Page 26 - Telemedicine - Essentials of Virtual Care Delivery Part Two

SVMIC Telemedicine: Essentials of Virtual Care Delivery

So far, there are relatively few reports of medical malpractice

cases related to telemedicine. This is somewhat a matter
of volume but is also the case because the early adopters

of telemedicine have been, for the most part, conservative
regarding the kinds of cases they consider appropriate for

remote management. Careful fallback and backup options
have been built into most published trials. Screening out high-

risk patients tends to limit the severity of injuries that might
result from e-misadventures. Lower severity claims may skew

obtainable data by excluding settlements which do not reach
the threshold for reporting. Moreover, higher-risk patients

tend to be managed by high-capability systems, with detailed
guidelines and documentation. These and other factors bias the

outcome data from telemedical practices in a positive direction
and may limit the visibility of adverse occurrences.

Misdiagnosis and treatment failures in telemedicine are

currently thought to be comparable to rates for traditional office
visits. One study found a higher rate of antibiotic prescribing

(for sinusitis) in e-visits than office visits and a lower rate of
urinalysis (for UTI). Like outcome data in any ambulatory
9
setting, it is difficult to know what findings can be generalized.

Liability allegations arising from telemedicine are largely going

to be the same as the common exposures for each specialty.
In general, the principle of “parity” means that the same

standards for acceptable practice apply to virtual visits that
would apply in-person. However, there are some twists that

need to be considered when treating patients at a distance.
Many are related to the functions of technology; some arise

9 Mehrotra A, Paone S and Martich D. 2013. A comparison of care at e-visits and physician office
visits for sinusitis and urinary tract infection. JAMA Intern Med 173:72-74.

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