Telemedicine has come a long way over the past 20 years. Modern technology has made it accessible to an extent undreamt of a few years ago. The communication infrastructure and equipment now available allows for high resolution imaging and excellent audiovisual transmission. Now, telemedicine can provide healthcare to remote or underserved areas. It can eliminate unnecessary travel times and make other improvements to achieve greater efficiency. It has many benefits and the potential for explosive growth as attempts are made to contain costs while improving quality.
Telemedicine’s importance and potential have just been recognized in Washington, D.C. where a bipartison group of senators has introduced new legislation to waive restrictions on Medicare telehealth coverage that is considered antiquated and arbitrary.
Telemedicine Liability: Potential Hazards
As telemedicine has become more widespread, more providers are involved. Some have not been properly trained and others may only be moonlighting occasionally to make a little extra cash. Hospitals and clinics may add telemedicine capabilities without adequate safeguards. It is all too easy to unwittingly make an oversight that can lead to legal or regulatory problems.
Telemedicine comes with risks. These may include:
- Violation of state licensing laws
- HIPAA violations
- Identity theft and other internet crimes
There are a number of factors that can contribute to risks:
- The provider has little knowledge of the patient
- The patient has little knowledge of the provider
- The interaction may be limited, with some parts of the physical exam deferred
- There may be problems of language resulting in miscommunication
- There may not be the chance for follow-up
- Subtle clues used in clinical practice may missed
- Documentation may be suboptimal with omissions
- There may be discontinuity of care
- There may be limited access to the patient’s medical history
- There may be limited security, especially in a remote or rural site
Some of these problems can be mitigated by implementation of processes to standardize the session. In addition to standardizing wherever possible, there are more ways to further mitigate risks.
How Medical Algorithms Can Help Reduce Telemedicine Liability Risks
Medical algorithms can provide a broad range of support in clinical practice. In the case of telemedicine, they can run before, during or after a clinical session. Algorithms can be executed in advance of the patient session based on the information already available to the physician. These results can help give the clinician a “head’s up”about potential issues prior to starting the session. During the session algorithms can run autonomously in the background, executing based on information as it becomes available and then sending an alert to the clinician if findings exceed pre-set limits. They can also be executed to retrieve important information about findings that were observed. After the session additional algorithms can be executed based on follow-up laboratory tests or imaging studies. All of the algorithms that were executed can be summarized into the medical record as additional documentation. Using a standard set of algorithms with automatic data entry can help to reduce omissions.
For example, data about the patient can help to identify risk factors for diabetes mellitus, chronic renal failure, substance abuse or other conditions prior to the session, and the physician can look for evidence of these conditions during the session. During the session, incongruities in the patient’s responses could identify malingering. Or the doctor may need to get quick access to reference material on-the-fly. After the session, identification of abnormal laboratory findings can be combined with other findings to suggest additional avenues to investigate. By integrating medical algorithms into the telemedicine process, potential gaps can be avoided and better medical care provided.
Here are a few examples of useful algorithms for telemedicine:
- Diabetes Risk Score for Identifying Patients in General Practice at Risk for Type 2 Diabetes Mellitus (Cambridge Risk Score)
- Alarm Symptoms for Patients with Gastroesophageal Reflux Disease
- Occupational Risk Factors Associated with Development of Chronic Renal Failure
- Risk Factors for Multidrug-Resistant Bacteria Causing an Exacerbation of Chronic Obstructive Pulmonary Disease (COPD)
- High Risk Alcohol Relapse (HAR) Model
- Findings Identifying a Malingering Patient with Low Back Pain