WHAT IS TELEMEDICINE?
Telemedicine is the practice of using telecommunications technology to deliver enhanced medical care by allowing physicians to observe patients and patient data from different locations. There are currently a variety of telemedicine systems being used across the United States. These systems can encompass anything from a fax machine to sophisticated two-way audiovisual communication systems. Telemedicine has also developed to incorporate both “store-and-forward” and real time data transmission. Over the past several years, telemedicine has grown into a multi-billion dollar industry. It is likely that telemedicine will continue to grow, especially in rural areas. However, some important legal issues may be significant obstacles.
HOW IS TELEMEDICINE BEING USED?
Telemedicine is currently being used both in the United States and abroad for a variety of functions in the health care industry. One of the primary uses of telemedicine is providing health care services to isolated rural areas. For example, the Medical College of Georgia uses a sophisticated interactive television system with electronic medical equipment, cameras, and sensors to allow consulting physicians to examine and advise patients in rural areas. Telemedicine systems are also currently being used to provide continuing medical education to providers.
More radical uses of telemedicine have also been attempted on an experimental basis, and may be promising fields of future growth. For example, physicians have conducted surgeries remotely through the use of robotics. Furthermore, there have been government-sponsored programs involving the installation of telemedical equipment in the homes of home care patients.
LEGAL ISSUES IN TELEMEDICINE
Telemedicine faces several significant legal challenges. These issues include licensure and accreditation issues, malpractice issues, and insurance issues. Licensure is particularly problematic for telemedicine providers because medical licensure is governed by the states. Since licensure is a source of revenue for the states, proposals to nationalize licensure or to provide for multi-state licensure have been controversial.
Malpractice issues can also be significant. Although there is some question about whether certain types of telemedicine can constitute a physician-patient relationship, there is a significant likelihood that telemedical consults can expose physicians to additional liability. Since the ability to examine a patient is limited in a telemedicine consultation, this risk may become a serious legal issue. Finally, both professional liability and health insurers have typically not included telemedicine practice in their policies. As a result, many insurers are unlikely to pay for telemedical consults.
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