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					                                                         MEDICAL COUNCIL
                                                         OF NEW ZEALAND
JUNE 06                                                                                                              www.mcnz.org.nz

Statement on use of the internet
and electronic communication
01	 The	internet,	email	and	other	methods	of	             06	 Patients	who	obtain	information	from	the	                    A	revised	edition	incorporating	
                                                                                                                           this	advice	is	expected	to	be	
   electronic	communication	are	useful	tools	which	          internet	may	wish	to	discuss	this	with	their	                 published	in	late	2006.
   can	help	health	professionals	communicate	with	           doctor.	Doctors	should	use	this	as	an	                   2	   For	further	information	on	
                                                                                                                           health	privacy	information	
   patients	and	one	another,	find	information	and	           opportunity	to	discuss	the	quality	of	the	
                                                                                                                           refer	to	Council’s	statement	
   participate	in	specialised,	worldwide	medical	            information	with	patients.	Sometimes	the	                     on	Confidentiality and the
                                                                                                                           public safety.	For	technical	
   discussion	groups.	The	internet	can	also	                 information	obtained	by	the	patient	may	be	of	
                                                                                                                           assistance	to	ensure	your	
   empower	patients	and	allow	them	to	inform	                poor	quality	and/or	creates	certain	expectations.	            system	is	secure	and	allows	
                                                                                                                           for	the	safe	exchange	of	
   themselves	about	their	illness	and	treatment.             In	such	cases	doctors	must	take	care	to	provide	
                                                                                                                           health	information	refer	to	
                                                             sound	reasons	why	the	patient	should	reject	                  the	Health Network Code
02	 However,	doctors	need	to	be	aware	of	the	limits	
                                                             the	information	and,	where	possible,	provide	                 of Practice	(published	by	
   of	any	method	of	communication	they	or	their	                                                                           Standards	New	Zealand)	or	
                                                             documentation	to	support	the	alternative	advice	              the	Ministry	of	Health’s	Privacy,
   patients	use	and	to	ensure	that	they	do	not	
                                                             or	treatment	that	they	are	recommending.                      Authentication and Security
   attempt	to	provide	a	service	which	puts	patient	                                                                        Framework	which	is	due	for	
   safety	at	risk.                                        07	 The	Council’s	publication	Cole’s medical                     release	in	2006	and	which	
                                                                                                                           will	supersede	the	Standards	
                                                             practice in New Zealand	includes	a	list	of	                   New	Zealand	code	of	practice.	   	
03	 The	Medical	Council	of	New	Zealand	(the	
                                                             reputable	websites	that	doctors	might	find	
   Council)	wishes	to	emphasise	the	inherent	risks	
                                                             useful.	This	list	is	also	available	on	the	Council’s	
   in	providing	medical	advice	when	a	physical	
                                                             website	www.mcnz.org.nz.
   examination	of	the	patient	is	not	possible.
                                                          Use of email and other forms of electronic
04	 Doctors	are	also	reminded	that	patients	have	
   rights	under	New	Zealand’s	privacy	laws	and	
   the	Code	of	Health	and	Disability	Services	            08	 Whatever	method	doctors	use	to	communicate,	
   Consumers’	Rights	with	respect	to	electronic	             they	must	consider	issues	of	privacy,	security	
   communication,	as	they	do	with	all	other	forms	           and	the	sensitivity	of	health	information.	
   of	communication.                                         The	Health	Information	Privacy	Code	1994	
                                                             applies	rules	to	the	health	sector	to	ensure	the	
Use of the internet for information by patients
                                                             protection	of	individual	privacy.	All	doctors	must	
05	 Patients	sometimes	come	to	doctors	with	                 ensure	that	they	act	within	the	rules	it	outlines2.
   detailed	information	about	their	conditions	
                                                          09	 If	a	doctor	chooses	to	use	email	to	
   obtained	from	the	internet.	Patients	should	
                                                             communicate	with	a	patient,	they	should	advise	
   not	be	discouraged	from	using	the	internet	
                                                             the	patient	of	any	limits	they	would	like	to	place	
   to	research	their	condition	or	treatment,	but	
                                                             on	its	use.	For	example	the	patient	should	
   they	may	need	to	be	reminded	that	internet	
                                                             be	advised	not	to	use	email	if	urgent	advice	
   research	cannot	take	the	place	of	a	face	to	face	
                                                             is	required.
   consultation.	Doctors	may	also	refer	patients	to	
   the	Council’s	resource,	You and your doctor1,	         10	 Patient	information	should	only	be	emailed	
   which	offers	advice	for	patients	on	using	the	            or	sent	electronically	when	the	means	of	
   internet	to	look	for	information	about	a	condition	       transmission	is	secure	and	preserves	the	quality	
   or	treatment.                                             of	the	information	(including	images).

