The explosion of “virtual medicine” made possible by Internet connectivity, mobile technology and electronic health records is rapidly transforming America’s health care and health insurance systems.
But getting to the future could prove to be a bumpy ambulance ride. The transformation is raising all sorts of variations on the question: Can you trust a virtual doctor?
- If a procedure is recommended during a patient’s online doctor visit with an expert physician hundreds of miles away and is executed by a rural doctor close to home, who’s liable if it’s botched or a court rules that it was unnecessary?
- If a physician takes a photo of a patient’s wound with his smartphone and sends it to another physician or a consultant, does that violate privacy laws?
- And who is liable if your doctor orders tests or procedures based on incomplete or faulty electronic medical records?
New opportunities, new challenges
One thing is certain: These and hosts of other virtual medical questions are slowly being addressed within the health care industry — before they land well-intentioned practitioners in court.
“Mobile technologies provide a number of new opportunities,” says P. Divya Parikh, director of research and risk management for PIAA, a medical liability insurance trade association based in Rockville, Maryland. “However, a myriad of new challenges include privacy and security issues, patient safety issues — including contamination from bringing ‘dirty’ mobile devices into a medical setting — and difficulty in centralizing data.”
The risks of consumer complaints and lawsuits have medical defense firms scrambling. The pace of changes has been dizzying for consumers as the health care industry simultaneously:
- Introduces patients to virtual doctor visits.
- Converts from pagers to secure texting.
- Tippy-toes into the uncharted territory of social media.
- Upgrades from paper to electronic records.
Let’s look at these one by one.
Virtual doctor visits
The doctor will see you now — via your computer. Online physician visits have become an option for millions of consumers and promise the winning combination of convenience and lower costs. Health insurers are working with companies such as MDLive, Doctor on Demand and Teladoc that advertise virtual access to board-certified physicians any time of the day or night.
The American Medical Association says it believes “telemedicine” can improve the availability and quality of care without jeopardizing patient safety, but the doctor group also cautions that the remote technology must be used appropriately. It recently adopted a policy laying down safeguards and standards.
“This new policy establishes a foundation for physicians to utilize telemedicine to help maintain an ongoing relationship with their patients, and as a means to enhance follow-up care, better coordinate care and manage chronic conditions,” says Dr. Robert Wah, the AMA president, in a statement.
Texting and social media
Left unsecured and unarchived, text and email exchanges between you and your doctor run afoul of patient privacy protections under the Health Information Portability and Accountability Act, or HIPAA.
“You’ve got to be careful there,” says Joshua Cohen, a senior partner in DeCorato Cohen Sheehan and Federico, a New York-based health care litigation defense firm. “I discourage my doctors from texting because, arguably, it’s a communication with a patient — and if it is, are they storing that?” He adds that the same holds true for email.
Doctors also should be leery of using Facebook, Twitter or other social media, warns Kevin Kelly, president and CEO of Medical Risk Management, a medical liability consulting firm based in Hartford, Connecticut. The Centers for Disease Control and Prevention has even weighed in with a social media toolkit to help physicians.
“It’s very dangerous because there’s no real precedence; you’re kind of shooting in the dark,” Kelly says. “Before jumping in headfirst, think it through, develop the protocols and beta-test, because there aren’t any legal cases that provide precedent.”
Electronic health records
But topping Kelly’s worry list is the transition to electronic health records. He gives one example of a potential source of trouble.
“It allows (a doctor) to simply carry forward all of the prior day’s notes when there are no substantive changes in a patient’s treatment,” he says. “Well, you can imagine how three or four days of this might be perceived as a sign that the physician didn’t really pay much attention.”
If you feel uneasy about your doctor’s use of electronic health records, the health care community may have itself to blame, says Cohen.
“In one recent case, a nurse testified that her new medical records system had ‘gremlins’ in it,” he says. “When you have to start defending your medical records by saying there are ‘gremlins’ in there, you’ve got a problem.”
How can patients protect themselves while their health care providers get a handle on virtual medicine?
Mary Griskewicz, senior director of health information systems for the nonprofit Healthcare Information and Management Systems Society, says the best solution is to learn how the new health care system works — and don’t be afraid to ask questions.
“Part of health literacy is knowing not only what questions to ask, but also what questions you are allowed to ask,” she says. “Some physicians may not like it, but where your health and money are concerned, understanding what your benefits cover, what deductibles are and how your health insurance works is essential.”