Telemedicine, Misdiagnosis and Medical Malpractice

Telemedicine is being lauded as the next step in the evolution of health care delivery. Whether the patient accesses their doctor through an online forum accessible from their home computer screen, or through a kiosk in a clinic or workplace, the patient is talking to the health care provider through a live, video conference arrangement. This kind of interaction is even one step removed from the experience a patient would have when they visit an urgent care clinic at their neighborhood pharmacy. The patient essentially describes their symptoms to the doctor, who then recommends treatment options.

But there are obvious dangers of dispensing medical care in such a way that distances doctors from being able to physically examine the patient. All the cues that an astute doctor will pick up when they are in the same room with a patient could be lost, and there is an increased risk that the doctor will misdiagnose the patient.

What exactly is “telehealth”?

The federal Health Resources and Services Administration (HRSA) defines telehealth as “the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health, and health administration.”

D.C. law defines Telemedicine/Telehealth in this way: “’Telehealth’ means the delivery of healthcare services through the use of interactive audio, video, or other electronic media used for the purpose of diagnosis, consultation, or treatment; provided, that services delivered through audio-only telephones, electronic mail messages, or facsimile transmissions are not included.” DC Code Sec. 31-3861. Proposed rules for the DC Department of Health set forth guidelines as to how telemedicine will be conducted in the District of Columbia that include requirements such as a physician must be licensed in D.C. and they must adhere to the same standards of care as when making a medical decision in an in-person, face to face encounter with a patient, medical records must be created and maintained along with other requirements.

The risks of telemedicine

To answer the question as to whether or not telemedicine patients are at greater risk of misdiagnosis, a recent research study that was published in the Journal of the American Medical Association Dermatology, looked at the quality of rapidly expanding direct-to-consumer (DTC) telemedicine websites and smartphone apps and how accurate they were in diagnosing and treating skin disease. After analyzing the results of 62 clinical encounters from 16 different DTC websites, researchers found that major diagnoses were repeatedly missed, and sometimes the patients were prescribed treatments that were at odds with existing guidelines.

The study concluded that while telemedicine has the potential to expand access to high-value health care, the findings of the research raise concerns about the quality of diagnosis and treatment options offered by the DTC telemedicine websites, and until improvements are made, patients risk accessing health care services that lack transparency, choice, thoroughness, diagnostic and therapeutic quality and care coordination. The research report offers several suggestions on how the apps can improve the quality of DTC telemedicine websites and apps in order to avoid the problems identified in the study.

Telemedicine is an emerging method of health care delivery, so the laws with regard to implementing the practice of telemedicine are just now being written and are moving through legislatures across the country. Given the results of the JAMA study, which was limited to dermatology, it can be quite a challenge to accurately and thoroughly examine a patient through a video teleconference linkup, which leaves a lot of room for misdiagnosis of what is really going on with a patient.