As technology transforms the healthcare landscape, providers are implementing new opportunities to expand, improve and enhance patient care. Telehealth services represent one of the more exciting innovations for the industry, but can also be a potential source of risk. It’s just one of the emerging risks addressed in the 2019 Benchmark Study of Healthcare Professional Liability Claims from Zurich North America.
With the use of digital technology, telehealth programs can offer a broad range of remote healthcare services and activities, not necessarily clinical in nature, to benefit patients and healthcare professionals alike. (“Telemedicine” typically refers to remote clinical services, while “telehealth” can also include a broader array of remote nonclinical services.) The New England Journal of Medicine Catalyst outlined leading telehealth examples, among them:
- Videoconferencing gives patients in rural locations, as well as those with limited ability to travel, newfound access to health specialists. Healthcare providers benefit, too: Primary care physicians can consult in real time with specialists and peers across the country, and care teams can collaborate on treatment plans for their patients.
- Mobile health apps on smartphones and tablets can help patients become more engaged in controlling their well-being. Educational videos and apps can help people manage chronic conditions, participate in wellness activities and build emotional resilience with online support groups.
- Remote patient monitoring collects and transmits medical and other types of health data from patients to healthcare providers. Electronic monitoring devices such as wearables can be used to track blood pressure, respiratory rates and other vital sign data.
Telehealth programs have witnessed significant growth across the U.S. Approximately 76% of U.S. hospitals reported having some form of computerized telehealth systems in 2017, more than double the 35% reported in 2010, reports the American Hospital Association.
Telehealth services: Recognizing the challenges
Telehealth is not without challenges, however. A 2018 report from the American Society for Health Care Risk Management (ASHRM) highlighted three operational risks for healthcare organizations seeking to implement these programs:
- Credentialing: Licensing and credentialing of healthcare professionals can be complicated when a patient is in one state and the provider is in another. Hospitals must be diligent in aligning their credentialing process with the July 2011 final rule issued by the Centers for Medicare and Medicaid Services, which stipulates that the originating site (where the patient is) will rely on the credentialing and privileging decisions of the distant-site hospital (where the specialist is located) for telehealth practitioners. In other words, the site receiving the service does not have to duplicate the credentialing process.
- Standard of care: Some states have defined a specific standard of care for telemedicine that addresses the physician-patient relationship, electronic prescribing and in-person follow-up. Whether or not standards have been established, risk managers need to inform their organization of professional association positions. The American Telemedicine Association has issued discipline-specific guidelines, as has the American Medical Association, American Psychiatric Association and American College of Physicians. In addition, the Federation of State Medical Boards has published a model policy of voluntary guidelines. Consideration also needs to be given as to whether and how advance practice professionals will be involved in telemedicine.
- Documentation: A patient-provider encounter, even a remote one, requires documentation in the patient’s health record. Access to this documentation by the patient and providers should align with existing rules and regulations, as well as institutional policies for privacy and security of this information. Documentation should include informed consent, prescribed medications, diagnostic test results, clinical evaluations and instructions.
The ASHRM report also emphasizes clinical/patient safety, recommending initiatives that “prevent or reduce errors, such as communication of test results, patient instructions, patient education and follow-up care.”
At-home monitoring devices, which put technology in the hands of the patient, also may pose liability risks that include device failure/inoperability and cyber security issues, according to a recent article in Risk & Insurance.
Ready, set, launch
A successful telemedicine program starts with a well-designed plan for implementation. A multidisciplinary team, including medical staff, information technology, finance and human resources, must evaluate the community’s needs and identify the program’s goals and services, as well as the geographic areas where service will be provided.
Additional issues to address include finalizing contracts with distant sites and vendors; providing staff education and training; defining measures to evaluate program goals; and assessing effectiveness and security of telehealth equipment. Identifying and enlisting clinical and administrative champions can help assure that a telehealth program is widely accepted and utilized.
It’s also critical to understand reimbursement policies for telehealth services. Telehealth providers should investigate the varying Medicare and Medicaid rules, which may differ by state, regarding payment for telehealth services, as well as each state’s telehealth parity laws. The Center for Connected Health Policy provides extensive information on telehealth laws and reimbursement policies by state.
The extent to which telehealth programs are embraced remains to be seen, but as technology evolves, so will the opportunities and risks associated with these services. Their myriad benefits point in a favorable direction for forward-looking organizations ready to keep pace with this new chapter in healthcare.