Level 13, Mid City Tower, 139-143 Willis St, PO Box 11-649, Wellington, Tel 04 384 7635, 0800 286 801, Fax 04 385 8902, Email mcnz@mcnz.org.nz
11	 There	are	security	issues	specific	to	the	use	of	         in	the	location	where	their	patient	is	located.	           For	further	information	refer	
                                                                                                                         to	Council’s	statement	on	The
   email.	It	is	difficult	to	verify	a	person’s	identity	      Doctors	may	also	be	liable	if	they	assist	patients	        maintenance and retention of
   from	an	email;	some	families	and	groups	share	             to	contravene	another	country’s	laws	or	                   medical records.
                                                                                                                    4	   Information	regarding	HON’s	
   a	common	email	address;	and	computers	                     regulations,	for	example,	a	country’s	importation	
                                                                                                                         Code	of	Conduct	is	available	
   (particularly	family	computers)	may	be	accessed	           and	possession	requirements.	Doctors	should	               from	www.hon.ch
                                                                                                                    5	   As	defined	by	the	Council’s	
   by	a	number	of	different	people.	For	these	                seek	legal	advice	in	that	country	if	necessary.	
                                                                                                                         definition	of	The practice of
   reasons,	in	the	absence	of	consent	and	an	                                                                            medicine.
                                                           Providing advice to a patient located within
   email	address	nominated	by	the	patient,	doctors	                                                                 6	   In	February	2001	a	charge	
                                                           New Zealand                                                   was	laid	before	the	British	
   should	use	other	forms	of	communication	to	                                                                           General	Medical	Council	after	
   transmit	sensitive	information.	Receiving	an	           18	 The	Health	Practitioners	Competence	                      a	doctor	prescribed	Xenical	

   email	from	a	patient	should	not	be	taken	as	               Assurance	Act	2003	requires	doctors	providing	             and	Viagra	to	a	patient	over	
                                                                                                                         the	internet.	The	Professional	
   tacit	consent	that	the	patient	is	happy	to	receive	        treatment	to	patients	located	in	New	Zealand	              Conduct	Committee	decided	

   personal	information	by	email.                             at	the	time	of	treatment	to	be	registered	by	              that	the	doctor’s	use	of	a	
                                                                                                                         closed	question	questionnaire	
                                                              the	Council	and	to	hold	a	current	practising	              was	not	sufficient	to	confirm	
12	 Doctors	must	maintain	a	clear,	accurate	and	
                                                              certificate	issued	by	the	Council.	Adherence	              the	patient’s	complaints	or	
   contemporaneous	record	of	all	communication	                                                                          to	discuss	the	options	for	
                                                              to	this	strict	legal	position	is	often	problematic	        managing	their	conditions.	
   concerning	their	medical	practice,	especially	
                                                              when	the	doctor	is	located	in	another	country,	            In	addition	in	one	case	the	
   anything	regarding	a	patient3.                                                                                        doctor	prescribed	Xenical	to	a	
                                                              particularly	in	regards	to	registration	and	               patient	whose	physical	profile	
13	 Prescriptions	issued	only	by	email	do	not		               recertification	requirements	and	enforcement.              indicated	he	would	not	benefit	
                                                                                                                         from	use	of	the	drug.	In	its	
   meet	New	Zealand	legislative	regulations		
                                                           19	 A	doctor	located	overseas	who	is	asked	to	                judgement	the	Professional	
   (see	point	29	below).                                                                                                 Conduct	Committee	noted	
                                                              provide	an	opinion	in	relation	to	a	patient	               that	it	“did	not	consider	that	
14	 When	publishing	information	on	the	internet,	             under	the	care	and	clinical	responsibility	of	a	           the	standard	of	care	given	to	
                                                                                                                         patients	or	the	prescribing	
   doctors	must	comply	with	the	Health	on	the	Net	            New	Zealand	registered	doctor	does	not	have		
                                                                                                                         practice	of	a	doctor	should	
   Foundation	(HON)	Code	of	Conduct .                         to	be	registered	to	practise	in	New	Zealand.               be	different,	whether	through	
                                                                                                                         the	internet	or	otherwise.”	The	
Distance medicine (incorporating prescribing)              20	 A	doctor	located	in	another	country	who	reports	          doctor	was	suspended	from	
                                                                                                                         practice	for	three	months.
