We strongly recommend that physicians educate themselves on the risks of telemedicine and implement safeguards that will help protect them from potential litigation.
Napa, CA (Vocus) January 21, 2009
As telemedicine continues to increase in popularity, it is critical for physicians to understand potential risks when communicating with patients by e-mail or phone. The Doctors Company, the largest national insurer of physician and surgeon medical liability with 44,000 member physicians, has developed guidelines to help physicians successfully navigate telemedicine liability risks.
"Adopting telemedicine best practices is vital to enhancing quality of care while simultaneously decreasing liability exposures," said David B. Troxel, MD, medical director, The Doctors Company. "We strongly recommend that physicians educate themselves on the risks of telemedicine and implement safeguards that will help protect them from potential litigation."
Outlined below are some guidelines physicians should follow when treating patients by phone or e-mail:
Telephone Best Practices:
- Inform patients in writing about when it is appropriate to seek telephone advice. Provide examples of the types of complaints, such as minor headaches, cuts, and bruises that may be adequately dealt with over the phone. Also, give examples of problems that are likely to require an office or emergency room visit.
- Only physicians or qualified staff such as RNs, NPs, and PAs should provide telephone advice. Written protocols need to be prepared for office staff and should include what questions to ask, recommended responses for minor problems, and which calls to refer immediately to a doctor or schedule for an office appointment.
- Give callers ample time to explain their problems. Avoid leading questions. For example, instead of asking, "Do you have any chest pain?" ask, "Exactly where do you feel pain?"
- Ask the caller to repeat the instructions back to you.
- Be careful about prescribing by phone, especially for new complaints. If your diagnosis is wrong, the medicine could be ineffective or even harmful.
- Document calls for advice in the medical chart, using the caller's own words whenever possible. If one of your staff members handles and documents calls, review the notes to make sure the adviser followed guidelines and dispensed appropriate advice.
E-mail Best Practices:
- Be careful what you write. Never put in an e-mail what you would not say in person.
- E-mails should be focused and concise. Always check your spelling and grammar and never use all caps.
- Incorporate your contact information in every message sent by using the automatic signature function in your e-mail software.
- Never use abbreviations. When communicating with patients, abbreviations can lead to dangerous misunderstandings.
- Include a disclaimer. Communicate your ground rules for e-mail exchanges up front. A standard disclaimer might read as follows: "Electronic mail is not secure, may not be read every day, and should not be used for urgent or sensitive issues."
- Maintain patient confidentiality. Conduct online communications with patients over a secure network that contains encryption technology. Standard e-mail services don't meet HIPAA requirements.
- Obtain informed consent. Be sure your patient signs an informed-consent form before initiating online communications. The consent form should list the appropriate use and limitation of online communications.
- Limit online communications to existing patients. Online communications of any kind are best suited for patients previously seen and evaluated in an office setting. Initiating a physician-patient relationship online may increase liability exposure.
- Pick up the phone. If you cross e-mails with another party two or three times, or if there is an emotionally charged issue involved in what you want to communicate, stop e-mailing and place a phone call instead.
The Doctors Company is a member of the eRisk Working Group for Healthcare and helped to develop guidelines for health care providers on the use of online communications. For more information on the guidelines, physicians should visit http://www.medem.com/phy/phy_eriskguidelines.cfm .
About The Doctors Company:
Founded by doctors for doctors in 1976, The Doctors Company (http://www.thedoctors.com ) is relentlessly committed to advancing, protecting, and rewarding the practice of good medicine. The Doctors Company is the largest national insurer of physician and surgeon medical liability with 44,000 member physicians, $3 billion in assets, and an A rating by Fitch Ratings.
smeraz (at) thedoctors (dot) com