Even before the COVID 19 outbreak in the spring of 2020, telehealth services were evolving and expanding rapidly. An American Well Survey in April of 2019, found that one in five physicians use telehealth to care for patients, and half of those who don’t currently use telehealth say it’s likely or very likely they’ll start by 2022.
Meanwhile, the Centers for Medicare & Medicaid Services (CMS) and private insurers are expanding coverage of telehealth services. Given this rapid growth, it’s important to look at the benefits and potential risks that come with new services.
What is Telehealth?
The American telehealth Association (ATA) defines telehealth as, “the remote delivery of health care services and clinical information using telecommunications technology. This includes a wide array of clinical services using internet, wireless, satellite, and telephone media.” The ATA considers telehealth and telemedicine to be synonymous.
There are three separate areas of telehealth.
- Store and Forward (Asynchronous) Applications: The use of a camera to record (store) an image that is transmitted (forwarded) to another site for review at a later time. A physician can use this type of technology to share electronic medical records with other physicians for consultation. This can include the forwarding of scans to a radiologist in another state for diagnostic purposes, for example.
- Interactive Audio and Video Telecommunications System: Real-time video teleconferencing involving both the live presence of the provider and patient in an interactive environment.
- Telemonitoring: Remotely collects and sends patient data to be interpreted by a specialist and is used in a person’s ongoing health care. For example Health information from a device, such as a pacemaker, is recorded and monitored by a patient’s physician remotely.
The Benefits of Telehealth
The use of telehealth has spread rapidly over the last several decades and is becoming integrated into health care delivery systems at an increasing rate. Telehealth offers benefits to both patients and providers that include:
- Reduced health care costs
- Increased patient access to providers, especially in medically underserved areas
- Improved quality and continuity of care
- Faster, more convenient treatment reducing lost work time & travel costs
What are the Risks Associated With Telehealth?
When telehealth medical malpractice claims arise, they often stem from one of three common issues. In part, issues are similar to what you would expect to see from traditional care, including an incorrect diagnosis or misinterpretation of an image. While other issues are new and only apply to the use of telehealth and the technologies it relies upon.
Miscommunication and Privacy Issues:
In some cases, the telehealth system could contribute to existing risks. Miscommunication, for example, could become more of an issue when physicians and patients aren’t meeting face-to-face. In other cases, claims could involve the very nature of telehealth itself by arguing that an exam should have been done in person, rather than remotely.
State Laws and Licensing:
In traditional health care, it’s reasonable to assume the patient and a physician are in the same state. With telehealth, this is not necessarily true. Because of the possibility of receiving treatment by an out of state physician, the laws and licensing requirements of multiple states may be relevant.
Documentation and Informed Consent:
Privacy and security risks must also be considered. Using telehealth and electronic health records can make providers vulnerable to malware and hacks.
Password-protected screensavers, encryption, and other safety measures can help keep information safe. However, unsecured devices and systems, such as laptops and email, can result in security weaknesses. Compliance with the HIPAA Security Rule is essential.
Patients must be made aware of the risks of telehealth, how the process works, and who will be in charge of their care. Both the patient and a physician should agree that telehealth is appropriate and retain the ability to stop treatment at any time.
HIPAA Regulations and Telehealth
The HIPAA Privacy Rule establishes national standards to protect individuals’ medical records and other personal health information. HIPAA applies to health plans, health care clearinghouses, and providers that conduct certain health care transactions electronically. The Rule requires appropriate safeguards to protect the privacy of personal health information, and sets limits and conditions on the uses and disclosures that may be made of such information without patient authorization. The Rule also gives patients rights over their health information, including rights to examine and obtain a copy of their health records, and to request corrections.
As of early spring 2020, covered health care providers will not be subject to penalties for violations of the HIPAA Privacy, Security, and Breach Notification Rules that occur in the good faith provision of telehealth during the COVID-19 nationwide public health emergency.
This means that HIPAA regulations may not be enforced during this time if you choose to use telehealth services, but will continue to be enforced for all in-person interactions with health care professionals.
Quick Telehealth Q&A:
When deciding whether or not to use telehealth, there are a few important questions to ask:
- What technical equipment do I need for a telehealth visit?
At minimum, most patients will need a computer or mobile device with an integrated camera and microphone.
- What conditions can I get treated for via telehealth?
Telehealth is currently being used to treat many different conditions including, but not limited to, rashes, flu, sinus infections, UTIs, migraines, acne, mental health counseling, substance abuse counseling, post-op check-ins, lab result reviews, contraceptive counseling, and prescription refills.
- How can a physician diagnose me without actually doing a physical exam?
Your physician doesn’t necessarily need to do a physical exam to diagnose and treat you. Your physician is also able to see you and view any picture uploads which gives them additional visual information needed to make a diagnosis. If they feel the telehealth visit did not give them the information they need to make a diagnosis, you may be asked to schedule an in person visit.
Telehealth is a Health Care Staple
Whether or not you’re taking part in using an interactive audio and video telecommunications system, it is likely that telehealth is already a part of your ongoing care. As technology advances, so too does the way we receive health care, regardless of our awareness. Having a complete understanding of how telehealth may be used in your care is an important step in advocating for yourself as a patient.
When dealing with health issues, personal privacy must be protected, and for good reason. Telehealth in particular, has actually been in use for the last 70 years, but the ways in which it is being used is constantly changing and evolving as new technologies become available. Telehealth offers many benefits, and is incredibly beneficial when used correctly. At the same time, privacy protection and protocols have not been able to keep up with the advancements and need to be taken into consideration when agreeing to use telehealth services.
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