Telemedicine Benefits and Risks

By Jeremy A. Wale, JD, ProAssurance Risk Resource Advisor

2016 Alliance sponsor feature article

The healthcare landscape has changed radically in recent years. Implementation of the Affordable Care Act, expanding roles for nurse practitioners and physician assistants, meaningful use, and ICD-10 implementation are just the highlights. But one change that often gets overlooked is the rapid expansion of telemedicine—“the ability to provide interactive healthcare utilizing modern technology and telecommunications.”1 Telemedicine includes interactive video, home monitoring devices, scanning and emailing photos, and myriad other ways physicians and patients can communicate without a face-to-face interaction.

Drivers
Several factors are driving the telemedicine explosion, including:

  • Convenience2—a patient can sit in their living room and consult with a dermatologist who can view the problem area. A cardiologist can review monitor readings from their office while the patient is at home. Diabetics can check blood sugar levels and upload the results for their physicians to monitor.
  • Cost savings—telemedicine allows physicians to consult with more patients within a shorter timeframe.3 This increases revenue for the physician, saves patients money on travel expenses, and decreases patients’ time away from work and family.
  • Efficiency—images and documents can be sent electronically. The consulting physician can then conduct an electronic visit with the patient. This decreases the potential for noncompliance (especially with regard to specialist follow-ups), saves time, and increases physician-to-physician collaboration.

Drawbacks
While technological advances have helped advance telemedicine, technological failures can be one of its biggest drawbacks. Networks are subject to interruptions, delays, system overloads, or other technical difficulties. Because telemedicine is wholly dependent on working technology, its effectiveness is severely hampered when technology fails.

Privacy, security, and confidentiality are other potential problems. Even when healthcare providers take necessary security precautions, hackers may still access electronic communications—and HIPAA extends to the patient’s living room. It’s important to take necessary precautions to ensure telecommunications are as protected as possible. Use encrypted emails, consult with cyber-security experts when setting up your telemedicine practice, and develop a well-written consent form that addresses the risk factors of telemedicine.

It also is important not to overlook physical interactions between physicians and patients. Sometimes patients need a physical exam for an effective diagnosis (e.g. broken bones). Seeing patients in person helps establish a trusting, cooperative relationship that may be challenging to build electronically. Both parties may be more engaged if conversations are conducted in-person. This may be less of an issue if you only use telemedicine for established patients. It is still a good idea to suggest an annual in-office examination.

Mobile Apps
Mobile app use is booming. According to one estimate, the global mhealth market was valued at $13.6 billion in 2015, with an expected compounded annual growth rate of 34% over the next six years.4 The implications are equally enormous.

Mobile apps can be used for anything from monitoring patients remotely to facilitating physician/patient communication. A brief review of cardiology related mobile apps5 revealed several that allow physicians to demonstrate, illustrate, or show videos to patients to help explain certain conditions. Mobile apps also can provide decision support for physicians or help with diagnoses.

Dermatology apps can help patients track moles and other skin lesions to document changes. One app, developed by University of Michigan physicians, includes a skin cancer risk calculator.6 Another dermatology app claims to be 70% accurate in predicting the severity of a mole; dermatologists are about 85% accurate according to the same article.7

Risk Management Considerations
Increased availability and real-time data are key telemedicine benefits. But while these two factors seem to foster patient/physician communication and nurture that relationship, they also may increase your risk exposure.

If you offer electronic availability to your patients, consider how it could negatively impact you when something doesn’t go as planned for a patient. A plaintiff’s attorney could present to a jury your claim to be available, and then state the patient didn’t receive the type of response promised. The attorney could assert your failure to be immediately available directly led to the patient’s negative outcome. Real-time data also can present challenges. On one hand, it may increase your effectiveness as a healthcare provider. However, it also can create professional liabilities, particularly in the event of a claim. Consider: If you receive real-time blood sugar results from a patient and fail to notice a large spike or depression, could you be held liable for a negative outcome? A juror might look at this information and ask, “Why didn’t the doctor notice this sooner?”

These examples highlight the importance of full disclosure and informed consent when it comes to telemedicine. It is important patients and healthcare providers are aware of both the advantages and limitations telemedicine presents.

You also may wish to consult with your insurance agent to determine if your current policy covers internet-based services.

About the Author
Mr. Wale is a licensed attorney in Michigan where he works as a Risk Resource Advisor for ProAssurance. He has authored numerous articles about mitigating medical professional liability risk. Mr. Wale also conducts loss prevention seminars to educate physicians about new and emerging risks.

Footnotes

  1. What is telemedicine? Telemedicine.com, Inc. website. http://www.telemedicine.com/whatis.html. Accessed April 16, 2015.
  2. Chief Editor. 10 major pros and cons of telemedicine. NLCATP website: http://nlcatp.org/10-major-pros-and-cons-of-telemedicine/. January 26, 2015. Accessed April 22, 2015.
  3. Chief Editor. 10 major pros and cons of telemedicine. NLCATP website. http://nlcatp.org/10-major-pros-and-cons-of-telemedicine/. January 26, 2015. Accessed April 22, 2015.
  4. Global mHealth market expected to grow at 34% CAGR during 2016-2022: by P&S market research. MarketWatch Web site. http://www.marketwatch.com/story/global-mhealth-market-expected-to-grow-at-34-cagr-during-2016—2022-by-ps-market-research-2016-03-14. March 14, 2016. Accessed March 24, 2016.
  5. Misra S. Top 10 medical apps for cardiology. iMedicalApps website. http://www.imedicalapps.com/2014/10/top-10-medical-apps-cardiology/. October 23, 2014. Accessed April 28, 2015.
  6. Dolan B. University of Michigan Health System offers skin cancer app. Mobihealthnews website.
    http://mobihealthnews.com/17863/university-of-michigan-health-system-offers-skin-cancer-app/. July 12, 2012.
    Accessed April 28, 2015.
  7. Dolan B. University of Michigan Health System offers skin cancer app. Mobihealthnews website.
    http://mobihealthnews.com/17863/university-of-michigan-health-system-offers-skin-cancer-app/. July 12, 2012.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: