Indiana Gov. Mike Pence recently signed into law House Enrolled Act (HEA) 1263, which expands physicians’ use of telemedicine. HEA 1263 will permit providers, which include physicians, optometrists, and advance practice nurses and physician assistants with prescriptive authority, to prescribe certain prescriptions, drugs and devices during remote patient visits. Currently, Indiana allows the prescribing of drugs through telemedicine only if a provider first examines a patient in person.
Effective July 1, HEA 1263 will provide greater convenience to patients located in rural areas by eliminating the need to make a trip to a provider’s office for simple things such as a cold or sinus infection. However, providers should be aware that there are certain limitations in place. Providers are not permitted to prescribe controlled substances, abortion inducing drugs or ophthalmic devices, including glasses, contact lenses and low vision devices, via telemedicine.
Additionally, providers should establish a proper physician-patient relationship, which includes at a minimum:
- Obtaining the patient’s name and contact information and: 1) a verbal statement or other data from the patient identifying the patient’s location; and 2) to the extent reasonably possible, the identity of the requesting patient.
- Disclosing the provider’s name and disclosing whether the provider is a physician, physician assistant, advanced practice nurse or optometrist.
- Obtaining informed consent from the patient.
- Obtaining the patient’s medical history and other information necessary to establish a diagnosis.
- Discussing with the patient the: 1) diagnosis; 2) evidence for the diagnosis; and 3) risks and benefits of various treatment options, including when it is advisable to seek in-person care.
- Creating and maintaining a medical record for the patient and, subject to the consent of the patient, notifying the patient’s primary care provider of any prescriptions the provider has written for the patient if the primary care provider’s contact information is provided by the patient. This requirement is not applicable when the provider is using an electronic health record system that the patient’s primary care provider is authorized to access.
- Issuing proper instructions for appropriate follow-up care.
- Providing a telemedicine visit summary to the patient, including information that indicates any prescription that is being prescribed.
It is important to note that HEA 1263 defines telemedicine as: (1) the use of secure videoconferencing; (2) interactive audio-using store and forward technology; or (3) remote patient monitoring technology between a provider in one location and a patient in another location. Accordingly, providers cannot utilize audio-only communication, email, instant messaging, fax, internet questionnaires, telephone consultation or internet consultation when prescribing from a remote location.
Providers who wish to prescribe drugs through telemedicine should consider carefully reviewing HEA 1263 or consulting with legal counsel to ensure they are adhering to all of the requirements of the law and utilizing appropriate technology when delivering healthcare services from remote locations. A copy of the final version of HEA 1263 that passed into law can be found here.