Establishing guidelines for Internet-based prescribing. (Letters to the Editor).

To the Editor: State medical boards are the primary vehicles by which medical practice is regulated in the United States. Their authority is established in state statutes, and their mandate is to protect the public through a system of 1) professional licensure to ensure that only qualified, competent physicians provide health care services and 2) regulation whereby standards of professional practice are established and enforced.

As the representative organization of state medical boards, the Federation of State Medical Boards is committed to improving the quality and integrity of U.S. health care by developing and promoting high standards of physician licensure and practice. Within the scope of its mission, the federation developed and adopted in April 2002 Model Guidelines for the Appropriate Use of the Internet in Medical Practice (1) to assist state medical boards in regulating and educating physicians who incorporate use of the Internet into their practice. The special committee of the federation that was charged with completing this project comprised professional and public members and staff members of state medical boards. The guidelines emphasize the following criteria that should be met by a physician who uses the Internet in his or her medical practice:

* A documented patient evaluation, including a history and a physical examination of the patient adequate to establish diagnoses and identify underlying conditions and/or contraindications to the recommended treatment must be obtained before treatment is provided, including the issuance of prescriptions electronically or otherwise.

* Treatment recommendations made in an on-line setting, including issuing prescriptions electronically, will be held to the same standards of appropriate practice as those that are made in the traditional (ie, face-to-face) of-flee setting. Treatment, including issuance of a prescription, that is administered solely on the basis of a patient's completion of an on-line questionnaire or on-line consultation does not constitute an acceptable standard of care.

* A written agreement should be used to document the patient's informed consent to the use of any patient-physician email consultation. This informed consent agreement should be discussed with and signed by the patient and included in the patient's medical record.

* Medical records should include copies of all patient-related electronic communications, including patient-physician emails, prescriptions, laboratory and test results, evaluations, consultations, records of past care, and instructions.

* Physicians who treat patients or issue prescriptions through Internet web sites are engaged in the practice of medicine and must possess appropriate licensure in all jurisdictions where their patients reside.

* Medical practice web sites should clearly disclose certain information, including but not limited to the owner of the web site, the specific services provided, an office address and contact information, licensure and qualifications of the physicians and health care providers associated with the web site, fees for on-line consultation and services, and the method of payment required, as well as any other pertinent information.

To date, at least 22 state medical boards have adopted policies or guidelines related to Internet prescribing. In addition, at least 11 states have enacted statutes related to the Internet practice of medicine. At least 27 state medical boards, including many boards in states without policies or laws pertinent to Internet medical practice, have taken disciplinary action against physicians for practicing medicine through the Internet because of their failure to meet an acceptable standard of care. As the agents charged with protecting the public, state medical boards by and large have stated that prescribing medication without performing an evaluation of the patient constitutes inappropriate and unprofessional conduct. The practice of Internet medicine should meet or exceed the established standards for medical practice in a traditional physician-patient face-to-face office setting.

James N. Thompson, MD

Executive Vice President and Chief Executive Officer

Federation of State Medical Boards Dallas, TX

Reference

(1.) Federation of State Medical Boards of the United States, Inc. Model Guidelines for the Appropriate Use of the Internet in Medical Practice. Available at: http://www.fsmb.org/Policy%20Documents%20and%20White%20 Papers/internet_use_guidelines.htm. Accessed May 16, 2003.