STATE MEMBER BOARD BRIEFS

Use of Prescription Monitoring Program in Arkansas on the Rise

The Arkansas State Medical Board (ASMB) announced recently that participation in the Arkansas Prescription Monitoring Program (APMP) has reached approximately 2,250 physicians, representing roughly 35% of physicians in the state who write prescriptions for controlled substances.

In an article in the ASMB's quarterly newsletter, a representative of the APMP Advisory Committee said that like state medical boards in many states, the ASMB is becoming more engaged with the APMP as a useful tool on many levels.

“The Arkansas State Medical Board is increasingly using the PMP as a part of their investigations of complaints against physicians,” said Gene Shelby, MD, Chair of the APMP Advisory Committee. He added that the ASMB is also “actively looking at ways to increase the registration and use of the PMP,” as well as “looking at tying the registration for the PMP with the license renewal process for physicians who write controlled medications.”

In 2015, the state legislature in Arkansas passed a number of modifications to increase the effectiveness of the APMP, including making it possible for prescribers to delegate to other individuals the ability to access the PMP on their behalf. This makes it possible for a nurse to print out a patient's APMP record before the physician sees the patient, for example.

The 2015 legislation also makes it possible for the state's health department to review information in the APMP that might indicate misuse of controlled medications and pass that information to the appropriate state licensing board.

The legislation also stipulates measures that physicians must take when treating chronic non-malignant pain, including checking the APMP, random drug checks, and creating a pain contract with patients, and it requires a two-hour prescribing course of all new licensees within two years of licensure.

Source: Arkansas State Medical Board Newsletter, Winter 2016

Medical Board of California Launches Verify a License Campaign

In an effort to educate the public about the importance of verifying a physician's license, the Medical Board of California has launched the Verify a License Campaign. The campaign encourages patients “to be proactive regarding their physician and health care”—taking steps to check physician credentialing.

As a part of the campaign, Board staff will be passing out brochures and providing consumer tips about the importance of checking physicians' credentials and disciplinary history, visiting health fairs, town hall meetings and shopping malls to raise awareness.

Source: Medical Board of California Newsletter, Fall 2015

Florida Board Revises State's Telemedicine Practice Rules for Physicians

The Florida Board of Medicine has revised Florida's Telemedicine Rule. The revised rule, implemented March 7, 2016, includes a number of key provisions and definitions, among them:

Use of telephone:The revised rule stipulates that telemedicine “shall not include the provision of health care services only through an audio-only telephone, email messages, text messages, facsimile transmission, U.S. Mail or other parcel service, or any combination thereof.”

Controlled substances: Prescriptions of controlled substances may not be written using telemedicine, with the exception of treatment of psychiatric disorders.

Electronic medical questionnaires: Prescribing medications based solely on an electronic medical questionnaire constitutes “the failure to practice medicine with that level of care, skill, and treatment which is recognized by reasonably prudent physicians as being acceptable under similar conditions and circumstances” under the revised rule.

The Board's revised rule also states that “a physician-patient relationship may be established through telemedicine.”

Source: Florida Board of Medicine announcement, January 1, 2016

Georgia Board and Public Health Department Create ‘THC Registry’

The Georgia Composite Medical Board and the Georgia Department of Public Health partnered recently to develop a “Low THC Oil Registry” for patients and caregivers who qualify to carry an identification card under Georgia's new medical cannabis law.

Under the new law, patients and caregivers of patients who believe they may be eligible can consult with their physician about the possibility of obtaining a card allowing them to possess 20 fluid ounces of low THC oil within the state of Georgia. If approved by the physician, the patient or patient's caregivers' information will be entered into DPH's secure Low THC Oil Registry, and a card will be issued.

Source: Georgia Composite Medical Board Annual News and Report, 2015

Maine Board Website Has New Look and Features

The Maine Board of Licensure in Medicine has redesigned its website, offering a new look and feel, improved navigation and new features.

To make it easier for licensees to access information quickly, the new website features “What's Happening” and “Laws/Rules Updates” features on its homepages — which provide up-to-date information on general Board news and emerging topics of interest.

The “Laws/Rules Updates” feature will include legislative information while Maine's state legislature is in session and information about current and upcoming Board rules.

The new website also contains updated versions of all MD applications under the heading “Apply for MD License,” and the Board is strongly encouraging licensees to use its online renewal system, easily accessible via the website's new navigation. Also new at the website is a “Jurisprudence Exam Study Guide,” which has updated and condensed previous study materials for licensees.

To view the website, please visit www.maine.gov/md.

Source: Maine Board of Licensure in Medicine Newsletter, Winter 2015

Regulatory Boards Adopt Updated Joint Statement on Pain Management

Minnesota's regulatory boards of medicine, nursing, and pharmacy recently updated their Joint Statement on Pain Management. The boards adopted the first Joint Statement on Pain Management in 2004, which was reaffirmed in 2009, to give guidance regarding untreated or inadequately-treated pain.

The boards recently reviewed the issue of pain management again in order to offer added guidance regarding appropriate prescribing with emphasis on the critical balance between pain management and the potential misuse of controlled substance medications.

Recognizing that pain management and opioid prescription drug abuse are significant issues in health care, the new joint statement seeks a critical balance between preventing opioid misuse while managing pain — and puts an emphasis on the need for education and awareness among physicians and other health care professionals.

The Joint Statement offers guidance to health care providers in the management of pain and to provide resources where practitioners can obtain additional information.

“Adequate knowledge of pain management and pharmacotherapeutics, effective communication with patients, family members and other health care providers, and a commitment to ethical, compassionate patient care are essential to responsible opioid prescribing,” said Ruth Martinez, MA, Executive Director of the Minnesota Board of Medical Practice.

