E-Medicine: The Cyber-Revolution Hits Medical Practice
By Mark Gorney, M.D., TDC Medical Director, TDC Board of Governors
The much-heralded cyber-revolution in medical practice has arrived. The population of online e-medicine consumers — known to most of us as patients — grew explosively just in the first quarter of 2000 alone, when more than 40 million Americans used the Internet for medical advice and service. By 2005, that number of e-medicine users in the U.S. could grow to an estimated 88 million.
The immediate concern e-medicine poses for medical liability is the range of new risk exposures for physicians associated with the increase of patient interaction and new services it allows. Unfortunately, there are more questions than answers, and we are only on the threshold of a vast expansion of physician-patient communication of as yet unknown dimensions. It behooves all physicians who actively embrace e-medicine (as well as those being reluctantly dragged into it) to consider the potential for its consequent liability exposures. We are in a period of transition. Our more mature colleagues (those of us older than 50) are still not entirely comfortable communicating across an impersonal square glass screen. Younger doctors, however, consider it quite natural as they have been accustomed to using computers since grade school.
Although computers may offer the advantage of easing the burdens of accounting, record keeping, and correspondence, many physicians are still uncomfortable with the concepts of consulting, diagnosing, prescribing, and even treating (i.e., electronic, robotic, long-distance surgery) via computer. Beyond that, e-medicine also raises several questions of liability, confidentiality, regulatory constraints, and ethics:
- A radiologist in California contracts with a medical group in Kansas to read their x-rays. The state of Kansas gets wind of this and comes after the doctor for practicing without a Kansas license.
- In North Carolina, the state acts against a physician who prescribed over the Internet without first seeing or examining the patient.
- Does consulting online with a patient you have never before seen establish a doctor-patient relationship? How different is that from giving medical advice over a martini at a cocktail party? What, in fact, constitutes the all-important doctor-patient relationship?
- Is it appropriate for a dermatologist to make a diagnosis from just an image on a monitor? What happens when a pathologist cannot move a slide around under a microscope? How is a fetal monitor or cardiograph strip read when only one section is shown?
Medem
Fortunately, help is available. In 1999, leaders of several national medical organizations, including the American Medical Association (AMA) and other major specialty societies, founded Medem. The goals of creating Medem were to improve patient access to quality health care information on the Internet and to provide physicians with secure communication tools that would enhance patient care and diminish medical liability.
Medem's first task was to assemble clinical information from multiple medical societies into a single library and make it available online through individual physicians' Web sites. These physician Web sites feature medical society and individual physician information as well as secure physician-patient communication via authentication and encryption software. Medem now works with 45 participating medical societies, including the AMA, and more than 80,000 physician-subscribers.
In an effort to mitigate physician liability and provide some guidelines for physicians to consider when communicating online, Medem leaders also asked national malpractice carriers to participate in the eRisk Working Group for Healthcare. Thirty-three malpractice carriers representing more than 70 percent of insured American physicians were included. The eRisk Working Group worked online and met in 2000 and again in 2001 to create, refine, and endorse a set of guidelines for online physician communication.
The Doctors Company's partnership with Medem produced meaningful guidelines to minimize medical liability exposure. We strongly urge you to contact Medem for a copy of the guidelines and other useful information on many services. For further information, visit www.medem.com or call Medem at (415) 591-5800.
