Patient Safety in Telemedicine and Cyber Liability

Telemedicine is defined as the remote delivery of healthcare services, whether they are medical consultations using videoconferencing, mobile apps, store and forward technology offering health assessments or lifestyle counseling. Technology can assist in the delivery of information and shorten the distance between the patient and the provider. Telemedicine can be classified into three main categories: remote patient monitoring, store and forward or interactive communication. Each of these has their own different risk profiles. 

Here are some examples of claims involving Telemedicine

●Device Monitoring Telehealth Failures: One form of remote healthcare monitoring through telemedicine is a device monitoring bracelet for an independent elderly client. The device was set up to alert the caretakers of a fall or a heart arrhythmia. This technology used a central in-house call center which would be triggered in the event of an arrhythmia or a fall.
In this claim, the device failed to detect a fall in the home, which resulted in the fracture of both arms. The patient eventually died, unable to find help while stuck under scalding hot water with a device that was not notifying of heart arrhythmia and somehow missed the fall.
▪ Asynchronous failures
In radiology, telemedicine is used for transmitting vital images. During an important emergency, a slow transmission rate of images from radiology of a trauma patient to a connected emergency medical department failed to inform the emergency trauma team in a timely manner about issues which would have provoked the proper response to save the life of the patient.
●Information transmission via email and record transfer
An interactive telemedicine service experienced a claim recently when a patient died as a result of a penicillin reaction. The medical record would have noted that as a contraindication and prevented the prescription of penicillin, but the physician trying to retrieve the patient's medical records was unable to access them because the healthcare information exchange was hit by a ransomware attack and taken completely offline. The physician manually completed a health care questionnaire through telemedicine and then prescribed the penicillin antibiotic to the patient.

Lloyds of London and Medical Professional Liability Insurance

One of the most innovative and committed insurance carriers in the telemedicine space is Lloyd’s of London.  If investors in telemedicine healthcare models can figure out how to work within the important legal regulations that govern conflict-of-interest and self-referral, support physicians and health care organizations working together, the physician-patient relationship can properly be established without requiring an in-person visit, and then perhaps more payers would respond to telemedicine.

The goal of the Affordable Care Act was to lower the cost of healthcare while increasing access and improving quality. There is evidence to suggest that telemedicine is an important component of the path to that result.

Lloyd’s of London is there to act as a strong partner in this effort, and the Doctors Insurance Agency is proud to represent CFC and Beazley:  two strong Telemedicine Professional Liability Insurance carriers. Lloyd’s of London divisions working hard to support the rapid expansion and innovation of telehealth. They are doing this by continuing to develop pricing models and insurance contracts that are sustainable for low-cost startup innovative healthcare models, as well as mature national venture capitalist health tech platforms.

Medical Professional Liability Insurance Policies should underwrite at the Organizational level and add the doctors so their tail is covered/included.
They have discovered that the key is to underwrite at the organizational level, to measure the type of service provided, the technology of the delivery of that service, and the protection the personal health information inherent in the product. Lloyd’s and the Doctors Company continue to lead the field in research and development of patient safety. They do this through an endless calendar of events, both virtual and physical, with specific collaborations and studies of claims in order to promote the practice of better use of telemedicine.

One of the many rapidly-growing specialties within telemedicine is dermatology. In the field of Dermatology, specialists rely on application software that can fail to identify rare and unusual conditions.

The images transmitted can fail to pick up pathologies that do not produce changing pigment or scaly surfaces. This can lead to a delay in treatment and diagnosis, which can in extreme cases accelerate or lead to death.  Dynamics such as these are going to require that insurance carriers, physicians, and investors, as well as telemedicine healthcare organizations, collaborate to share data and form focus groups just as clinical practices and physicians have done with insurance associates have done over the years.

There are other unique and peculiar gaps represented in healthcare technologies:  

•    Some apps fail to factor in the age of the patient,
•    or they lack information regarding clinical trials,
•    Or the technology is simply not a good fit for the flow of service unique to each specialty decision. 

Emergency medical support, intensive care, radiology, and dermatology all depend on the clarity of images or the video connection to enable providers to make sound decisions. When a misdiagnosis occurs, it could be either the provider or the technology. The Telemedicine Malpractice Insurance and Medical Professional Liability Insurance policies offered by the Doctors Insurance Agency include protecting the physicians and the organization against bodily injury claims because of the failure of technology to deliver the correct diagnosis.

As recently as five years ago, the idea of diagnosing a cancerous mole using a mobile app was out of the question.  The healthcare industry is shifting towards universal adoption of digitized solutions and the Doctors Insurance Agency continues its commitment towards representing these leaders in medical professional liability insurance.


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