Online doctors put on notice over text-based prescribing

The Medical Board of Australia has cracked down on commercial telehealth outfits that prescribe medicines to patients without ever talking to them or conducting a live consultation in a move that will jeopardise the business model of some prominent medtech start-ups.

The Medical Board of Australia has cracked down on commercial telehealth outfits that prescribe medicines to patients without ever talking to them or conducting a live consultation in a move that will jeopardise the business model of some prominent medtech start-ups.

The Australian Health Practitioner Regulation Agency announced new guidelines on telehealth on Wednesday and placed the medical profession on notice that any doctor who prescribes medicine based on an online questionnaire, online chat or text message exchange without access to the patient’s clinical records or having spoken to them first would need to explain themselves to the Medical Board.

The Medical Board had been concerned at the practice known as asynchronous prescribing, under which commercial telehealth operators issued scripts based on information supplied electronically by a patient.

Many of the larger telehealth companies used such methods largely for repeat scripts and patients’ regular medicines, but more recently the practices of telehealth start-ups focused on prescribing weight-loss drugs had been raising eyebrows, with the profession and regulators.

The Australian first exposed the practices in which patients of the online outfits Juniper and Mosh who inputted false information were given scripts for the weight-loss drug Saxenda after filling out an online questionnaire, the details of which was never verified by a doctor. Both companies’ business model is built on targeting consumers with weight-loss advertising, and directing them to their websites, which offer a medical solution to overweight and obesity, with prescription via a quiz.

“A doctor who has not consulted directly with the patient and does not have access to their medical records is unable to exercise good, safe clinical judgment,’ Medical Board of Australia chair Anne Tonkin said. “Prescribing medication is not a tick and flick exercise. It relies on a doctor’s skill and judgment, having consulted a patient, and recognises that prescription medication can cause harm when not used properly.

“A doctor who has not consulted directly with the patient and does not have access to their medical records is unable to exercise good, safe clinical judgment,” Dr Tonkin said.

The Medical Board was bombarded with more than 770 submissions during its review of the guidelines. AHPRA said “more than 650 of them from customers of two asynchronous prescribing companies, at least one of which offered consumers the chance of a $500 prize for completing a survey about their service”.

Australia’s growing number of commercial telehealth providers will now have to change their practices and pricing schemes to allow for prescription to only happen after a video consultation. But they will be able to continue to provide asynchronous prescribing if the patient has had a telehealth consult on a previous occasion, or if the prescribing doctor has access to the medical record.

InstantScripts chief operating officer Richard Skimin said the guidelines were not unexpected, but would to some extent “mean greater cost and less convenience for Australian patients who are already hurting”.