telemedicine: managing the risks of virtual healthcare · telemedicine: managing the risks of...

46
TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM Patient Safety Risk Manager II, SE Region Department of Patient Safety and Risk Management February 17, 2017

Upload: others

Post on 21-Jun-2020

10 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

TELEMEDICINE:Managing the Risks of Virtual Healthcare

Amy Wasdin, RN, MBA, CPHRMPatient Safety Risk Manager II, SE RegionDepartment of Patient Safety and Risk Management

February 17, 2017

Page 2: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

DISCLOSURE STATEMENT

The Doctors Company would like to disclose that no one in a position to control or influence the content of this activity has reported relevant financial relationships with commercial interests.

The information and guidelines contained in this activity are generalized and may not apply to all practice situations. The faculty recommends that legal advice be obtained from a qualified attorney for specific application to your practice. The information is intended for educational purposes and should be used as a reference guide only.

2 TELEMEDICINE: Managing the Risks of Virtual Healthcare

Page 3: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

AMY WASDIN, RN, MBA, CPHRM

Amy Wasdin earned her Associate’s Degree in Nursing at Brunswick College and her Bachelor of Science Degree in Nursing from Armstrong Atlantic State University in Savannah, Georgia. She went on to earn her Master of Business Administration Degree from Brenau University in Gainesville, Georgia. She has over 20 years of experience as a registered nurse, including more than seven in health care risk management and claims administration. Ms. Wasdin is a member of the American Society for Healthcare Risk Management and the Georgia Society for Healthcare Risk Management. She has earned multiple designations and certifications over the course of her health care career, including Certified Legal Nurse Consultant (CLNC), Critical Care Registered Nurse (CCRN), Certified Professional in Healthcare Risk Management (CPHRM), and Healthcare Management.

Ms. Wasdin’s health care risk management experience includes multihospital, long-term care, and physician practice risk management oversight. She has worked in multiple areas in health care, including quality assurance, compliance, medical malpractice litigation, medical ethics, policy and procedure development, staff education, and grievance resolution. Ms. Wasdin has provided risk assessments and implemented loss control measures in the operational, clinical, and environmental settings. She is an experienced presenter who frequently speaks to health care providers and administrators on a variety of risk management topics.

Patient Safety Risk Manager II, SE Region, Department of Patient Safety and Risk Management, The Doctors Company

3 TELEMEDICINE: Managing the Risks of Virtual Healthcare

Page 4: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

OBJECTIVESAfter completing this program, learners will be able to:

Discuss three types of telemedicine and how it has evolved.

Identify risks associated with practicing telemedicine.

Apply strategies to reduce the risks associated with practicing telemedicine.

TELEMEDICINE: Managing the Risks of Virtual Healthcare4

Page 5: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

TELEMEDICINE DEFINED

Earliest examples– Smoke signals– Hippocrates made remote diagnoses – Early 1900s–two-way radios were used in Australia – 1960s–NASA used real-time remote monitoring

Advanced telecommunication providing clinical healthcare remotely– Telehealth, eHealth, and mHealth (related but different) – Primarily late 20th century technology

Source: Time for a little telehealth trivia. June 12, 2015. Ranya Habash, MD http://www.mhealthnews.com/blog/time-little-telehealth-trivia A Brief History of NASA’s Contributions to Telemedicine. August 16, 2013.http://www.nasa.gov/content/a-brief-history-of-nasa-s-contributions-to-telemedicine/#.VmCZS63lvcs

TELEMEDICINE: Managing the Risks of Virtual Healthcare5

Page 6: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

TELEMEDICINE DEFINED

American Telemedicine Association– “The use of medical information exchanged from one site to another

via electronic communications to improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology.”

Centers for Medicare & Medicaid Services– “Professional services given to a patient through an interactive

telecommunications system by a practitioner at a distant site.”

