Legal Concerns of Telemedicine: A Point of View

“Computers are a mixed blessing, because the ease with which they can make data widely available poses new risks to individual privacy. Compared to paper-based medical records, electronic information is more easily manipulated and linked…. [and] also raises the specter of a huge national database of identifiable, comprehensive health information”…..  Rybowski (1998)

 Telemedicine came into existence in the latter half of 90’s, mainly focusing upon patient data storage. Quite obviously it is linked to the growth of information technology across other sectors.

However, the boundaries got stretched in the early Y2K period, when the online education trend was picking up. Also online training and certifications for physicians was the new trend.

One of the first training programs I remember to be delivered online was on one of most difficult and important procedures, Cardio Pulmonary Resuscitation. That’s around the time legal barriers for telemedicine started kicking in. Legal barriers or rather laws around telemedicine got beefed up only recently also, this is when the actual online physician consultations or tele-radiology began.

Tele-medicine or eHealth has for sure increased the access, adherence, and availability of healthcare services, but along with it raised many questions in the minds of healthcare providers, payers, enablers, and recipients.

  • Is storing patient data electronically, ‘on the cloud’, as safe as it is perceived or projected to be?
  • Are the online training or certifications for physicians the same as live or in person training?
  • Are online physician consultations provided by qualified doctors?
  • Is an online consultation equivalent to an in person visit to physician clinic?
  • Does my insurance cover an online consultation?
  • Can a physician practicing in a different country provide a tele-consult to a patient in a different country, without legal implications?

Legal considerations remain as a major obstacle in successful implementation of tele-medicine across the globe. Some of the key challenges include:

  • Absence of an international legal framework to allow physicians to deliver services across geographies, for example tele-medicine laws vary from state to state within the US and for a practicing physician from New Jersey to treat a patient in Arizona, he must hold a licence from both the states. Similarly, for a US based physician to provide consultation for a patient in India, law in India mandates that no Indian patient can be treated by a foreign national physician, without a referral from an Indian physician.
  • There are lack of policies around confidentiality and patient privacy. A recent survey from WHO shows that even among the developed nations, only 30% have started to implement a national tele-medicine policy. In other places the governing laws include a combination of medical and information technology or tele-communication laws, for example, in the UK an extension was added to the Data Protection and Security Law by the Medical Council to include tele-medicine.
  • In India scenario is not much different from other developing nations. We are still in the process of drafting a comprehensive tele-medicine law. However, all physicians will have to abide by the MCI Act, Drugs and Cosmetics Act, and Information Technology Act to practice tele-medicine. There is recommendation published in 2003, but not a binding guideline.

The need of the hour is to have tele-medicine implemented with the highest ethical standards across geographies and therapy areas with comprehensive legal coverage to ensure at most patient information safety and zero compromise on quality of care.

References: Centre for Law Ethics & Risk in Telemedicine: http://www.seas.gwu.edu/~shmuel/cs355/Law%20and%20Risk%20in%20Telemedicine.ppt; Telemedicine WHO: http://www.who.int/goe/publications/goe_telemedicine_2010.pdf ; E-Health Laws And Regulations In India: http://archivehealthcare.financialexpress.com/201111/itathealthcare05.shtml ;E-Health Laws And Regulations In India: http://corporatelawsforindia.blogspot.in/2012/03/e-health-laws-and-regulations-in-india.html ; Recommended Guidelines & Standards for Practice of Telemedicine in India: http://www.sathi.org/Documents/MIT_Standardisation.pdf

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