Providing advice to a patient located outside                 by	telemedicine	on	diagnostic	procedures	             7	   In	particular	the	RANZCR	
New Zealand                                                   performed	in	New	Zealand	should,	wherever	                 position	statement	on	
                                                              practicable,	be	registered	to	practise	in	                 teleradiology	should	be	the	
15	 Doctors	residing	in	New	Zealand	who	practise	                                                                        first	point	of	reference	for	
                                                              New	Zealand.	Council	recognises	that	this	                 those	involved	in	teleradiology.
   medicine5,	but	only	provide	services	to	patients	
                                                              may	not	always	be	possible.	When	a	doctor	
   located	in	another	country	at	the	time	of	
                                                              located	in	another	country	is	not	registered	to	
   treatment	are	not	required	to	be	registered	with	
                                                              practise	in	New	Zealand,	it	is	incumbent	on	the	
   the	Council.	However,	they	are	expected	to	be	
                                                              New	Zealand	practice	performing	the	procedure	
   registered	in	the	country	where	the	patient	is	
                                                              to	ensure	that	the	remote	reporting	doctor	is	
   located	and	meet	all	the	requirements	expected	
                                                              suitably	qualified	to	provide	the	advice	being	
   of	a	doctor	in	that	country.	
                                                              sought	and	is	appropriately	registered	in	their	
16	 The	standard	of	care	that	New	Zealand	                    country	of	residence.
   registered	doctors	provide	to	patients	located	
                                                           21	 A	doctor	who	is	uncertain	whether	a	remote	
   in	another	country	falls	within	the	Council’s	
                                                              reporting	colleague’s	qualifications	are	
   jurisdiction	insofar	as	it	reflects	on	the	doctor’s	
                                                              appropriate	should	seek	advice	from	the	
   competence	to	practise	medicine.
                                                              appropriate	branch	advisory	body.
17	 Those	doctors	who	practise	medicine,	
                                                           22	 When	a	New	Zealand	registered	doctor	assists	
   but	whose	patients	are	located	outside	
                                                              a	patient	located	in	New	Zealand	to	seek	advice	
   New	Zealand	at	the	time	of	treatment	remain	
                                                              or	treatment	from	an	overseas	based	doctor,	the	
   subject	to	New	Zealand	law	(notably	in	respect	
                                                              patient	should	be	advised	that	the	doctor	may	
   of	prescribing)	and	may	be	subject	to	other	
                                                              not	be	registered	to	practise	in	New	Zealand,	
   legal	obligations,	requirements	or	liabilities	
                                                              and	if	something	goes	wrong	New	Zealand	
   authorities	may	not	be	able	to	hold	them	to	             Prescribing                                                      In	2001	the	Auckland	District	
                                                                                                                             Court	convicted	a	doctor	
   account	for	their	actions.	                                                                                               who	had	been	involved	in	the	
                                                            29	 The	issuing	of	prescriptions	is	legally	restricted8.	
                                                                                                                             internet	sale	of	prescription	
23	 Doctors	who	use	telemedicine	must	assume	                   In	particular	it	is	noted	that:                              medications	and	sentenced	
   responsibility	for	ensuring	the	introduction	of	and	                                                                      him	to	a	term	of	imprisonment	
                                                                 	 Under	section	39	of	the	Medicines	                        for	the	following	offences	
   adherence	to	appropriate	quality	standards	at	                                                                            under	the	Medicines	Act	1981	
                                                                    Regulations	1984	no	doctor	is	permitted	to	
   both	the	transmitting	and	receiving	sites.	Where	                                                                         (Police v Roy Christopher
                                                                    prescribe	medication	to	an	individual	unless	            Simpson,	Auckland	District	
   both	the	transmitting	site	and	the	receiving	
                                                                    it	is	for	the	treatment	of	a	patient	under	his	          Court,	17	October	2001)	:
   site	are	located	in	New	Zealand	and	doctors	                                                                              −	Selling	by	retail	a	prescription	
                                                                    or	her	care.	                                              medicine	other	than	under	
   are	involved	at	each	location,	responsibility	
                                                                                                                               a	prescription	given	by	
   is	shared.	Quality	standards	and	procedures	                  	 Prescriptions	must	be	legibly	and	indelibly	                a	medical	practitioner	or	

   should	encompass	technical	personnel	and	all	                    printed	and	personally	signed	by	the	                      designated	prescriber.
                                                                                                                             −	Selling	by	retail	a	
   equipment	used	in	the	telemedicine	process.                      prescriber	with	his	or	her	usual	signature	
                                                                                                                               prescription	medicine	
                                                                    (not	a	facsimile	or	other	stamp).	Therefore	               without	being	a	pharmacist	
24	 With	each	communication	and	before	advising	                                                                               or	other	authorised	person.