State definition(s)– Complex and still evolving

(continued)

TELEMEDICINE: Managing the Risks of Virtual Healthcare6

Page 7: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

7 TELEMEDICINE: Managing the Risks of Virtual Healthcare

Page 8: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

ADVANTAGES AND BENEFITS

Increases direct access to medical care– Distance barriers eliminated–travel avoided– Decreased delay for specialty referrals and testing– Remote areas receive current techniques sooner

Improves patient safety and outcomes– Reduction in morbidity and mortality

Reduces costs, grows revenue, drives efficiency– Permits shared staffing at different locations

Improves patient convenience– Studies demonstrate enhanced patient satisfaction

Source: The Empirical Foundations of Telemedicine Interventions for Chronic Disease Managementwww.ncbi.nlm.nih.gov/pmc/articles/PMC4148063/ Telemed J E Health. 2014 Sep 1; 20(9): 769–800.

TELEMEDICINE: Managing the Risks of Virtual Healthcare8

Page 9: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

TYPES OF TELEMEDICINE

Store-and-forward (asynchronous)– Acquires data (e.g., images) and transmits for later review– Physician and patient not “present” together– Provider relies on history–no physical exam

Remote monitoring– Utilizes technology devices (e.g., blood pressure, glucose, heart rate)– Manages chronic conditions (e.g., heart disease, diabetes)– Usually comparable outcomes to in-person visits– May improve patient satisfaction and cost effectiveness

Source: Coverage of and Payment for Telemedicine. (Reference Committee A) American Medical Association. 2014.www.jonesday.com/files/upload/AMA%20Policy%20on%20Telehealth%20(June%202014).PDF

TELEMEDICINE: Managing the Risks of Virtual Healthcare9

Page 10: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

TYPES OF TELEMEDICINE

Real-time interactive (synchronous) – Broad spectrum of platforms and models– Includes telephone, video, and online communication– Similar advantages to in-office visit– More cost and time efficient than in-office visit– Peripheral devices can aid in conducting an

interactive examination– May or may not include a telepresenter (with the patient)

Source: Coverage of and Payment for Telemedicine. (Reference Committee A). American Medical Association. 2014.www.jonesday.com/files/upload/AMA%20Policy%20on%20Telehealth%20(June%202014).PDF What is Telemedicine? www.icucare.com/PageFiles/Telemedicine.pdf Accessed December 3, 2015

(continued)

TELEMEDICINE: Managing the Risks of Virtual Healthcare10

Page 11: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

EVOLUTIONARY FORCES

Massive new private investment since 2007

Increased numbers of patients with healthcare insurance

Shortage of physicians and advanced practice providers

1.3 billion walk-in visits per year

Preference for online video visit over office visit

Sources: Time for a little telehealth trivia. June 12, 2015. Ranya Habash, MD www.mhealthnews.com/blog/time-little-telehealth-triviaDesigning the Consumer-Telehealth & eVisit Experience. White Paper prepared for ONC/HIT USDHHS www.healthit.gov/sites/default/files/DesigningConsumerCenteredTelehealtheVisit-ONC-WHITEPAPER-2015V2edits.pdf EngagedIn.com . Kyra Bobinet, MD MPH, John Petito, MS. 2015.Telemedicine puts a doctor virtually at your bedside. www.pbs.org/newshour/bb/telemedicine-puts-doctor-virtually-bedside/ July 13, 2015. PBS video.

TELEMEDICINE: Managing the Risks of Virtual Healthcare11

Page 12: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

EVOLUTIONARY FORCES

Reimbursement and coverage increasing

$27B industry in 2015 and growing

Direct to consumer model

Grooming of consumer expectations

(continued)

TELEMEDICINE: Managing the Risks of Virtual Healthcare12

Page 13: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

STANDARDS AND GUIDELINES Centers for Medicare and Medicaid Services

The Joint Commission

DNV Healthcare Inc.

American Medical Association

American Telemedicine Association

Federation of State Medical Boards

State Medical Boards

Medical societies

14 TELEMEDICINE: Managing the Risks of Virtual Healthcare

Page 14: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

HOW IS YOUR FACILITY UTILIZING TELEMEDICINE?

