Month: March 2017

 

Hepatitis B and C patients more likely to develop Parkinson's disease, study finds

The viruses hepatitis B and C may both be associated with an increased risk of Parkinson’s disease, according to a study published in the March 29, 2017, online issue of Neurology, the medical journal of the American Academy of Neurology. The hepatitis virus affects the liver.

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Gum disease and tooth loss may be linked to increased risk of death in postmenopausal women

Gum disease and tooth loss may be associated with a higher risk of death in postmenopausal women but not increased cardiovascular disease risk, according to new research in Journal of the American Heart Association, the open access journal of the American Heart Association/American Stroke Association.

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High blood pressure not related to elevated mortality risk for older adults with weak grip strength

A study of nearly 7,500 Americans age 65 or older suggests that elevated blood pressure is not related to high mortality risk among people in that age group with weak grip strength.

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Enhanced women's status linked to decline in solid fuel use

Globally, more people die each year of indoor air pollution than HIV, TB and malaria combined. So why is household air pollution such a neglected health issue and what needs to change in order to stop this “silent killer of women”?

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Survey finds alarming rates of shared decision making for prostate cancer screening

A new study finds that while a blood test that helps to screen for prostate cancer remains common, only 30 percent of men in a large national survey reported having a balanced discussion of the advantages and disadvantages of the screening with their doctor.

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New fluorescent probe could illuminate tumors during surgery

What if you could plaster cancer cells with glowing “Here We Are” signs, so surgeons could be confident that they’d removed every last speck of a tumor? That’s what Haiying Liu has in mind for his new fluorescent probe.

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New report suggests older adults as powerful allies in addressing climate change

Older adults are powerful allies in addressing climate change, according to “Gray and Green Together: Climate Change in an Aging World,” the latest edition of Public Policy & Aging Report (PP&AR) from The Gerontological Society of America.

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TSRI researchers reveal how viruses incapacitate bacterial defense system

Picture bacteria and viruses locked in an arms race. For many bacteria, one line of defense against viral infection is a sophisticated RNA-guided “immune system” called CRISPR-Cas.

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Ohio Telemedicine Prescribing and Controlled Substances Laws

Ohio

The Ohio Medical Board just last week adopted new rules for telemedicine prescribing of drugs and controlled substances, allowing providers to prescribe drugs via telemedicine without conducting an in-person examination.  Effective March 23, 2017, the new rule 4731-11-09 and rule 7331-11-01 set forth the requirements a physician must follow when prescribing via telemedicine in Ohio.

Prescribing Drugs via Telemedicine

An Ohio physician may prescribe non-controlled substances via telemedicine, without an in-person exam, if the physician satisfies the following nine requirements:

  • Establishes the patient’s identity and physical location;
  • Obtains the patient’s informed consent for treatment through remote examination;
  • Requests the patient’s consent and, if granted, forwards the medical record to the patient’s primary care provider or other health care provider, if applicable, or refers the patient to an appropriate health care provider or health care facility;
  • Completes a medical evaluation through interaction with the patient that meets the minimal standards of care appropriate to the condition for which the patient presents;
  • Establishes a diagnosis and treatment plan, including documentation of necessity for the utilization of a prescription drug, including contraindications to the recommended treatment;
  • Documents in the medical record the care provided, patient’s consent, medical information, and any referrals made to other providers;
  • Provides appropriate follow-up care or recommends follow-up care;
  • Makes the medical record of the visit available to the patient; and
  • Uses appropriate technology sufficient for the physician to conduct the above as if the medical evaluation occurred during an in-person visit.

Prescribing Controlled Substances via Telemedicine

An Ohio physician may prescribe controlled substances via telemedicine, without an in-person exam, if the physician satisfies the nine steps outlined above and when one of the following six situations exists:

  • The patient is an “active patient” of a health care provider who is a colleague of the physician and the controlled substances are provided through an on call or cross coverage arrangement between the health care providers. “Active patient” is a defined term under the new rules and means that “within the previous twenty-four months the physician or other health care provider acting within the scope of their professional license conducted at least one in-person medical evaluation of the patient or an evaluation of the patient through the practice of telemedicine as that term is defined in 21 C.F.R. 1300.04, in effect as of the effective date of this rule.”
  • The patient is located in a DEA-registered hospital or clinic;
  • The patient is being treated by, and in the physical presence of, an Ohio-licensed physician or health care practitioner registered with the DEA;
  • The telemedicine consult is conducted by a practitioner who has obtained a DEA special registration for telemedicine;
  • A hospice program physician prescribes the controlled substance to a hospice program patient in accordance with the board of pharmacy rules; or
  • The physician is the medical director of, or attending physician at, an “institutional facility” (defined in rule 4729-17-01) and 1) the controlled substance is being provided to a person who has been admitted as an inpatient to or is a resident of an institutional facility, and 2) the prescription is transmitted to the pharmacy by a means that is compliant with Ohio board of pharmacy rules.

The above six situations largely mirror exceptions under the federal Ryan Haight Act.  Telemedicine advocates have noted the Ryan Haight Act’s rules on prescribing controlled substances have hindered contemporary, legitimate telemedicine practices.  Members of the American Telemedicine Association have advocated for provider-friendly changes, and the DEA is expected to issue new rules this year, opening a special telemedicine registration for prescribers.

The Buckeye State now joins others (e.g., Delaware, Florida, New Hampshire, and West Virginia) that have carved out express exceptions to allow for telemedicine prescribing of controlled substances.  This is encouraging news for providers using telemedicine in their practice, as controlled substances are an important and clinically significant component of certain specialties, including telepsychiatry and hospitalists/emergency medicine.

For more information on telemedicine, telehealth, virtual care, and other health innovations, including the team, publications, and other materials, visit Foley’s Telemedicine and Virtual Care practice.

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Researchers use machine learning approach to accurately predict risk of depression

Depression affects more than 15 million American adults, or about 6.7 percent of the U.S. population, each year. It is the leading cause of disability for those between the ages of 15 and 44.

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