Teleprescribing Controlled Substances: Flowchart Analysis of the Ryan Haight Act and State Telemedicine Laws

Abstract

Legal liability concerns rank among the top organizational barriers to telemedicine adoption. Such concerns extend to medication-assisted treatment for opioid use disorders and to clinical use of controlled substances in general. These concerns stem from the complex web of federal and state regulations that govern teleprescribing of controlled substances. Existing health law literature on this topic has in large measure summarized regulations and exceptions under the Ryan Haight Act Online Pharmacy Consumer Protection Act (Ryan Haight Act) or categorized state telemedicine laws by nature and breadth of requirement. However, flowcharts can aid in the cognition, understanding, and evaluation of complex legal knowledge. This study analyzed the Ryan Haight Act, state administrative code, and published telemedicine guidelines using a multimethod qualitative approach. Legal analysis identified the structure and key language of federal statute through examination of sentence structure, logical connectors, punctuation, and key terms and language. Subsequently, Ryan Haight Act and state regulatory compliance flowcharts were developed using an adapted version of the six-stage process described by the American Society for Quality (ASQ). The creation of flowcharts proceeded in an iterative manner, and an interdisciplinary workgroup of subject matter experts reviewed the results for logic, clarity, cohesion, completion, and accuracy. Regulatory compliance flowcharts for teleprescribing of controlled substances may provide practitioners, educators, and advocates a tool for telemedicine risk management, competency-based education, and policy development.