As mobile devices become more and more integrated into clinical practice, our health system will have to not only figure out how this technology will change the face of medicine, but also how it will change the system of medical liability. Physicians and administrators alike shudder at the thought of malpractice, but considering the fact that 60% of physicians over the age of 55 have been sued at least once during their career, we have to carefully think about how all of our new tools fit into the liability picture. Michelle Mello, a Harvard health law professor, offered some insight at the World Congress Leadership Summit on mHealth.
Mellow warned about the temptation for physicians to rely too heavily on remote monitoring and mobile imaging technologies. In an age where one can check a patients vitals, look at a real time ECG, and request a video consult all from the comfort of his or her home, there exists the potential for routine care to be delivered remotely, instead of in person. This can lead to physicians missing important clues that can only be observed face to face, as well as patients feeling that they are not getting enough attention at the bedside. Mello argues that this could be seen as negligence on the doctor’s part, even though the doctor may have been making correct decisions based on their remote information.
In addition, email correspondence between providers and patients has been on the rise. While many patients may prefer this, doctors must be careful to keep emails personalized and thoughtful. When you are not talking face to face with somebody, it is easier to answer questions quickly and abruptly. Physicians that utilize mobile devices to answer such emails, or have staff take care of emails run the risk of leaving some patients dissatisfied, opening themselves up to potential lawsuits.
One more consideration of mHealth and liability that Mello points out comes in the enormous amounts of information now available at the point of care. With CDS apps, evidence based medicine guidelines, and various other tools at a clinician’s disposal, there is the possibility of doctors being overwhelmed with an information overload. Sifting through all the material out there could lead to some physicians missing smaller details.
All of these aspects of mHealth that will complicate liablity are, of course, also ways in which doctors will reduce their exposure to lawsuits. Just as remote monitoring has the potential for doctors to decrease their in person interaction with patients, it also offers more access to information in a more timely manner, which can prevent errors from happening in the first place. Video consults can be more useful than a phone consult, and email communications can increase connectivity between doctors and patients. The “information overload” can be an extremely useful tool in finding information quickly, while having mobile devices integrated with EHR will automatically document decisions and other considerations relevant to liability.
It would be very hard – nearly impossible – to argue that the liability risks associated with mHealth outweigh the enormous clinical and economic benefits we are already seeing. But it will grow increasingly important to keep these issues in mind as the mHealth revolution goes forward.