                                                                    those	issued	only	by	email	or	other	
   or	treating	patients	in	another	location	doctors	                                                                         −	Publishing	or	causing	to	
                                                                    electronic	means	do	not	meet	New	Zealand	                  be	published	a	medical	
   must	first	confirm	to	their	satisfaction	the	identity	
                                                                    legislative	standards	under	sections	40-41	                advertisement	that	was	likely	
   of	the	patient.	                                                                                                            to	mislead	any	person	with	
                                                                    of	the	Medicines	Regulations.                              regard	to	the	use	and/or	
25	 Doctors	who	advise	or	treat	patients	are	                                                                                  effect	of	that	medicine	and	
                                                            30	 The	Council’s	view	is	that	for	a	patient	to	be	                which	failed	to	give	sufficient	
   responsible	for	the	evaluation	of	information	
                                                                “under	his	or	her	care”,	a	doctor	must	have	                   information	on	precautions,	
   used	to	form	a	diagnosis,	irrespective	of	                                                                                  contraindications	and	
                                                                had	a	face	to	face	consultation	with	the	patient	              side	effects	required	
   its	source.	A	doctor	who	receives	a	referral	
                                                                or	have	discussed	the	patient’s	treatment	with	                by	Regulation	8	of	the	
   which	does	not	contain	the	information	                                                                                     Medicines	Regulations	1984.
                                                                another	medical	practitioner	who	can	verify	
                                                                                                                             −	Publishing	or	causing	to	
   required	to	make	a	fair	assessment,	should	
                                                                physical	data	and	identity.	                                   be	published	a	medical	
   request	the	relevant	information	or	return	the	                                                                             advertisement	that	failed	to	
   referral	to	the	referrer	with	a	request	for	more	        31	 Doctors	may	therefore	only	prescribe	medication	               make	statements	required	
                                                                                                                               by	Regulation	8	of	the	
   specific	information.                                        when	they	have	had	a	face	to	face	consultation	
                                                                                                                               Medical	Regulations	1984	to	
                                                                with	a	patient	or	have	discussed	the	patient’s	                be	made	in	an	advertisement	
26	 Advice	or	treatment	provided	to	a	patient	in	                                                                              relating	to	medicines	of	that	
                                                                treatment	with	another	doctor	who	can	verify	
   another	location	must	meet	the	same	standards	                                                                              description,	kind	or	class.
                                                                physical	data	and	identity.                             	    A	finding	of	the	Hamilton	
   as	care	provided	in	a	face	to	face	consultation6.	                                                                        District	Court	and	affirmed	
   This	includes	standards	relating	to	patient	             Related statements                                               in	the	High	Court	(Ministry of
                                                                                                                             Health vs Ink Electronic Media
   selection,	assessment,	diagnosis,	consent	and	            	 Responsibilities in any relationships between                 Ltd and others,	Hamilton	
   follow-up.	                                                  doctors and health related commercial                        District	Court	12	December	
                                                                                                                             2003)	and	Ministry of Health vs
                                                                organisations	(December	2003).
27	 Doctors	need	to	be	confident	that	a	physical	                                                                            Ink Electronic Media Ltd and
                                                                                                                             others	(High	Court,	18	August	
   examination	would	not	add	critical	information	           	 The maintenance and retention of patient                      2004)	looked	at	another	case	
   before	providing	treatment	or	advice	to	a	patient	           records	(August	2001).                                       of	internet	prescribing	and	
                                                                                                                             considered	the	meaning	of	
   and	must	be	prepared	to	defend	that	position,	
                                                             	 Information and consent	(April	2002).                         “under	his	or	her	care”	in	
   with	evidence,	in	the	event	of	a	subsequent	                                                                              section	39	of	the	Medicines	
                                                                                                                             Regulations.		The	Court	held	
   complaint	or	legal	proceedings.                          15 May 2006                                                      that	as	a	minimum	there	
                                                                                                                             must	be:
28	 Specific	distance	medicine	applications	have	           This statement is scheduled for review by                        −	Some	information	given	
   been	demonstrated	to	provide	safe	and	effective	         May 2011. Legislative changes may make this                        about	the	patient	to	
                                                                                                                               the	doctor.
   care	and	are	the	subject	of	College	approved	            statement obsolete before this review date.                      −	An	acknowledgement	by		
   clinical	guidelines.	Such	guidelines	may	place	                                                                             the	patient	that	the	doctor	is	
   additional	requirements	on	doctors7.	                                                                                       his	or	her	medical	adviser	for	
                                                                                                                               this	purpose.
                                                                                                                             −	The	doctor	accepts	
                                                                                                                               responsibility	for	treating	
                                                                                                                               the	patient	for	the	condition	
                                                                                                                               referred	to.

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