Telemedicine and Medical Malpractice
This scenario may become “the new normal” for millennials: A young woman at work starts feeling nauseous and feverish, but doesn’t have time to visit her PCP’s office. There is a dull pain in her abdomen and she can’t find a comfortable position to sit in. She whips out her smartphone and enters her symptoms into an application. The app asks her a few quick questions with multiple answer choices. Based on the nature, duration, and location of her pain, the app informs her that it could possibly be appendicitis. She is advised to seek immediate medical attention. A co-worker drives her to urgent care, where the diagnosis is confirmed. Without prompt treatment, her appendix could have burst and the infection spread throughout her abdomen, a potentially life-threatening condition. Telemedicine might have saved her life.
What is telemedicine?
The formal definition of telemedicine is the electronic exchange of medical information. In essence, telemedicine and digital medicine are the different names given to what is essentially remote healthcare – an encounter between a patient and a physician who are not in the same room. The term telehealth is sometimes used to include non-clinical care, for example, a radiologist remotely interpreting at an x-ray.
Why is telemedicine growing exponentially?
In one word: technology. In 1994, Boston’s Massachusetts General Hospital helped set up a teleradiology system in Saudi Arabia. Proprietary equipment was shipped by air to Riyadh and engineers from the U.S. flew down and spent weeks establishing the system which cost $100,000 and took 5 minutes to transmit a single plain film x-ray. In 1997, just three years later, when MGH set up a similar teleradiology link with a medical center in Turkey, all it took to set up the system was a commercially-available personal computer, a digitizer, and two hours of phone calls between engineers in the two countries.
How is telemedicine useful?
While it has been around for more than three decades now, telemedicine has only recently come into its own, primarily due to lightning fast internet connections and the ubiquitous smartphones. Telemedicine saves both time and money. Patients can transmit heart rate, blood pressure, and other signs and symptoms to a doctor enabling split-second decisions that are sometimes lifesaving. Chronic conditions can be managed more efficiently.
Telemedicine is making better healthcare possible for people living in underserved rural areas. High-resolution video cameras have made it possible for a physician located in a large metropolitan city to read the fine print on the IV bag of a patient in a small community hospital hundreds of miles away and make changes in treatment. A doctor can hear a patient’s cough and see a patient’s swollen eyes from a remote location.
Digital medicine has made it possible for physicians on a medical mission in deep Africa to consult experts in the United States about complicated cases. Hospitals without beds are a reality, serving only to provide consultation to smaller hospitals that don’t have 24×7 on-site physicians.
What are the pros and cons of telemedicine?
Advantages of telemedicine:
- Easy access to healthcare
- Saves time
- Cost effective
- Provides access to specialists
- Billable like regular healthcare services
Disadvantages of telemedicine:
- High upfront cost of telemedicine equipment
- Not cost-effective for smaller healthcare facilities
- Specialized training needed for healthcare personnel
- Impersonal due to absence of face-to-face encounters
- Reduced continuity of care (care from a different physician each time)
What are the legal implications of telemedicine?
While it has been hailed as revolutionary and has grown exponentially in the last decade, telemedicine raises several questions for patients, healthcare providers, insurers, and regulators. In addition to its medical significance, there are many legal implications to telemedicine.
Digital medicine has taken off like a rocket, but healthcare laws, privacy protection regulations, and reimbursement policies are still struggling to keep pace. Telemedicine is considered high-risk by many insurance networks, inviting higher medical liability premiums for physicians who practice it.
In terms of malpractice claims involving telemedicine, the number of lawsuits to date is infinitesimally small. Even when it figures in a case, telemedicine is frequently not the primary focus of the lawsuit. The decision to file a lawsuit for medical negligence is not an easy one, and when telemedicine is involved, it can get even more complicated.
A telemedicine malpractice claim can be complex because of the dearth of case law to rely on. Further complicating the situation is the difficulty in establishing jurisdiction across state lines. The fact that certain states have adopted standards of medical care that are different from the national standards makes the situation even murkier. The inconsistent clinical guidelines for telemedicine propagated by different medical specialty societies have led to more confusion. This lack of consensus is further aggravated by inflexible guidelines that quickly become obsolete as technology advances.
What’s next for Telemedicine?
Telemedicine and medical malpractice is uncharted territory. It is theoretically possible to file a claim under various scenarios of medical negligence such as incorrect interpretation of data, miscommunication or failure to communicate, inadequate monitoring, and incorrect or incomplete treatment. While the legal implications of telemedicine remain complex, there is no doubt that this multi-billion dollar industry will continue to grow at a rapid pace.