A Research Anthology of Law and Policy Resources on Telehealth and Telemedicine

Introduction:

According to the telehealth definition, "the use of electronic information and communications technology to support and enhance long-distance clinical health care, patient and professional health-related education, public health, and health administration.” Often, the phrases telehealth and telemedicine or eHealth are used interchangeably. Telehealth, on the other hand, is a larger phrase than these other categories; telemedicine and eHealth are subsets of telehealth. The Federation of State Medical Boards defines telemedicine as "the Practice of medicine between a physician in one location and a patient in another location, with or without an intervening health care provider, using electronic communication, information technology, or other means." "The use of information and communication technology (ICT) for health," according to the World Health Organization.

Telehealth is a promising public health strategy because it has the ability to greatly enhance access to health care for medically underserved communities, as well as broad conviction that it can lower healthcare costs and improve overall health outcomes. Telehealth is generally considered as a more efficient way for individuals to receive care in rural areas, where federal legislation is boosting demand for medical services that are already in limited supply.

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Resources for Identifying and Discussing Telehealth Barriers

Since the start of the COVID-19 pandemic, widespread use of telehealth has revolutionised health care delivery and posed significant hurdles to its large-scale application and adaption. Given the paradigm shift from telehealth as an alternative mode of care delivery to telehealth as an integral part of the health system, a systematic approach to identifying barriers to, opportunities for, and the overall impact of telehealth implementation in the face of the current pandemic is critical. In this paper, we use the Systems Engineering Initiative for Patient Safety model as a human factors framework to guide our holistic analysis and discussion of telehealth implementation, which includes the health care work system, care processes, and results.

Many healthcare providers were quarantined at various points of the COVID-19 pandemic after possible exposure to or proven infection with the virus, resulting in a diminished workforce and health-care system capacity. Telehealth can help with workforce reorganisation and reassignment while also maintaining capacity by allowing quarantined health care personnel to continue working without jeopardising the safety of the health-care system. Furthermore, care facilities without telemedicine programmes can outsource a portion of their services to entities with well-established telemedicine programmes in order to achieve these objectives.

Telehealth Benefits and Barriers

Obstacles to Telehealth

Telehealth has some drawbacks, such as the inability to undertake full physical examinations, the potential for technical issues, security breaches, and regulatory hurdles. Some telehealth sceptics fear that it would disrupt continuity of care, claiming that online interactions are impersonal and harmful because the virtual clinician lacks the advantage of a thorough history and physical examination to aid diagnosis and treatment. Face-to-face meetings are required in many situations where auscultation or palpation is required, telehealth should be viewed as an auxiliary to in-person visits and should be utilised to supplement them.

There is no multistate telehealth licencing.

Telehealth practitioners can give medical services to patients and other healthcare providers across geographic boundaries while sharing clinical expertise. Because clinicians must obtain and maintain licencing (together with the related medical education and financial duties) in many jurisdictions, the lack of multistate licensure creates a barrier to telehealth. The Interstate Medical Licensure Compact was formed by the Federation of State Medical Boards to make it easier for physicians and physician assistants to transfer their licences and Practice telemedicine from one state to the next. State medical boards would retain licence and disciplinary authority over providers under the accord. They would, however, share information and processes that are critical to these providers' licensure and compliance with rules. Nurse practitioners (NPs) are exempt from the compact because they are licenced by state boards of nursing rather than medicine. NPs confront more obstacles than doctors or physician assistants since state regulation and practising authority differ from state to state. It's crucial to note that COVID-19 has temporarily amended some standards in specific locations. For the most precise and up-to-date regulations governing telehealth Practice, NPs should consult with their state board of nursing.

Privacy and Confidentiality of Patients

Telemedicine encounters are more subject to privacy and security threats than face-to-face contacts.

Although most telehealth platforms are heavily encrypted and adhere to HIPAA standards and laws, no platform is completely secure from hackers or data breaches. Concerns about telehealth systems' privacy and security are another roadblock to widespread acceptance and use. Both clinicians and patients should have confidence that information transmitted during telehealth sessions is kept private and secure. Several laws safeguard medical information in both face-to-face and telehealth encounters, including the Health Insurance Portability and Accountability Act, the Health Information Technology for Economic and Clinical Health Act, and the Children's Online Privacy Protection Act. The ability to Practice telehealth requires a thorough understanding of both state and federal laws. When working in a telehealth model, telehealth providers must be responsible for maintaining regulatory compliance, patient confidentiality, and system security at all times.

