Monday, November 30, 2009

Standards of Care - Key to Telemedicine’s Growth

ATA recently announced new telemental health practice guidelines. Such guidelines and associated efforts to create Standards of Care for telemedicine are important from several perspectives:

Payer Acceptance

Private insurers, employers sponsoring their own employee health insurance plans, government agencies and consumers are all payers of health care. A commonly expressed concern by many payers is that telemedicine is still an unproven practice and needs additional time and research before being considered for payment. Interestingly, such views are not as strong in closed systems such as the VA or in countries with socialized medicine. The real fear is uncontrolled spending, fraud and abuse.

The development of practice guidelines can help payers control utilization as well as assuring a degree of uniformity in the delivery of telemedicine. ATA has been contacted by a couple of payer organization about our progress in developing practice guidelines.

Avoiding Legal Negligence

According to law (and Wikipedia) the standard of care is the degree of prudence and caution required of an individual who is under a duty of care. A breach of the standard is necessary for a successful action for negligence. For medicine, a standard of care is a medical or psychological treatment guideline, and can be general or specific. It specifies appropriate treatment based on scientific evidence and collaboration between medical and/or psychological professionals involved in the treatment of a given condition. The legal standard of care for medicine varies from state to state, but the further use of telemedicine may result in national standards of care, at least for the most common uses.

Recently, a law suit was filed against a hospital for negligence for NOT using teleradiology. In this and a similar case, the suit claimed that patient was harmed because the hospital failed to use teleradiology to provide imaging services. The suits claimed that, because of the widespread use of teleradiology by many hospitals, the lack of access to a radiologist violated the established “standard of care.” While the cases were all settled out of court, the point has been made and hospitals everywhere should be considering such use to avoid a similar legal challenge in the future.

The development of practice guidelines for telemedicine applications, especially those accompanied by a documentation of empirical evidence, moves us closer to having that application recognized by medicine, and by the law, as a standard of care. Certainly the existence of practice guidelines alone is not sufficient proof of the existence of a standard of care. But it certainly places one more stake in the ground. If such practice guidelines are also endorsed by the relevant medical society, it goes a long way in establishing the legitimacy of such use.

Regional and Worldwide Partnerships in the Delivery of Health Care

Health care delivery in America is still largely local, or at least regional. Internationally, health care delivery is mostly confined to the boundaries of the country. Physician shortages, increased costs and global travel are setting the stage for a shift in how care is delivered. Practice guidelines will help assure that no matter who is providing care in whatever location, there will be uniformity in the care delivered. It will also allow new forms of partnerships between various healthcare providers and payers.