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As online medical technology spreads - seemingly limited only by cost,
health-care cutbacks, or technological questions of available bandwidth
- challenging issues of patient privacy and liability follow in its
trail, writes Melanie Egan.
One of the pioneers of telemedicine in this country, John Mitchell,
managing director of John Mitchell and Associates, is involved in
a range of initiatives, including aged care using telemedicine in
Victoria, diabetic and renal telemedicine between South Australia
and the Northern Territory.
He identifies problem areas as "privacy and confidentiality,
professional liability, ethical standards, fee payment, and legal
issues".
"Concerns of patient privacy centre on the environment in
which the equipment is located so that it maintains patient and
client privacy," said Mitchell. It is also important, he said,
"processes are in place for storage and ownership of medical
information obtained via telemedicine, and video taping and the
storage of video tapes."
Protocols to protect the confidentiality of private health information,
need to be developed, he said, and "with specific additions
for some applications".
Diagnostic errors are generally the largest category of malpractice
claims. In an ever-more litigious society, and with the presenters
of current affairs programs waiting like vultures for good doctors
to make bad decisions, it seems that health-care professionals increasingly
need to practice defensive medicine.
Liability issues are raised, said Mitchell, in the context as to
whether medical decision-making using telemedicine is as reliable
as face-to-face contact. He refers, however, to precedents where
the risk of legal action is lower where the practitioner maintains
an advisory role rather than a patient-doctor relationship.
The electronic broadcast of a medical or video teleconferencing
changes the nature of the doctor-patient relationship. Mitchell
suggests each telemedicine application involving clinical care should
provide care to the same standard, of ‘best practice’,
as in a face-to-face situation.
The fees issue mainly relates to medical practitioners. At present,
Medicare provides a medical benefit for a service provided by a
medical practitioner to a patient in the same location. There is
no fee structure for a telemedicine consultation.
Most applications are within the public health system and do not
require reimbursement. But payment becomes an issue when private
practitioners are involved, Mitchell said.
"The issue of fee payment is complex, involving control over
the extent of utilisation and level of health care expenditure."
It may become more complicated as the government renegotiates the
Medicare agreement next year.
Legal issues such as licensing and accreditation "arise when
telemedicine applications involve a practitioner providing clinical
care to a person in another state, where the practitioner is not
registered", said Mitchell. In the US, where this question
is an ongoing debate, the American Medical Association has recommended
that the state medical boards promote full and unrestricted licensure
for physicians who wish to practise telemedicine across state lines.
In Australia, however, all states recognise most professional registrations
without re-examination, he said.
Excerpts from article written by Melanie Egan and published in
Medical Imaging & Monitoring, May 1997, pp. 24-25.
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