Standards for Telemedicine Practice

 

DEPARTMENT OF HEALTH

Board of Osteopathic Medicine

RULE NO.:RULE TITLE:

64B15ER14-2Standards for Telemedicine Practice

SPECIFIC REASON FOR FINDING AN IMMEDIATE DANGER TO THE PUBLIC HEALTH, SAFETY OR WELFARE:

The Board of Osteopathic Medicine (hereinafter “the Board”) has statutory authority to set standards of practice in various medical practice settings. Pursuant to this aforementioned authority, the Board recently promulgated rules setting forth standards for telemedicine practice. Rule 64B15-14.0081, F.A.C., went into effect on March 12, 2014. The Board of Medicine has an identical rule, Rule 64B8-9.0141, F.A.C., which also went into effect March 12, 2014. Shortly thereafter, the Board of Medicine began to receive reports from physicians and hospital representatives that expressed concerns that the standards for telemedicine practice rule precluded physicians from ordering controlled substances through the use of telemedicine for their hospitalized patients. In fact, interested persons reported that in some instances hospital pharmacists have expressed their reluctance to dispense controlled substances ordered via telemedicine because they believe it is precluded by the telemedicine rule. Allopathic and osteopathic physicians have the same responsibilities and work in the same patient settings. Thus, the critical and immediate concerns raised by physicians and hospital representatives to the Board of Medicine are equally applicable to osteopathic physicians working in the same capacity and patient settings.

Subsection 64B15-14.0081(4), F.A.C., currently precludes the prescribing of controlled substances through the use of telemedicine. While the rule does not preclude the ordering of controlled substances to hospitalized patients, the current prescribing prohibition has created doubt amongst licensees and pharmacist because of the ambiguity of the definition of term “prescribing” as set forth in Sections 465.003(14) and 893.02(22), Florida Statutes.

Through its promulgation of Rule 64B15-14.0081, F.A.C., the Board has inadvertently created doubt as to whether it is legal to order controlled substances for hospitalized patients through the use of telemedicine. Therefore, the Board believes that this current situation presents an immediate danger to the public health, safety and welfare because it may prevent critically ill hospital patients from obtaining necessary controlled substances on a timely basis. This scenario presents a particular problem for those hospitals that staff intensive care units (ICUs) after hours through the use of telemedicine technology.

The Board believes that the filing of a narrowly tailored emergency rule amending Rule 64B15-14.0081, F.A.C., to clarify that the ordering of controlled substances for hospitalized patients through the use of telemedicine is not precluded by subsection 64B15-14.0081(4), F.A.C., is justified. It will prevent unnecessary patient harm in an expeditious manner and will not harm licensees or any health care practitioners in any way.

REASONS FOR CONCLUDING THAT THE PROCEDURE USED IS FAIR UNDER THE CIRCUMSTANCES:

The procedures employed for adopting this emergency rule are fair under the circumstances. The emergency rule amendment in question does not prescribe the behavior or actions of any regulated entity or licensee but rather clarifies that physicians can indeed order controlled substances for hospitalized patients through the use of telemedicine. In addition, upon filing of the emergency rule the Agency for Health Care Administration (AHCA) will notify all Florida licensed hospitals of the new rule and the Department of Health will publish notices of the emergency rule on the Board of Osteopathic Medicine's and the Board of Pharmacy's official websites.

The Board acknowledges that in promulgating this emergency rule it has acted with limited prior notice. However, the Board believes that exigent circumstances and the rule's limited scope and design mitigates any perceived notice shortcomings.

SUMMARY OF THE RULE: The emergency rule clarifies the existing rule by stating that the ordering of controlled substances for hospitalized patients through the use of telemedicine is not precluded by Rule 64B15-14.0081(4), F.A.C.

THE PERSON TO BE CONTACTED REGARDING THE EMERGENCY RULE IS: Christy Robinson, Acting Executive Director, Board of Osteopathic Medicine, 4052 Bald Cypress Way, Bin #C06, Tallahassee, Florida 43499-3056

 

THE FULL TEXT OF THE EMERGENCY RULE IS:

 

64B15ER14-2 (64B15-14.0081) Standards for Telemedicine Practice.

(1) through (3) No change.

(4) Controlled substances shall not be prescribed through the use of telemedicine. This provision does not preclude physicians from ordering controlled substances through the use of telemedicine for patients hospitalized in a facility licensed pursuant to Chapter 395, F.S.

(5) through (7) No change.

Rulemaking Authority 459.015(1)(z) FS. Law Implemented 459.015(1)(z) FS. History‒New 3-12-14, Amended 5-5-14.

 

THIS RULE SHALL TAKE EFFECT IMMEDIATELY UPON FILING WITH THE DEPARTMENT OF STATE UNLESS A LATER TIME AND DATE IS SPECIFIED IN THE RULE.

EFFECTIVE DATE: May 5, 2014