Radiology

Cardiology

Behavioral Health

Pediatrics

Neurology

Pathology

Dermatology

Chronic disease monitoring/management

Emergency care/intervention

Other – home health, dentistry, schools, prisons, etc.

15 TELEMEDICINE: Managing the Risks of Virtual Healthcare

Page 15: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

TELEMEDICINE IN GEORIGA

2005: One of the first in the nation to require reimbursement from private payers for telemedicine visits via the Georgia Telemedicine Act. O.C.G.A. 33-24-56.4

2014: Practice Through Electronic or Other Such Means is found under the Georgia Composite Rules and Regulations, rule 360-3-.07 and established minimum standards of practice while providing treatment and/or consultation recommendations through the use of telemedicine.

16 TELEMEDICINE: Managing the Risks of Virtual Healthcare

Page 16: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

O.C.G.A. 33-24-56.4GEORGIA TELEMEDICINE ACT

“Telemedicine” means the practice, by a duly licensed physician or other health care provider acting within the scope

of such provider’s practice, of health care delivery, diagnosis, consultation, treatment, or transfer of medical data by means of audio, video, or data communications

which are used during a medical visit with a patient or which are used to transfer medical data obtained during a medical

visit with a patient. Standard telephone, facsimile transmissions, unsecured electronic mail, or a combination

thereof do not constitute telemedicine services.

17 TELEMEDICINE: Managing the Risks of Virtual Healthcare

Page 17: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

360-3-.07PRACTICE THROUGH ELECTRONIC

OR OTHER MEANS Georgia license required

In-person examination

Patient records

NPs and PAs

Annual in-person exam

Clear follow up instructions and provider contact information

No prescribing of controlled substances

Standard of Care

18 TELEMEDICINE: Managing the Risks of Virtual Healthcare

Page 18: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

WHERE ARE THE RISKS?

Page 19: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

MALPRACTICE CASES

Not many cases to draw from yet.

With sharp increases in direct to consumer encounters and clinical care of stroke patients, dermatology, and cardiac patients, an increase in malpractice claims is expected.

TELEMEDICINE: Managing the Risks of Virtual Healthcare20

Page 20: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

LICENSING RISKS

Practice intra-state– No licensing issue– Professional liability–standard of care met

What if Georgia license, patient now located outside of state– Scope of practice generally determined by location of patient– Significant variation among jurisdictions

Out-of-state physicians practicing telemedicine must know local state law

TELEMEDICINE: Managing the Risks of Virtual Healthcare21

Page 21: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

LICENSING RISKS

Violations carry many potential adverse consequences– Unlawful practice may result in criminal prosecution

– Medical board action → mandatory National Practitioner Data Bank report

– Lawsuit filed in other jurisdiction– if tort reform where suit is filed, may be issues if provider not licensed in that state

– Medical professional liability policy – may specify that claim must arise in covered territory

TELEMEDICINE: Managing the Risks of Virtual Healthcare22

(continued)

Page 22: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

DO YOU KNOW WHERE YOUR PHYSICIANS ARE?

Doctor on Demand

HealthTap

HelloMD

LiveHealth Online

Microsoft HealthVault

Pillpack

PingMD

RevUP by MD Revolution

Text4Baby

Vida Health Coach

23 TELEMEDICINE: Managing the Risks of Virtual Healthcare

Source: 10 Apps That Are Changing Healthcare. Feb 11 2105. Jill Duffy. www.pcmag.com/article2/0,2817,2476623,00.asp

Page 23: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

PRIVACY AND SECURITY RISKS

Health Insurance Portability and Accountability Act (HIPAA)– Privacy Rule regulates use and disclosure of Protected Health

Information (PHI)

