Clinicians may have concerns with telehealth models of care for many reasons. These include the;
- lack of physical examination by specialists
- reliance on the ability of a rural-based clinician to continue care
- physical distance
- non-traditional forms of doctor-patient communication used during consultations.
Many of the legal concerns that clinicians may have about using telehealth for clinical reviews can be overcome through greater familiarity with the telehealth process. This includes following recommended practices, building the telehealth capacity of the rural health workforce and following the principles of evidence based clinical care.
There have been no reported medico-legal cases involving telehealth. A qualitative study of ethical, medico-legal and clinical governance matters in Australian telehealth services reported the following findings:
- Telehealth was beneficial in reducing adverse events, improving health outcomes and offering increased patient choice of service delivery.
- There were some problems with privacy and security and variable informed consent practices.
- No examples of malpractice were raised.
- Potential ethical, medico-legal and governance problems were easily managed within the practice.
The Medical Board of Australia and the Australian College of Rural and Remote Medicine have endorsed telehealth models of care by developing standards and guidelines. These guidelines complement good clinical practice with a specific focus on technology-based care. The focus of these guidelines is on selecting the appropriate patient, consent, documentation and the setup of telehealth systems. A number of Australian medical colleges have also published documents to support their members who wish to use telehealth, including comments on medico-legal aspects:
Medical indemnity organisations in Australia also provide advice to practitioners regarding Medicare requirements, documentation, patient follow-up, technology issues, communication and consent, direct video consultations and risk management advice.
It is important for clinicians to be familiar with the principles of good clinical practice along with specific guidelines from various jurisdictions on technology based consultations.
Asking for consent, communication with patients and members of the multidisciplinary team, documentation and plans for continuity of care will avoid most medico-legal problems.
In addition to providing evidence-based care, ethical issues can emerge when using telehealth models of care. Clear communication is essential for ensuring that the patient and individual team member are aware of who is responsible for managing which aspect of the patient's care. Agreeing on and documenting these responsibilities ensures that clinicians who are geographically separated take responsibility for ensuring the patient's continuity of care.
It is preferable to follow the regional and jurisdictional referral pathways to optimise communication between clinicians and prevent fragmented care.
It is beneficial to clarify the indemnity arrangements when service is provided across jurisdictions.
- Wade VA, Eliott JA, Hiller JE. A qualitative study of ethical, medico-legal and clinical governance matters in Australian telehealth services. J Telemed Telecare 2012 Mar;18(2):109-14 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22267306.
- Sabesan S, Allen D, Loh PK, Caldwell P, Mozer R, Komesaroff PA, et al. Practical aspects of telehealth: are my patients suited to telehealth? Intern Med J 2013 May;43(5):581-4 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23668268.
- Allen DT, Caldwell P, Komesaroff PA, Loh PK, Mozer R, Sabesan S, et al. Practical aspects of telehealth: set-up and preparation for video consultations. Intern Med J 2013 Oct;43(10):1133-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/24134169.
- Sabesan S, Allen D, Caldwell P, Loh PK, Mozer R, Komesaroff PA, et al. Practical aspects of telehealth: doctor-patient relationship and communication. Intern Med J 2014 Jan;44(1):101-3 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/24450527.