Malpractice, medical liability among barriers to telestroke programs

Telestroke programs are valuable for rural areas with the proper facilitators and state policies, though they're not without their barriers, according to a study published this month in the journal Telemedicine and e-Health.

For the study, researchers from the Fulton County Juvenile Court, Columbus Technologies and Services and the Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (CDC) in Atlanta reviewed statutes and regulations in all 50 states that affect the adoption of telemedicine programs.

"This review presents evidence of the value and effectiveness of telestroke programs, as well as an explanation of common barriers and facilitators of telestroke, including licensing and credentialing rules, reimbursement issues and liability concerns," the study's authors said. "Most states have adopted policies that affect the adoption of telestroke policies. Georgia and South Carolina are examples of states implementing stroke policies using a telestroke model to treat stroke patients in rural areas."

Common state telemedicine statutory and regulatory provisions, the study's authors said, included:

  • Establishing a task force or advisory council to guide the adoption and implementation of telestroke
  • Requiring state-sponsored and private health insurers to reimburse telemedicine services
  • Simplifying licensure and credentialing requirements to allow easier access to stroke expertise through telemedicine
  • Providing incentives or grants that support partnerships between rural hospitals and primary stroke centers

Some barriers to telestroke programs identified by the authors included medical liability and malpractice across state lines. Telemedicine providers, they said, are affected by what standard of care applies, whether they can be held liable in multiple states and whether their malpractice insurance covers cross-borders telelmedicine. Many of these questions go unanswered because of "limited public policy" and "no major court rulings to provide clarity."

Last March, researchers from the University of Pennsylvania School of Medicine determined that a telestroke program based in Oregon was able to increase access to stroke care by 40 percent in certain regions of the Beaver State. Telemedicine programs in rural parts of Oregon upped the percentage of residents with access to stroke care within one hour from 54.5 percent to 80 percent, according to the researchers. They noted that in-person stoke care was crowded in urban areas, and said that while telestroke care was available in urban centers, it didn't reach less populated, uninsured areas quite as well.

Remote rehabilitation programs for stroke patients, especially in rural areas, have helped to improve lower-body function and get back in regular day-to-day routines, additional research has found.

To learn more:
- read the study in Telemedicine and e-Health (.pdf)

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