An increase in enquiries and concerns from members about the potential medico-legal risks with use of telehealth services has prompted Avant to seek views from members, colleges and other stakeholders. We hope the feedback will generate discussion on the issues surrounding telehealth, and perhaps establish a robust framework to address these issues.
Feedback will be based on a discussion paper we have released outlining our experience, the benefits and medico-legal risks, and current professional guidelines associated with use of telehealth services.
There are many reported and established benefits of telehealth including more timely access to health care1, cost savings2, clinical effectiveness3, empowering patients4 and better care coordination5. However, we have identified a number of challenges drawing on our experience and a review of the literature. These include:
- Lack of face-to face consultation
The inability to examine the patient when deemed necessary may lead to bias that may result in errors in diagnosis and treatment. Inappropriate testing and prescribing may be more likely to compensate for the limitations posed by being unable to examine the patient. Telehealth services are also generally (except in certain circumstances) not reimbursed by Medicare.
- Disruption of the doctor-patient relationship and continuity of care
Disruption to care can occur because patients have easier access to services via telehealth from healthcare providers other than their usual doctor. Telehealth may also lead to depersonalisation of the doctor-patient relationship, since touch and communication with body language have been shown to have therapeutic value in this relationship.6
- Supervision issues
Although no different to services provided in person by non-doctors, telehealth services provided by allied health and nursing professionals may prompt issues regarding supervision and credentialing of those services. Roles and responsibilities may be uncertain and may lead to an increase in medico-legal and clinical risk.
- Cross-border issues
Providing telehealth services across international and state borders raises privacy, licensing and other regulatory issues and concerns.
- Technological limitations
Services provided by telehealth may be subject to technological limitations and uncertainty. A lack of band-width for video or internet-based consultations may hamper the delivery of care and lead to an increase in risk to patients.
Other issues include the impact of use of telehealth services on doctor dissatisfaction, confidentiality and privacy, and professional skills.
In view of these potential challenges and medico-legal risks, and in considering our approach to the use of telehealth services, we have requested feedback on the key issues below:
- What are the benefits, clinical risks, and medicolegal risks of these services?
- What is the expected standard of care and who should set the standard?
- How can safety be ensured?
- Do we have, or need, speciality-specific guidelines to ensure that the professional boundaries created by our profession are respected?
- Should Colleges and professional societies in Australia develop speciality-specific guidelines or guiding principles for the use of telehealth by their members?
Read the Telehealth: an Avant issues and discussion paper in full.
Have an opinion?
We value your feedback – what do you see as the key issues related to the use of telehealth services? Email: firstname.lastname@example.org
- Phillips RL et al. A Family Medicine Health Technology Strategy for Achieving the Triple Aim for US Health Care. Family Medicine. 2015; 47(8): 628-35.
- Ekeland AG, Bowes A, Flottorp S. Effectiveness of telemedicine: A Systematic review of reviews. International Journal of Medical Informatics. 2010; 79:736-71.
- Flodgren G et al. Interactive telemedicine: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews. 2015;(9): Art No. CD002098.
- Ekeland AG, Bowes A, Flottorp S. Effectiveness of telemedicine: A systematic review of reviews. International Journal of Medical Informatics.2010;79:736-71.
- Hill RD et al. Review of Veterans Health Administration Telemedicine Interventions. American Journal of Managed Care.2010;16:e302-10.
- Daniel H, Sulmasy LS. Policy Recommendations to Guide the Use of Telemedicine in Primary Care Settings: An American College of Physicians Position Paper. Annals of Internal Medicine. 2015;163:787.
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