to whether the nursing board has any
plans to propose a similar rule applicable to nurse
practitioners.
The new rule would replace the current Rule
4731-11-09, which requires a physician to have personally and
physically examined a patient before prescribing any drug to the
patient, except in specific situations.
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