Professional liability and patient safety risks associated with Telemedicine

1. Professional liability and patient safety risks associated with Telemedicine Dr. Abbas Khosravi Assistant professor of Anesthesia and Intensive care E-Health clinical advisor Trauma centre Shiraz - Iran

2. Definition • The use of telecommunications technology to provide, enhance, or expedite health care services. • Accessing off-site databases, linking clinics or physicians' offices to central hospitals, or transmitting x-rays or other diagnostic images for examination at another site.

3. Our mission : Electronic transfer of information should be secure and remain confidential . We should make sure the right access to the right data by the right people.

5. Difficult equations • Patient information + Inappropriate disclosure = Breach of confidentiality Patient information + Inaccurate / Incomplete data = possible medical error or compromised patient safety

6. Law • Telemedicine law is still in the formative stage, so: providers are encouraged to adjust telemedicine policies and procedures appropriately. • Standards of care and informed consent laws are different than what we are doing now in our daily practice and even vary from country to country and providers should always be in touch with legal counsels.

7. Telemedicine doesn’t change a providers duty to protect the confidentiality of patients medical information • The originating site remains responsible for overseeing the safety and quality of services offered to it’s patients. • hospitals are encouraged to use same facilities and applications.

8. Legal issues in Telemedicine • (1) the traditional medico-legal issues not unique to the medium; • (2) conflicts in state law, which telemedicine amplifies because it connects geographically separate facilities; • (3) issues unique to telemedicine.

9. Risk specific to telemedicine • The telemedicine system can fail without provider control • Power failure • Telecommunication interruption • Remote equipment failure • Unreliable information : distorted colors , incomplete files ,… • Hackers

10. additional documentation • Identity of all participating physician and staff • Location of the patient and healthcare provider • The beginning and ending time of the encounters • The equipment used and the resolution of the images and or sound

11. Informed consent in telemedicine • Patient has an option to withhold or withdraw consent at any time without affecting the right to future care or treatment • The potential risks consequences and benefits of telemedicine • All existing confidentiality protections apply

12. All existing law regarding patient access to medical information and copies of medical records. • Prior to receiving telemedicine services the patient must sign a statement confirming that the above information was provided.

13. E-mail • E-mail correspondence with patients is simple but it has it’s own risks : • Inadequate protection • Miscommunication and availability to unauthorized individuals • Delayed treatment

14. E-mail correspondence guidelines • Establish a turnaround time for messages • Used an automatic reply function to acknowledge receipt • Inform patient about privacy and security limitations of e-mail • Retain and integrate electronic and or paper copies of medical reports

15. Establish policies that describe the types of transaction ( prescription refill , appropriate scheduling , etc …) and sensitivity of subject matter ( HIV , mental health , etc …). • Instruct patients ( indicate category of transaction in the subjective of message to expedite response).