by: Marlene M. Maheu, Ph. D.
Paper Delivered to the American Telemedicine Association
Phoenix, Arizona 05/23/00
Traditional Elements of Risk Management

Obtain required licensure for each state of practice.
Identify court definitions of malpractice in your geographic and specialty areas.
Obtain liability insurance for each state of practice
Limit services to areas of licensure & competence.
Cultural Competence
Linguistic Competence
Identify community standards.
Identify and follow treatment and practice guidelines for your profession.
Conduct scientific research before offering services to the public.
Define at-risk populations and developing specialized services for them (backup and emergency services).
Document consultation.
Develop thorough patient consent agreement.

Consent Agreement

Requirements may vary among states.
Identify requirements for patient consent agreements in every state of practice.
Discuss the patient consent agreement with patients both verbally and in writing.
When developing your document, consider adding these phrases:
Procedures used are outside the standard of care.
Procedures used are not validated by research.
Give a description of equipment and services to be delivered.
Describe how services via technology differ from services delivered face-to-face.
Describe positive and negative consequences of services via technology.
Describe positive and negative consequences of engaging in services through technology.
Detail the risks and benefits of working electronically.
Discuss the purpose of remote contact.
Describe the limits of confidentiality.
Be sure to discuss how breeches in confidentiality may be difficult to remedy
Inform patients of who will have access to their email address, phone number, or any other contact information
Inform the patient of who else might contact the patient on your behalf.
Describe the specific roles of any consultant or local referring practitioner and who will have ultimate authority over the patient's treatment.
Discuss whether patient information will be stored in a computerized database.
Give details regarding the limits of your licensure.
Provide written procedures for various types of follow-up when patient does not appear for remote consultation.
Describe how deficiencies electronic equipment could possibly cause interference with diagnosis or treatment; equipment failure.
Discuss issues of jurisdiction.
Make provision for non-receipt of email, delayed receipt, problems with servers, or unannounced changes in the schedule of email communications.
Mention how easily human error could lead to incorrectly delivered messages.
Document vacation arrangements, average response time, and topics not appropriate for discussion via technology.
Provide patients with alternatives and behavioral suggestions for equipment failure, accident, catastrophe or natural disaster.
Allow patients the opportunity to prohibit identifiable medical information or images from appearing in any electronic medium.
Allow patients to prohibit use of identifiable images or information by researchers or other, unidentified entities.

Risk Management into the Future

Above all, do no harm.
Remember that the responsibility for how the tool is used lies not in the tool itself, but in the hand that uses it.
Let's proceed.

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