New Telehealth Guidelines Approved by the Colorado Medical Board: Should Colorado Pharmacists Be Concerned?
The Colorado Medical Board (Board) has adopted Guidelines for the Appropriate Use of Telehealth Technologies in the Practice of Medicine (Guidelines) as the state seeks to enact a new law expanding telehealth services.
The Board defines “telehealth” as:
‘a mode of delivery of health care services through telecommunications systems, including information, electronic, and communication technologies, to facilitate the assessment, diagnosis, consultation, treatment, education, care management, or self-management of a person’s health care while the person is located at an originating site and the provider is located at a distant site. The term includes synchronous and store-and-forward transfers.’
Interestingly, the Guidelines include the following, which, presently are directly at odds with the Colorado Board of Pharmacy Rules as discussed previously on the Baer Law Blog:
1. Establishment of a Patient-Physician Relationship.
- Where an existing patient-provider relationship is not present, a provider must take appropriate steps to establish a patient-provider relationship consistent with the guidelines identified in Board Policy 40-03. Patient-provider relationships may be established using telehealth technologies so long as the relationship is established in conformance with generally accepted standards of practice.
2. Prescribing
- Prescribing medications, in-person or via telehealth technologies, is at the professional discretion of the provider. The indication, appropriateness, and safety considerations for teach telehealth visit prescription must be evaluated by the provider in accordance with current standards of practice and consequently carry the same professional accountability as prescriptions delivered during an encounter in person. However, where such measures are upheld, and the appropriate clinical consideration is carried out and documented, providers may exercise their judgment and prescribe medications as part of telehealth encounters.
- The recommendation of medical marijuana via telehealth is prohibited.
The Colorado Board of Pharmacy rules that state, in part, the following:
3.00.21.
- A pharmacist shall make every reasonable effort to ensure that any order, regardless of the means of transmission, has been issued for a legitimate medical purpose by an authorized practitioner.
- A pharmacist shall not dispense a prescription drug if the pharmacist knows or should have known that the order for such drug was issued on the basis of an internet-based questionnaire, an internet-based consultation, or a telephonic consultation, all without a valid preexisting patient-practitioner relationship.
Colorado pharmacists should continue to use extreme caution when they identify prescriptions issued to patients based on telehealth consultations until Colorado Board addresses issues such as:
Can a valid, preexisting patient-practioner relationship be established using telehealth technologies without first having to meet in-person such that a pharmacist can legally fill the prescription if issued for a legitimate medical purpose?’
In conclusion, pharmacists should consider contacting the Colorado Medical Board or the Board of Pharmacy directly to determine if (1) a patient-practitioner relationship was established under the new policy and (2) obtain guidance on whether that relationship was sufficient enough to satisfy the “preexisting” relationship requirement under current Colorado pharmacy rules.