Telemedicine in the 90's

In reviewing our early risk management newsletters, I stumbled upon the fact that PRMS’ risk managers have been writing on the topic of telemedicine since 1998! The Fall 1998 issue of our risk management newsletter contained an article titled “ Telemedicine: The Next Generation of Care?” So for a “Throwback Thursday” post, I thought I would review what my colleagues had to say on the subject that long ago.

This article was written before I joined PRMS, but the fact that it was written goes to show that we’ve always taken our role of professional liability trend spotter very seriously. With hindsight vision, let’s see how accurate they were. They opined that the major issues surrounding telemedicine were:

– Reimbursement, specifically lack thereof

– Lack of insurance company reimbursement is currently still a barrier to telemedicine 16 years later. However, Medicare is providing reimbursement in limited circumstances, such as in rural areas.

– Licensure

– At the time the article was written, national licensure standards seemed to hold more promise than today. Licensing boards are unanimous in the position that services are rendered in the state where the patient is physically located. Today all state medical and osteopathic boards require some type of licensure (full license, special telemedicine license) or registration for out-of-state licensed physicians to treat patients in their states.

– Privacy and confidentiality

– My colleagues were spot-on in terms of identifying confidentiality as a significant issue in telemedicine. They even noted back in 1998 that under HIPAA (enacted two years prior), HHS was “to make detailed recommendations to Congress with respect to the privacy of individually identifiable health information.” Of course we have those recommendations today – the regulations known as the Privacy Rule and the Security Rule.

– Liability

– My colleagues noted “the extent of liability is largely unknown at this time, because there is a lack of relevant statutory or case law.” This still remains true today. There is a paucity of reported cases involving telemedicine, and even fewer for telepsychiatry. My colleagues also provided steps to minimize the risk, and they are remarkably similar to the advice we give today.

Overall I think my colleagues did a great job in spotting the issues and providing advice to minimize the risk associated with those issues.

I did chuckle when I saw the adjacent article on “The Year 2000 Problem.” For those of you old enough to have been worried about Y2K, I know you were as relieved as I was that it did not cause the technology shutdown that was predicted!

Donna Vanderpool, MBA, JD – Vice PresidentAs Vice President of Risk Management, Ms. Vanderpool is responsible for the development and implementation of PRMS’s risk management services for The Psychiatrists’ Program. Ms. Vanderpool has developed expertise in the areas of HIPAA and forensic practice, and has consulted, written and spoken nationally on these and other healthcare law and risk management topics. She most recently wrote a chapter concerning the risks of harm to forensic experts for Robert L. Sadoff, MD’s book Ethical Issues in Forensic Psychiatry: Minimizing Harm, (Feb. 2011/Wiley). Ms. Vanderpool received her undergraduate degree from James Madison University, and her MBA and JD from George Mason University. Prior to joining PRMS in 2000, Ms. Vanderpool practiced criminal defense law, taught business and legal courses as an adjunct faculty member at a community college and spent eight years managing a general surgical practice in Virginia.

This blog has also been cross-posted on LinkedIn.

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