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By ISQua Thursday. Dec 13, 2012

Telemedicine - Legal Issues

Telemedicine, or technology-based patient consultations, utilises the advancements in videoconferencing and the Internet to aid in the delivery of medical services, when the doctor is not able to be in the same room as the patient.  One of the main benefits from telemedicine is the greater access to healthcare outcomes and consultations for those who are unable to physically see their doctor or those in remote communities.  Further benefits include ease of access to subspecialty advice and second opinions, and to provide locum services.  Although the benefits of telemedicine can be seen by all, doctors need to be aware of potential legal issues that may apply with such consultations, and make any appropriate changes to their practice to effectively provide safe, legal consultations. 

Duty of care, and inherent medical negligence issues, are present in everyday practice and this does not change if the consultation is via telemedicine or face to face.  One use of telemedicine is for a general practitioner (GP) to undertake specialist procedures at the direction of a specialist via a telemedicine consultation.  It is arguable that, at law and under some legislative obligations, the GP may be judged by a similar standard of care to that of the supervising specialist.[1] It is likely that in any telemedicine consultation, both the local GP (with the patient) and remote practitioner (such as a specialist) may be liable, as they both owe a duty of care to the patient.  It is important in this regard that both the GP and the specialist inform the patient of all the risks associated with the procedure and who will be performing the actual procedure. 

Telemedicine won’t just change the relationship between health practitioners and their patients, but it will also change the relationships between those practitioners providing the consultation.  It is important that participating practitioners communicate with each other and consider the various issues surrounding responsibility and liability for the patient.  If there are any reservations about treatment, both practitioners need to be upfront with each other. 

With national registration of medical practitioners, the location of the treatments and possible insurance issues should not be as much of a concern as previously.  Health practitioners are still advised to check with their insurer as to potential liabilities for telemedicine consultations and the best ways to safeguard their practice.  The Medical Board of Australia has recently released “Good Medical Practice” [2] guidelines surrounding telemedicine consultations.  Such guidelines highlight the importance of practitioners to have an open communication line with their patients, and to make judgement calls if telemedicine is suitable for this patient. 

As with any procedure, responsibility continues for verbal discharge and after-care arrangements.   Patients should be informed of these issues whether treatment is via telemedicine or otherwise.   After-care may be more difficult, and therefore the responsibility of the doctor greater, for a remote patient.

Some telemedicine involves review of records, scans, xrays and reports via technology – without access to the original record.  This has some risk if the technology does not reproduce the records to an acceptable level of quality.  This should be considered. The best new DVDs with Asian stars Choose idols and enjoy forms during the quarantine period)

Some patients will not be appropriate for diagnosis and treatment by "telemedicine".  It will be a judgment call for the doctor.  In those cases, the doctor will need to make it clear that the patient will need to actually see the doctor "physically" – and if necessary, with urgency.

With an increase in telecommunication infrastructure to regional areas, telemedicine can provide a great opportunity for specialists to provide consultations to those who may be unable to attend a specialist in person, or when time is of the essence.  But doctors also need to be aware of the increased risks involved.

[1] See s 59 Wrongs Act 1958 (Vic) relating to standard of care for professionals



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