– Security Rule sets national standards for security of electronic PHI

Source: Health Information Privacy. http://www.hhs.gov/ocr/privacy/index.html

TELEMEDICINE: Managing the Risks of Virtual Healthcare24

Page 24: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

PRIVACY AND SECURITY RISKS

American Recovery and Reinvestment Act of 2009–Title XIII, Health Information Technology for Economic and Clinical Health Act (HIPAA/HITECH)– Breach Notification Rule requires covered entities and business

associates to provide notification following a breach of unsecuredprotected health information

– Office of Civil Rights audits

– Enhanced penalties ($$ billions) for breaches of unsecured PHI and media notification for large scale breaches

Source: Health Information Privacy. www.hhs.gov/ocr/privacy/index.html

(continued)

TELEMEDICINE: Managing the Risks of Virtual Healthcare25

Page 25: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

PATIENT RELATIONSHIP RISKS

Telemedicine challenges the traditional physician-patient relationship.

Is it authentically formed?– Can you verify and authenticate the location and

identity of the patient?

– Are the provider’s identity and applicable credential(s) disclosed to the patient?

– Is appropriate disclosure and consent obtained?

Source: Report of the State Medical Boards’ Appropriate Regulation of Telemedicine (SMART) Workgroup www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/FSMB_Telemedicine_Policy.pdf Federation of State Medical Boards. 2014.

TELEMEDICINE: Managing the Risks of Virtual Healthcare26

Page 26: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

Physical exam challenges

– Increased risk of diagnostic error

– Very dependent on technology, Internet service, and equipment,over which provider has no control

Source: Report of the State Medical Boards’ Appropriate Regulation of Telemedicine (SMART) Workgroup https://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/FSMB_Telemedicine_Policy.pdf Federation of State Medical Boards. 2014.

(continued)

TELEMEDICINE: Managing the Risks of Virtual Healthcare27

PATIENT RELATIONSHIP RISKS

Page 27: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

TREATMENT AND PRESCRIBING RISKS

Treatment delivered online should be held to the samestandard of care as treatment delivered in person

Treatment, including issuing a prescription based solely on an online questionnaire, does not constitutean acceptable standard of care

Source: Report of the State Medical Boards’ Appropriate Regulation of Telemedicine (SMART) Workgroup www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/FSMB_Telemedicine_Policy.pdf Federation of State Medical Boards. 2014.

TELEMEDICINE: Managing the Risks of Virtual Healthcare28

Page 28: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

OTHER RISKS

Continuity of care– Integration of data back to the primary health record is needed to

avoid fragmenting care and potentially impacting patient safety

– Lot of healthy people in their 20s, 30s and even 40s have not felt a need to see a doctor and, thus, have never developed a relationship with a primary care provider

– Access and ability to retrieve personal health information via patient portal or access code for established physician or specialist

– Protocols for emergency services referrals

TELEMEDICINE: Managing the Risks of Virtual Healthcare29

Page 29: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

OTHER RISKS

Telepresenter– Qualifications, license, or certification

– Scope of practice

– Vicarious liability

– Supervisory obligations

Fraud and Abuse– Anti-kickback

– Stark

– False Claims

(continued)

TELEMEDICINE: Managing the Risks of Virtual Healthcare30

Page 30: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

STARTING POINT

In what states will the involved health care providers, patients, and any related technologies be located?

What types of health care practitioners will be participating in the activity at both the provider’s location and the patient’s location?

What types of facilities will be involved in the activity?

What types of reimbursement will be sought for the service?

Does the activity involve any tope of remote prescribing or dispensing of pharmaceuticals?

How can malpractice, liability, and fraud and abuse risks be minimized?

31 TELEMEDICINE: Managing the Risks of Virtual Healthcare

Page 31: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

WHAT ARE THE STRATEGIES?

