Telehealth Prescribing in NZ
This section summarises recent changes in prescribing rules. To be fully informed on prescribing when using telehealth / virtual health during COVID-19, please refer to the Ministry of Health and Medical Council of New Zealand links shown below.
New Rules for Electronic Prescriptions
The Ministry of Health has introduced new rules to make it easier to provide electronic prescriptions to support virtual care*. This is especially important during this COVID-19 epidemic when exchanging paper prescriptions between prescriber, patient and pharmacy is burdensome, challenging and unsafe.
Some of the rules apply to systems that are integrated into the New Zealand Electronic Prescription Service (NZePS). Others are temporary and will expire when the COVID-19 alert levels are lowered.
Links to the new rules on the Ministry website are New rules for electronic prescriptions to support virtual care in the community. *Note: the terms “virtual care” and “virtual consultations” in the Ministry announcement also apply to telehealth.
Signature Exempt Prescriptions and Remote Prescribing
The Ministry has also launched a section on its site. The section covers a large number of topics and questions relating to signature exemptions under COVID-19. Signature Exempt Prescriptions and remote prescribing.
The various paths for prescribing with the new rules are shown in this flowchart.
Medical Council of NZ re: Prescribing and Telehealth
The Medical Council issued a clarification around prescribing and telehealth on 26 March 2020.
The clarification included the following:
“Many primary and secondary care services are now offering consultations by telephone or other remote technologies. This is a sensible solution given the circumstances of the national lockdown.
Council's Statement on Telehealth and Statement on use of the internet and electronic communication provides guidance to support your practice using these technologies.”
Key changes to the new Telehealth statement in Section 16 on Prescribing are:
- Recognising the waiver issued by the Director-General of Health on regulation 41 requiring signatures for NZePS users. See details and links above.
- Adding a telephone conversation as an alternative to in-person and video: The revised statement is:
“Before prescribing any medicine for the first time to a patient, Council expects you to have an in-person consultation with that patient. If this is not possible because of exceptional circumstances, consider a telephone or video consultation with the patient or discuss the patient’s treatment with another New Zealand registered health practitioner who can verify the patient’s physical data and identity."
The Medical Council provide some examples, and there is no doubt that the current COVID-19 pandemic is an exceptional circumstance. We are working towards supplementing these examples with some additional examples of 'exceptional circumstances' relating to COVID-19 Alert Levels.
- Removing the requirement for an in-person assessment before prescribing controlled drugs for the first time. The revised statement allows for a telehealth consultation:
“It is never appropriate to prescribe medicines with a risk of addiction or misuse, or psychotropic medication, for the first time to a patient who has not been appropriately assessed.”
Note the waivers issued by the Ministry of Health do not apply to controlled drugs and signatures are still required.
Creating a prescription for a patient is an integral part of many telehealth consultations. Providers must be aware of all legal restrictions and professional expectations.
In addition to the new rules described above, prescribers should also be familiar with the Medical Council Good Prescribing Practice.
Some organisations have been granted individual waivers for their specific circumstances.
New e-prescription guidelines lead to telehealth success during COVID-19 lockdown
News Apr 2020: The COVID-19 pandemic has generated a shift towards telehealth as being part of the solution for breaking community transmission. In addition, key changes have been made regarding electronic prescribing of drugs which has a significant impact on clinicians – particularly those in the field of mental health. Read the full story.
Waiver from Ministry offers opportunity to trial e-prescription
News Apr 2020: Released to support virtual care during the Level 4 lockdown, the Ministry of Health’s new waiver regarding electronic prescriptions is paving the way for more clinicians to trial the concept of e-prescriptions. Prior to the COVID-19 lockdown, clinicians could only provide prescriptions electronically via the NZePS system. If not set up for NZePS, the clinician would need to print, sign, fax and post copies of the prescription to the pharmacy – a process which is time-consuming, and which isn’t ideal during a period of enforced social distancing. Read the full story.