Informed consent central to telehealth, poses challenges

The very nature of telehealth--the use of technology across distance to provide healthcare services--can increase the risk associated with even routine treatments. That makes patients' informed consent even more important, according to an article at

Imperfect technological tools can produce hiccups and failures, or even transmission errors that can affect information sent electronically, including patient records, images or medical device logs. That can results in delays in treatment or misdiagnoses, writes author Bonnie Scott of law firm Epstein Becker Green.

Treating patients off-site can carry other risks, she says. The providers have no way of knowing who else is in the room during a videoconference with a patient, for instance, which could violate the patient's HIPAA privacy rights. Distance also prevents providers from performing hands-on exams, which also can affect diagnosis and treatment.

States have varying requirements for obtaining informed consent. Nebraska, for instance, requires written informed consent before the start of treatment, while California and Arizona allow verbal consent. Texas law doesn't specify the form the consent must take, while Oklahoma law is the most specific about the types of information providers must give to patients, Scott writes.

Improved documentation can help providers limit legal exposure associated with telehealth, she says, adding three recommendations:

  • Use easy-to-understand language
  • Describe the risks and benefits of telehealth
  • Provider other information to help the patient make an informed choice, such as alternatives and referral information for a local provider.

Informed consent is among the topics covered in the guidelines issued by the American Telemedicine Association in its document "Practice Guidelines For Video-Based Online Mental Health Services."

Scott's colleague at Epstein Becker Green, René Y. Quashie, earlier this week wrote about telehealth concerns that keep providers up at night, including the difficulty in complying with myriad state licensure and prescribing laws and lack of highly developed protocols and guidelines.

A recent Rand Corp. report found that the U.S. Department of Defense needs to invest in more research to deal with patients' privacy preferences.

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