The Boards will continue to jointly promote appropriate prescribing, dispensing, and administration of controlled substance medications and are encouraging Minnesota health care providers to “work cooperatively and effectively to manage the dimensions of pain and minimize prescription drug misuse.”

The 2015 Joint Statement on Pain Management may be accessed at the website of the Minnesota Board of Medical Practice, at http://mn.gov/boards/medical-practice.

Source: Minnesota Board of Medical Practice website

Ohio's New Opioid Prescribing Guidelines for Acute Pain Expand Fight Against Prescription Drug Abuse

As part of Ohio's continuing effort to curb the misuse and abuse of prescription pain medications and unintentional overdoses, the Governor's Cabinet Opiate Action Team has issued new opioid prescribing guidelines for the treatment of patients with acute pain.

The new acute guidelines expand upon Ohio's existing prescribing guidelines for emergency departments and acute care facilities, issued in 2012, and for treatment of chronic pain lasting longer than 12 weeks, issued in 2013. The guidelines were developed by the Governor's Cabinet Opiate Action Team in conjunction with clinical professionals associations, health care providers, state agencies and state licensing boards — including the State Medical Board of Ohio (SMBO).

In 2014, more than 262 million opioid doses were dispensed in Ohio for the management of acute pain — 35 percent of the state's 750 million total dispensed opioid doses.

The new guidelines urge prescribers to first consider non-opioid therapies and pain medications — when appropriate — for the outpatient management of acute pain. When opioid medications are necessary to manage a patient's acute pain, the guidelines recommend that the clinician prescribe the minimum quantity necessary without automatic refills.

The new acute pain guidelines call for prescribers to check the State Board of Pharmacy's Ohio Automated Rx Reporting System (OARRS) before prescribing an opioid. A review of OARRS is required for most opioid and benzodiazepine prescriptions of seven days or longer.

Among other steps Ohio is taking to combat prescription drug abuse, it recently launched an effort to streamline access to OARRS by integrating OARRS directly into electronic medical records and pharmacy dispensing systems across Ohio. More than 110 hospitals, pharmacies and physician offices have requested integration, according to SMBO.

To view the new prescribing guidelines, and for more information about Ohio's initiative to address prescription drug abuse, please visit www.opioidprescribing.ohio.gov.

Source: Ohio Med Bd E-News, Special Edition, January 22, 2016

PA Practice Act Updated In Oklahoma

Oklahoma physicians who supervise Physician Assistants (PA) no longer are required to be on-site at least one half day per week, and supervising physicians also now have more autonomy in determining the scope of services offered by PAs in the state.

Oklahoma Senate Bill 753, signed by Governor Mary Fallon, allows supervising physicians to be available via telecommunications. The bill permits supervising physicians to establish the scope of practice and level of supervision for their PAs as long as the services are within the PA's skill level, the supervising physician's scope of practice and properly supervised.

The updated bill eliminates former requirements that the supervising physician be on-site at clinics at least one half day a week and removes the list of services that can be provided by a PA. The amended law also does away with the requirement that a PA must receive approval from the Oklahoma Board of Medical Licensure and Supervision and have practiced for at least one year before working in a remote heath care setting.

The new measure also clarifies the situations when a PA must report within forty-eight hours a “newly diagnosed complex illness” to the supervising physician in order to schedule an appropriate evaluation by the supervising doctor. Oklahoma Senate Bill 753 states: “The supervising physician shall determine which conditions qualify as complex illnesses based on the clinical setting and the skill and experience of the PA.”

Source: Oklahoma Board of Medical Licensure and Supervision website

Oregon Board Adopts New Statement of Philosophy on Social Media

The Oregon Medical Board (OMB) adopted a formal position statement on the use of social media in health care recently.

Titled, “Statement of Philosophy: Social Media,” the position statement acknowledges that “online social networking has become a resource for healthcare professionals to share information and to form meaningful professional relationships” and offering guidelines to help ensure that the use of social media doesn't interfere with the safe and ethical delivery of health care. The Board's position statement reminds its licensees that “healthcare professionals are bound by ethical and professional obligations that extend beyond the exam room, and social media creates new challenges.” The statement offers general parameters to help health care professionals avoid problems in three key areas: confidentiality, boundaries, and overall professionalism.

Confidentiality: The statement notes that health care professionals “have an obligation to protect patient privacy and confidentiality in all environments,” and that identifiable patient information — even seemingly minor details of a case or patient interaction — must never be posted online. Health care professionals should never discuss a patient's medical treatment or answer a patient's health-related question through personal social media, and take steps to ensure e-mail communications are secure.

Boundaries: The statement urges health care professionals to maintain appropriate boundaries in the physician-patient relationship at all times — including considering separating their personal and professional social media accounts and exercising caution if interacting with patients or their families online through personal social networking sites. The statement notes that “it is the professional's responsibility to maintain appropriate boundaries, not the patient's.”

Professionalism: Online actions and content directly reflect on professionalism, and therefore the statement advises health care professionals that they must “understand that their online activity may negatively impact their reputations and careers as well as undermine the public's overall trust in the profession.” They should not make negative statements about other health care providers and should use caution when responding to the negative comments of others on social media. “When conflicted about posting online content, healthcare professionals should err on the side of caution and refrain,” the statement urges. Those who write online about their professional experiences must be “honest about their credentials and reveal any conflicts of interest.”

The new position statement is accessible at www.oregon.gov/omb/board/philosophy.

Source: Oregon Medical Board Report, Volume 128, No.1