Misdiagnosis and data accuracy

Another possible stumbling block to good telehealth Practice is data transfer accuracy. The validity and reliability of fine motor task measures are affected by Internet connectivity, according to a study looking into the accuracy of physical function measurements. If health care practitioners are unaware of technical disparities, they may make clinical treatment decisions and recommendations based on possibly erroneous patient data. Relationships between providers and patients

States have different standards for establishing provider-patient relationships, which can include a health care provider's examination or evaluation of a patient. Before any drug is prescribed, it is especially important to understand the requirements for establishing a provider-patient relationship. Arkansas, for example, requires a face-to-face episode of care before a physician can write a prescription. In other jurisdictions, such as Missouri, the terms in-person and face-to-face are not used, but a physical examination or evaluation is required. Other states, such as Virginia and Maryland, allow electronic technologies, such as telemedicine, to be used for physical examinations or evaluations.

Liability in the Medical Field

Informed consent, Practice standards and protocols, supervision requirements for nonphysician providers, and the provision of professional liability insurance coverage are just a few of the issues that telehealth poses in terms of malpractice liability. It's not easy to apply existing malpractice liability standards to telemedicine, especially when it's unclear what a suitable "standard of care" is. Telehealth may or may not be covered by professional liability insurance. Errors and omissions, negligent credentialing, breaches of privacy, and service outages due to equipment or technology failures should all be avoided. Particularly when offering telehealth services in other jurisdictions, providers must be aware of what their liability insurance coverage cover.

Evidence of Cost and Health Outcomes Using Telehealth Resources

Telehealth proponents claim that remote technologies will increase access, lower costs, and enhance health outcomes. Researchers have attempted to scientifically investigate claims that telehealth improves health outcomes, lowers healthcare costs, or both in the following resources.

What is the mHealth Economic Evidence? A Systematic Review of mHealth Solution Economic Evaluations

The body of evidence relating to economic evaluations of mHealth interventions is summarised and assessed. The cost savings in this meta-analysis are limited to primary outcomes, which is a conservative approach. Despite the fact that most studies claiming cost savings lack sufficient evidence, the review itself supports the cost-effectiveness of mHealth interventions in general. It does, however, caution against applying the findings to all therapies.

Access to Acute Illness Care is more equitable thanks to urban telemedicine.

A comparison of urban telemedicine utilisation for acute care to suburban populations who do not use telemedicine. The study indicated that overall costs were reduced, owing to fewer trips to the emergency room. The usage of telemedicine significantly enhanced healthcare access in the urban population, according to the study. In addition, providers claimed that telemedicine could have replaced the bulk of office visits.

A National Emergency Airway Registry Study of Telemedicine-Assisted Intubation in Rural Emergency Departments

A study focused on the use of telemedicine to assist non-emergency-trained physicians intubating patients in rural, Midwestern hospitals. The study discovered that using technology enhanced health outcomes.

Analysis of State Telemedicine Gaps

Coverage and reimbursement gaps in state laws relating to the provision of telehealth services are reported on.

State Telehealth Reimbursement Policies Legal Mapping Analysis

Since 1997, a review of state legislation and policies relevant to telehealth reimbursement has been conducted in 50 states. The authors indicate where policies exist, as well as the sorts of telehealth that are covered or prohibited by each state, as well as the type of telehealth. Separate analyses of state Medicaid reimbursement are also provided.

From a Legal and Regulatory Perspective, Telehealth Applications

An examination of policies and regulations, with a focus on determining which agencies have the authority to regulate telehealth and the breadth of those powers. The authors highlight successful government telehealth projects, but they also acknowledge a lack of uniformity across policies and the ambiguous legal status of telemedicine.

Telehealth Resources in Rural Areas

One of the most frequently touted advantages of telehealth is its capacity to provide access to medically underserved communities. The provision of access to rural communities receives the most attention. The resources below describe attempts to expand healthcare access using telehealth interventions, including accomplishments and future potential.

Telehealth's Promise: Strategies to Improve Rural America's Access to Quality Healthcare

Identifies legal and administrative impediments to expanding the use of telehealth to improve healthcare access in remote populations, as well as ways for overcoming them.

The Use of a Web-Based Mental Health Intervention by Rural and Urban/Suburban Families

A study looking into the applicability of web-based mental health care Practices. The study indicated that regional disparities had no effect on whether patients or caregivers used the technology, implying that advances in telehealth will enhance access to rural areas that have previously been underserved.

Conclusion:

Given the extent of the opioid overdose epidemic and the potential of telemedicine to improve access, efficiency, and quality of care, this study sought to learn how states are using telehealth laws to combat the epidemic. Finally, we discovered that telehealth laws are being used to combat addiction and overdose by limiting telemedicine prescriptions for pain management, providing telehealth-based access to medicines and counselling for addiction treatment, and facilitating professional collaborations. Telehealth legislation have the potential to improve access to care for opioid use disorder, especially in rural areas where preventive mental health care and treatment, such as MAT, are not always available. Because the legislation in this field is continually evolving, it is important to conduct ongoing research, particularly on how larger, implicit authorities can be used to combat the opioid overdose problem through telemedicine.

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