Class 9  – TELEHEALTH

Considerations in Telehealth Include:

  • Medical licensure issues, such as will physician be rendering care in any way to patients not located in the state(s) in which physician is licensed and if yes, then a question would be whether a physician providing an interstate telemedical consultation is required to be fully licensed in the state where the patient is located.
  • Product liability issues involving healthcare technological equipment.
  • Abandonment of patients type of issues as they might apply under telemedicine – Because with the physicians and patients residing in distant locations, it increases the possibility that communication between the patient and the physician will break down.
  • To what extent physician’s medical malpractice insurance would apply in this position or if physician has some type of coverage from physician’s employer.

A growing area in medicine in a variety of ways is the field of telemedicine.  According to the California Telehealth &Telemedicine Center, telehealth & telemedicine are broadly defined as application of electronic communication technologies to practice of health education and medicine. The essence of telehealth & telemedicine is the movement of data and information instead of movement of people for health care services & health information. Benefits include: extended reach of specialty care in a more economical manner, enhanced primary care services, increased access to medical education & training programs in rural & underserved communities.

In Illinois, legislation specifies “telemedicine” includes rendering written or oral opinions concerning diagnosis or treatment of a patient in Illinois by a person located outside the State of Illinois as a result of transmission of individual patient data by telephone, electronic or other means of communication within this State.

Across the nation, a current issue involving the need for licensure focuses on practice of telemedicine. In particular, the question is whether a physician providing an interstate telemedical consultation is required to be fully licensed in the state where the patient is located.  Federation of State Medical Boards recommended states create a special license for physicians in such situations, American Medical Association in 1996 asked for full licensure in each state where a patient is located. In reaction to this controversy, in 1997 the Illinois General Assembly enacted legislation that any person who engages in practice of telemedicine without a license issued under the Medical Practice Act is subject to sanctions for unlicensed practice of medicine.

Under the Illinois legislation, practice of telemedicine does not include: periodic consultations between an Illinois physician and a physician licensed in another state, second opinions provided to Illinois physicians, follow-up services provided to an Illinois patient by a physician who has initially seen the patient in another state.

U.S. News & World Report (6-21-99), reports there have been about ten doctors disciplined by state medical boards for Internet prescribing. In Kansas, regulators sued several out-of-state Internet doctors for prescribing medicine without a Kansas license and state board pursued a site selling a DEA controlled substance after seeing how easy it was for U.S. News to get it. To purchase Meridia, (appetite suppressant approved only for very obese that can cause blood pressure and heart valve problems), the on-line pharmacy had U.S. News fill out a questionere about height, weight, & medical history & charged a $250 fee for 30 day supply & review of their application by a staff physician. The physician was located in Ohio so Kansas regulators took actions to stop him from practicing medicine in Kansas. Also, Kansas board may ask Ohio to also honor the order. Kansas wants to send a clear message to providers to not do this. Kansas state attorney general has filed 5 consumer-protection suits against Internet companies & their associated doctors & pharmacists for similar activity including prescribing viagra to a 16 year old boy. Other states including Wisconsin & Illinois have also taken legal action. Pharmacy boards hope a new Internet licensing criteria will help by being a seal of approval supposed to go only on sites that verify that prescribing doctors have more than electronic relationships with their patients.

Illinois Department of Public Aid reimburses providers for selected telemedicine services. When speaking of the site where the client is located the Department defines that location as the Spoke site. When speaking of the site where the telemedicine consultant is located, the Department defines that location as the Hub site.

Note, because there is no precedent involving malpractice claims in the context of telemedicine, the extent of a telemedicine practitioner’s exposure to malpractice liability remains unclear. Technology manufacturers of teleconferencing equipment used in telemedicine may be liable for discrepancies in images that might cause misdiagnosis. Currently there are no standards for this equipment. Liability against manufacturers of telemedicine equipment would be product liability actions.

Further, consider when abandonment of patients type of issues might apply under telemedicine. Because with the physicians and patients residing in distant locations, it increases the possibility that communication between the patient and the physician will break down. Also, to what extent does the malpractice insurance apply in telemedicine. Will the insurance cover consultations performed outside the physician’s state of licensure. If there is a lawsuit, would the physician have sufficient contacts with the state in which the patient resides to be subject to that state’s jurisdiction.

An exciting area of telemedicine are the many scientific developments using new information and other types of technologies taking place around the world where the patient is in one location receiving treatment and services from providers located in another location.

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