While the whole world has been turned sideways due to the CoViD-19 pandemic this year, there have been some precious few positives that we can take some solace from. For one, Working From Home (WFH) as a viable business practice has now been given a lot more credit since many businesses were forced to continue with their work while being confined at home.
But for the health professionals, this ability to work from home brings a whole other meaning since they are directly in the frontline of this natural disaster. Under those circumstances, any effort to continue providing their valuable service without putting themselves in harm’s way would be welcomed. For most general practitioners, this is where telemedicine provides a safe avenue to care for patients without having to put either party at risk of inadvertently spreading CoViD-19.
What is Telemedicine?
Telemedicine refers to medical services that can be provided safely and securely using technology where the doctor and patient are located away from each other. This is not a new concept and several platforms already exist all around the world to facilitate medical treatment to be offered remotely. Some activities that are done via telemedicine include virtual consulting, e-prescribing, tele-diagnostics, tele-monitoring, and collaborating remotely for medical discussion.
During the past few months, a more watered-down version has been adopted by many health professionals where generic tools such as ZOOM and Skype were used during the period of movement control to consult with their regular patients. However, there are a few things to be mindful of when it comes to handling patient information and providing duty of care. Using a generic platform means that extra consideration must be made to ensure that the right level of care and high standard of confidentiality is maintained at all times. As we saw with ZOOM, there is always the potential of data theft and privacy breach when it comes to using technology.
Practising Telemedicine Safely
Just as medical professionals take their duty of care seriously and take precautions not to expose their patients to any physical or emotional harm, so too must they use telemedicine with the same principles. When a doctor sets up their clinical practice, they ensure their premises are secure and install the necessary safety precautions to safeguard patient information. The same attitude must be adopted when using any platform to engage the patient.
First of all, there must be consent between the doctor and patient to have a health discussion remotely over the platform. This consent can be in the form of an email or text message so that it is explicitly understood. If a non-telemedicine platform is used, it is especially important to ensure that the patient is aware of the fact that the doctor is not able to guarantee the digital security in spite of taking all necessary precautions.
As for the consultation session itself, it is important to establish the identity of both parties so that there is no accidental malpractice (e.g. wrong diagnosis or advice given inadvertently, etc.). It is equally important to establish the extent of information exposure that might be needed. For example, is there a need to record video of the online consultation or do any images need to be exchanged as part of the consultation process? If there is a need for either, will the digital files for these elements be retained and where would they be stored?
The Malaysian Medical Council (MMC) has offered some guidelines on how doctors can practise telemedicine safely. The advisory from the council recommends that doctors should use telemedicine only if they are competent with doing so and maintain the same ethical and legal requirements as they would during in-person consultations. In addition, doctors are expected to verify identity of both parties during each session and ensure that only secure platforms are used. The main limitation imposed by MMC is that the patient to be consulted is already known to the doctor.
Medical Malpractice Indemnity Considerations
Malpractice insurance always complements what the doctors do and it is no different for telemedicine medical practice. The underlying factor is to ensure that all national and local guidelines from the respective regulatory body is followed at all times. In addition, some additional aspects such as where the patient is physically located, whether the doctor feels confident to treat the patient remotely and whether the patient is known well, are all important elements to take note of.
Apart from the medical service provided, doctors should especially take note of the digital security when engaging with the patient. The likelihood of data breach or privacy breach is much higher in telemedicine than in face-to-face consultation, hence the chance of medical malpractice claims due to breach of confidentiality is a real risk. Therefore, doctors should ensure that patient records are well protected and that any information being transmitted should be the minimum necessary to make informed decisions. Simple protective actions such as ensuring that files and accounts are password-encrypted would improve the safety of the data and maintain confidentiality.
It is also beneficial to prepare the patient and ensure the expectations are realistic to what can be achieved using telemedicine and particularly, how much can be done during a pandemic situation that significantly limits everyone. Some basic points to raise are the level of technology proficiency that the patient has (e.g. the doctor can’t be responsible if the patient’s computer is not protected against viruses), and the physical limitations that are present (e.g. the doctor won’t be able to examine the medical issue from all angles when doing so via video). By preparing the patient in this way, the potential for something to go wrong because of the patient’s actions and then blaming the doctor would be reduced.
Fundamentally, doctors need to observe five underlying principles that can be represented by the acronym SMART. Namely, those embarking on the telemedicine route should:
Adopt Good Communication
Recognise Ability and Limitations
Treat Patients with Confidence
In addition, doctors need to be mindful of the possibility that a face-to-face consultation might be needed due to various developments such as missing documentation, necessity for further diagnosis or suspicion that data has been breached. It is also important that enough records are kept of all activity such as the digital consent, the types of diagnosis made (and their limitations), relevant images of the diagnosis or screen-capture, and the follow-up arrangements as agreed by both parties. If a video recording is done of the consultation, consent should be expressly given by the patient and the video file storage methods should be explicitly explained to him or her.
Future of Telemedicine
Fit-for-purpose telemedicine platforms already incorporate all these elements in their design and therefore relieve the pressure on individual doctors to ensure they have covered all their bases. Unfortunately, there has been a resistance on the part of government policy and healthcare legislation (including healthcare insurance cover) all over the world to be updated to suit this new approach. However, CoViD-19 appears to have hastened the need for these updates to be moved along further and sooner so that telemedicine can be the solution for the current times and insurance against a future catastrophe of this type.
Hence, it is a good time for healthcare professionals – especially general practitioners – to seriously look into how they can incorporate or adopt telemedicine as part of their ongoing medical practice.
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