Web prescribing guidelines need clarification

Delegates to the AMA Annual Meeting want the Association's board to review and make more specific its proposed rules for physicians who write electronic prescriptions.

By Tyler Chin, amednews staff. July 8/15, 2002.

The AMA House of Delegates has directed the Board of Trustees to refine the guidelines it has developed to help physicians use the Internet appropriately in prescribing medications.

Some delegates praised the guidelines, but most who spoke on the matter at the AMA's Annual Meeting expressed concerns that the guidelines, as written, were impractical, burdensome or needed to be clarified.

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Two guidelines, for example, called on physicians prescribing over the Internet to be licensed in every state where their patients reside and disclose on their Web site every jurisdiction where doctors are licensed.

"I think it's almost impossible for a physician to have a license in every jurisdiction where he may possibly have patients," said David M. Rosenthal, MD, a delegate from California. "This is particularly important at a university hospital where [a doctor] may get patients from throughout the country."

The proposed guidelines also said physicians should perform or have a documented physical examination; have sufficient dialogue with the patient regarding treatment options, risks and benefits; follow up with patients to assess therapeutic outcome; maintain a medical record that would be readily available to patients and their health care professionals; and include the electronic prescription information as part of the patient record.

The board recommended exceptions in cases involving medical emergencies, treatment provided in consultation with another physician and when doctors are on call.

But the exceptions were either too broad or did not make sense given the criteria the board had suggested for appropriate Internet prescribing, some delegates said.

Delegates asked the board to specify what exception should apply to which guideline.