Page 32: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

STRATEGIESTO REDUCE RISKS

Licensing – Physicians and other healthcare

professionals must be licensed in state wherepatient resides

– Be aware of what is allowed and under whatcircumstances telemedicine is permitted in thestate where the patient is located

– Abide by state medical practice act requirements–especially documentation

– Communicate practice changes to your insurance agent/broker and carrier

TELEMEDICINE: Managing the Risks of Virtual Healthcare33

Page 33: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

STRATEGIESTO REDUCE RISKS

Privacy and security – Understand how Web-based portals send encryption keys so that

hackers can’t access the stream and decrypt the conversation

– Use mechanisms to protect the privacy of individuals who do not want to be seen on camera

– Leverage unique user identities, including user names and passwords

– Establish authenticated and role-based access at both the physical and information technology level

(continued)

TELEMEDICINE: Managing the Risks of Virtual Healthcare34

Page 34: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

STRATEGIESTO REDUCE RISKS

Multiple physicians– Develop processes to assist in clarifying who

actually has control over the care of the patient.

Patient abandonment– Establish clear communication among providers and with patient

Physician-patient relationship– Develop a method to ensure that the patient is

who he/she claims to be Source: Report of the State Medical Boards’ Appropriate Regulation of Telemedicine (SMART) Workgroup www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/FSMB_Telemedicine_Policy.pdf Federation of State Medical Boards. 2014.Direct-to-Consumer Telemedicine: Has its time come? http://chealthblog.connectedhealth.org/page/4/ Joseph Kvedar, MD. April 10, 2014.

(continued)

TELEMEDICINE: Managing the Risks of Virtual Healthcare35

Page 35: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

STRATEGIESTO REDUCE RISKS

Physician-patient relationship (continued)

– Documented informed consent should include:

• Identity of the patient, the healthcare professional,and his/her credentials

• Patient acknowledgement and expressed “understanding that theonline interaction is problem specific and may carry risks, particularlyfor omission of care involving other health problems”

• Types of transmissions permitted using telemedicine technologies(e.g., prescription, appointment scheduling, patient education)

Source: Report of the State Medical Boards’ Appropriate Regulation of Telemedicine (SMART) Workgroup www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/FSMB_Telemedicine_Policy.pdf Federation of State Medical Boards. 2014.Direct-to-Consumer Telemedicine: Has its time come? http://chealthblog.connectedhealth.org/page/4/ Joseph Kvedar, MD. April 10, 2014.

(continued)

TELEMEDICINE: Managing the Risks of Virtual Healthcare36

Page 36: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

STRATEGIESTO REDUCE RISKS

Physician-patient relationship (continued)

– Documented informed consent should include:

• Agreement that healthcare professional determineswhether or not condition being diagnosed and/or treated is appropriate for a telemedicine encounter

• Security measures such as encryption, password protection,and other technology authentication techniques

• Hold harmless clause for technical failures

• Permission to forward patient information to a third party

Source: Report of the State Medical Boards’ Appropriate Regulation of Telemedicine (SMART) Workgroup www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/FSMB_Telemedicine_Policy.pdf Federation of State Medical Boards. 2014.

(continued)

TELEMEDICINE: Managing the Risks of Virtual Healthcare37

Page 37: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

STRATEGIESTO REDUCE RISKS

Prescribing– Follow state requirements and standard of care

– Prescribing is at the professional discretion of the physician

(continued)

Source: Report of the State Medical Boards’ Appropriate Regulation of Telemedicine (SMART) Workgroup www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/FSMB_Telemedicine_Policy.pdf Federation of State Medical Boards. 2014.

TELEMEDICINE: Managing the Risks of Virtual Healthcare38

Page 38: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

STRATEGIESTO REDUCE RISKS

Continuity of care– Make arrangements for access to follow-up care

– Make record available to patient and your designee in your absence

Use of telepresenter and/or advanced practice provider– Address qualifications and scope of practice

– Fulfill any supervisory obligations

(continued)

Source: Report of the State Medical Boards’ Appropriate Regulation of Telemedicine (SMART) Workgroup www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/FSMB_Telemedicine_Policy.pdf Federation of State Medical Boards. 2014.

