Telemedicine – is there a trade off between quality and convenience?
Telemedicine has opened up greater access and choice of care for millions of Americans. As a supplement to in-person health visits telemedicine has many benefits but there are concerns that this might come at the expense of the quality of care - increasing the risk of dissatisfied patients and litigation against both healthcare providers that offer remote services and the technology companies that make these services possible.
According to an estimate by IHS Markit, there will be 46 million remote consultations conducted in the US by 2020 as telemedicine moves from the periphery into the mainstream.
The main driver comes from the convenience it provides for patients. With Accenture's 2018 Digital Health Consumer Survey highlighting that 47% of patients would opt for a remote consultation if it meant seeing a doctor sooner.
The challenge for healthcare providers that have adopted telemedicine lies in using technology in a way which meets demand for more convenient healthcare without compromising on care or risk management.
The often cited argument is that without an in-person relationship the medical professional may be unable to make a full and accurate diagnosis - the physical distance prevents the professional from being able to see and treat the whole person. As a consequence, the effect of telemedicine is to reduce medical interactions to the treatment of individual symptoms. This has led critics to argue this does not amount to effective patient care and increases the risk of misdiagnosis.
One study conducted by the Journal of the American Medical Association (JAMA) on tele-dermatology in 2016 highlighted the risks of misdiagnosis in remote consultation. Researchers posed as patients with prepared medical histories and various skin conditions.
A diagnosis was provided in 77% of presented cases but the study was critical of the quality of care with many diagnoses being "proffered without reasonable attempts to ask basic medical history follow-up questions". Often they were conducted on the basis of a single photo shared by the patient. Worryingly in three cases the doctors advised the patient that their nodular melanoma, an aggressive skin cancer, was benign.
This challenge is not unique to telemedicine. Misdiagnosis through a lack of appropriate interrogation of the symptoms can also occur in in-person healthcare.
Whereas in traditional settings of care the doctor is reliant on their skill and knowledge, the introduction of technology increases the risk of a lawsuit. Where a diagnosis hinges on a single electronic image taken by the patient the medical professional needs to be confident that it is of sufficient quality to make a diagnosis, or where the patient is using equipment to send data, such as blood sugar or heart rate, that the equipment is fully functional and being used appropriately.
The plaintiffs' bar is well aware of the potential for misdiagnosis. Many are quoting the outcome of the JAMA study to advertise for patients. Those medical professionals who use telemedicine should discuss their existing coverages with their insurance agent to ensure they are adequately covered. By working with trusted partners to evaluate the risks posed by the technology they are employing, they can seek to mitigate those risks where possible.
The growing appeal of telemedicine
Younger patients in particular are more likely to view healthcare in the same light as any other service, that is to say it should be accessible on demand anywhere, anytime. The urban time poor can fit in a physician appointment during their working day; expectant mothers can seek timely reassuring advice from an experienced midwife; and individuals can talk with their therapist from the comfort of their home. The advantages are not only being realised by city dwellers; telemedicine has reduced the need for patients to travel for routine appointments or to see a specialist at a time when rural access to in-person care is decreasing.
San Francisco School of Medicine
IHS Markit in Time
About the author:
Jennifer Schoenthal is a miscellaneous medical healthcare underwriter with Beazley. She has almost 20 years’ insurance industry experience with a particular focus on medical and professional liability insurance. She has been at Beazley since 2013 and is based in Atlanta, Georgia.