Healthcare risks in the digital age
Telemedicine has opened up access to healthcare for many in the UK by providing an alternative way to get routine care. As a supplement to face-to-face consultations it has the potential to bring many benefits but there are concerns this may compromise the quality of care – increasing the potential for claims against both healthcare providers and those who supply the technology.
The advancement of mobile technology has accelerated the adoption of telemedicine however the origins of telemedicine can be traced back to as early as the 1920s.
Hugo Gernsback, an inventor, science fiction enthusiast and founder of a scientific journal called The Electrical Experimenter is credited with being the first to outline the potential role technology could play in medicine. It was in a 1925 edition of the magazine that Gernsback conceived of a device that would permit a doctor to conduct consultations from the comfort of the patient’s own home. The Teledactyl (from the Greek for ‘far’ and ‘finger’) would allow the doctor to see and speak to the patient while two remotely controlled arms would allow the doctor to examine the patient.
It took until the late 1950s when radiologists began to send images to each other via cable that telemedicine started to be realised. Then in the 1960s, the Nebraska Psychiatric Institute and Norfolk State Hospital began to undertake remote psychiatric consultations. In the UK, the NHS has had a digital strategy since 1992 though its early measures were limited to improving administration rather than assisting with care. It took until the development of mobile technology and wireless internet for the potential of telemedicine to be realised.
According to the Topol Report, undertaken on behalf of the government in 2019 to look at the future of health in the UK, there will be an “inexorable increase” in the demand on healthcare services as people live longer, and do so with more long-term conditions. This, the report says, creates the need for the wide ranging adoption of technology in healthcare. With this in mind the UK government is taking a variety of steps to deploy technology in order to relieve pressure on front line practitioners.
Demand also comes from patients. Faced with longer wait times, some patients value the convenience telemedicine provides. Accenture’s 2019 Digital Health Consumer Survey of patients in England and Wales revealed that 33% of those surveyed had used telemedicine services with two-thirds saying they would consider it in the future – the main drivers being convenience and transparency of care.
But despite willingness and demand for the adoption of technology in healthcare, it is not without risk. Inserting technology between the patient and the medical provider adds a layer of complexity and potentially increases the risk of misdiagnosis.
An often cited argument is that without an in-person relationship the medical professional may be unable to make a full and accurate diagnosis. There is concern that the physical distance prevents the professional from being able to see and treat the whole person and, as a consequence, the effect of telemedicine is to reduce medical interactions to the treatment of individual symptoms. This has led critics to argue this does not amount to effective patient care and increases the risk of misdiagnosis.
One study conducted on tele-dermatology highlighted the risks of misdiagnosis in remote consultation. In the trial researchers posed as patients with prepared medical histories and various skin conditions.
A diagnosis was provided in 77% of presented cases but the study was critical of the quality of care with many diagnoses being “proffered without reasonable attempts to ask basic medical history follow-up questions”. Often they were conducted on the basis of a single photo shared by the patient. Worryingly in three cases the doctors advised the patient that their nodular melanoma, an aggressive skin cancer, was benign.
This challenge is not unique to telemedicine. Misdiagnosis through a lack of appropriate interrogation of the symptoms can also occur in in-person healthcare. However whereas in traditional settings of care the doctor is reliant on their skill and knowledge, the introduction of technology could increase the risk of misdiagnosis.
Where a diagnosis hinges on a single electronic image or video consultation taken by the patient, the medical professional needs to be confident the technology is reliable enough to support an accurate diagnosis. Where the patient is using equipment to send data such as blood sugar or heart rate, the professional must ensure equipment is fully functional and being used appropriately by the patient.
Healthcare professionals who use technology to deliver services, and those who supply healthcare technology, should ensure their insurance policies have been designed to provide coverage in the event of a claim for bodily injury. Some standard insurance policies may exclude claims for bodily injury arising from technological services, or, there may be gaps in coverage where an insured has two separate policies in place. Beazley’s Virtual Care product is designed for healthcare professionals who use technology and those who supply it providing seamless coverage for a range of technology enabled healthcare services.
About the author:
Chris is a senior underwriter, leading the London large risk healthcare team, writing medical malpractice, life sciences and associated liability risks on a worldwide basis as well as the recently launched virtual care product. The team insures hospitals of all types across Europe, Latin America, Australia and the Middle East; UK and Irish primary and social care risks; and international clinical trials.