TELEMEDICINE: Managing the Risks of Virtual Healthcare39

Page 39: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

FINAL RECOMMENDATIONS

Ensure that providers and staff are properly trained to use telemedicine equipment, technology, or software

Become familiar with the established malpractice issues for traditional medical encounters that are most similar to the telemedicine activity in question

Create procedures at the onset of the telemedicine project to ensure proper creation and termination of the physician-patient relationship, continuity of care, coordination of care, and ultimate responsibility over the patient among multiple providers and facilities

Keep a list of the relevant state laws or professional standards of care that create heighten requirements for your particular telemedicine activity.

40 TELEMEDICINE: Managing the Risks of Virtual Healthcare

Page 40: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

FINAL RECOMMENDATIONS

Verify that your malpractice carrier covers the telemedicine act in question

Be critical of any arrangement in which telemedicine equipment, software, or services are provided free of charge

Do not assume that the federal antikickback and Stark laws are more rigorous than any similar, applicable state laws prohibiting patient solicitation or referral conflicts of interest.

41 TELEMEDICINE: Managing the Risks of Virtual Healthcare

(continued)

Page 41: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

CONCLUSION

Telemedicine is a tool for delivering healthcare, not a separate form of medicine

Remember that good communication is the foundation for a successful telemedicine program.

Sources: Practicing Medicine Through Telehealth Technology. http://www.mbc.ca.gov/Licensees/Telehealth.aspx. The Medical Board of CaliforniaSafe Telemedicine Principles http://ctel.org/wp-content/uploads/2014/10/CTeL-Telemedicine-Medicine-Principles-1.0.pdf Center for Telemedicine and eHealth Law

TELEMEDICINE: Managing the Risks of Virtual Healthcare42

Page 42: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

RESOURCES

Medical specialty societies and state medical board(s)

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy, Security and Breach Notification Rules(www.hhs.gov/ocr/privacy/)

American Telemedicine Association (http://www.americantelemed.org/home)

– Practice Guidelines; State Telemedicine Gaps Analysis: Physician Practice Standards and Licensure; Coverage and Reimbursement; FAQs

Center for Connected Health Policy (http://cchpca.org/)

– Customizable search of state laws and reimbursement policies

TELEMEDICINE: Managing the Risks of Virtual Healthcare43

Page 43: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

RESOURCES

Center for Telehealth and e-Health Law (ctel.org/) – Research Library

Federation of State Medical Boards – Model Policy for the Appropriate Use of Telemedicine Technologies

in the Practice of Medicine www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/FSMB_Telemedicine_Policy.pdf

The Doctors Company Knowledge Center (Patient Safety) – Example informed consent forms– Electronic Health Record and Telemedicine Resource Center

www.thedoctors.com/KnowledgeCenter/EHRandTelemedicine/ehr-and-telemedicine

TELEMEDICINE: Managing the Risks of Virtual Healthcare44

(continued)

Page 44: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

GEORGIA RESOURCESAND REFERENCES

Georgia Partnership for Telehealth http://www.gatelehealth.org/georgia-partnership-for-telehealth/

Georgia Composite Medical Board http://medicalboard.georgia.gov/

45 TELEMEDICINE: Managing the Risks of Virtual Healthcare

Page 45: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

Contact Information

46 TELEMEDICINE: Managing the Risks of Virtual Healthcare

Amy Wasdin, RN, MBA, CPHRMPatient Safety Risk Manager II, SE Region

Department of Patient Safety and Risk [email protected](800) 421-2368, ext. 6728

Patient Safety and Risk Management, [email protected]

Additional resources and activities please visitwww.thedoctors.com

Page 46: TELEMEDICINE: Managing the Risks of Virtual Healthcare · TELEMEDICINE: Managing the Risks of Virtual Healthcare Amy Wasdin, RN, MBA, CPHRM ... Managing the Risks of Virtual Healthcare

THANK YOUWe relentlessly defend, protect, and reward

the practice of good medicine.