Telemedicina: aspectos juridicos

A AMHB agrade a participação dos doutores: Dr. Carlos Michaelis: Advogado Especialista em Direito Médico, consultor em telemedicina e Assessor do CREMESP. Dr.Sílvio Eduardo Valente: Médico, advogado e perito Médico. Doutor em Biodireito pela USP. Presidente da comissão de Direito Médico da OAB-SP (2014-2018).

Telemedicina: aspectos juridicos

A AMHB agrade a participação dos doutores: Dr. Carlos Michaelis: Advogado Especialista em Direito Médico, consultor em telemedicina e Assessor do CREMESP. Dr.Sílvio Eduardo Valente: Médico, advogado e perito Médico. Doutor em Biodireito pela USP. Presidente da comissão de Direito Médico da OAB-SP (2014-2018).

Pacientes y protección de datos. Una aproximación jurídica / Patients and data protection. A legal approach

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Connecting at the Webside: Rapid Telehealth Implementation for Musculoskeletal Clinicians.

SYNOPSIS: Telehealth is rapidly being implemented during the COVID-19 pandemic. Despite evidence for the effectiveness of telehealth for musculoskeletal examination and treatment, there is a lack of clear guidance related to implementation. We provide recommendations on practical concerns related to delivering telehealth, including choice of platform; legal, ethical, and administrative considerations; building a "webside manner"; and implications for musculoskeletal examination and treatment. J Orthop Sports Phys Ther 2021;51(1):8-11. doi:10.2519/jospt.2021.9902.

The rules for online clinical engagement in the COVID era.

Coronavirus disease-2019 (COVID-19) has generated a need to rapidly increase online consulting in secondary care, an area in which it has previously been underutilised. We sought to review the guidance on conducting remote consultations and found that while there is a large amount of information about the implementation of remote consultations at an organisation level, there is a paucity of high-quality papers considering the guidelines for online consultations alongside practical advice for their implementation at the individual level. We reviewed guidelines from reputable medical sources and generated practical advice to assist practitioners to perform safe and effective video consultation. Additionally, we noted reports in the literature of a lack of transparency and resulting confusion regarding the choice of telemedicine platforms. We, therefore, sought to summarise key characteristics of a number of major telemedicine platforms. We recognised a lack of clarity regarding the legal status of performing remote consultations, and reviewed advice from medico-legal sources. Finally, we address the sources of these individual uncertainties, and give recommendations on how these might be addressed systematically, so the practitioners are well trained and competent in the use of online consultations, which will inevitably play an increasingly large role in both primary and secondary care settings in the future.

[Legal aspects of teleconsultation]. / Aspects juridiques de la téléconsultation.

There is no specific legal framework in Switzerland for the practice of telemedicine. The doctor carrying out a teleconsultation must therefore respect the general principles of medical practice : provide care online with professional recommendations, provide his patient with clear, appropriate and complete information, and also respect medical confidentiality. The doctor, due in particular to the limitation of the senses and the absence of direct physical examination, must maintain a degree of caution in the practice of remote consultations. He also remains responsible for the medical data exchanged and it is up to him to use a telemedicine solution adapted to the data security and confidentiality standards.

Il n'existe pas en Suisse de cadre légal spécifique à l'exercice de la télémédecine. Le médecin réalisant une téléconsultation doit ainsi respecter les principes généraux de l'exercice médical : apporter des soins en adéquation avec les recommandations professionnelles, délivrer à son patient une information claire, adaptée et complète, mais aussi respecter le secret médical. Le médecin, du fait notamment de la limitation des sens et de l'absence d'examen physique direct, doit garder un degré de prudence dans la pratique de consultations à distance. Il reste également responsable des données médicales échangées et il lui appartient d'utiliser une solution de télémédecine adaptée aux normes de sécurité et de confidentialité des données en vigueur.

[Legal limits of (online) marketing for doctors]. / Rechtliche Grenzen des (Online-) Marketings für Ärzte.

The online marketing of physicians must be measured against the same advertising regulations as conventional marketing. In this context, the Medical Professional Code of Conduct, the Medical Products Advertising Act ("Heilmittelwerbegesetz") and the Law against Unfair Competition are particularly relevant. In addition, data and personal rights aspects have to be considered in the area of online marketing. Despite increasing liberalisation tendencies, there continue to be considerable legal advertising limits for doctors, which are outlined in this article. The relatively high number of current court rulings cited in the article also shows that there are questions yet to be clarified with regard to all regulations. The judgements, which are often strongly related to the individual cases, have not answered all questions conclusively. Nevertheless, it can be stated that the legal limits of medical marketing have never been more liberal than they are now.

eHealth: los pacientes ante la nueva realidad tecnológica en el ámbito sanitario / eHealth: patients in the face of the new technological reality in the health field

En la actualidad la tecnología, su comprensión y aplicabilidad en muchos escenarios de la vida diaria de las personas, así como la producción de transformaciones radicales en cuanto a la irrupción y asentamiento de nuevos modelos socio sanitarios, resulta un tema de profunda complejidad. Por ello, para entender dichas transformaciones y como son percibidas por la ciudadanía, resulta necesario incorporar sus voces, discursos y narrativas sobre eHealth

Nowadays, technology, its understanding and applicability in many daily arenas, as well as the production of radical transformations in terms of the emergence and establishment of new social and health models, is a matter of deep complexity. Therefore, to understand these transformations and how they are perceived by citizens, it is necessary to incorporate their voices, discourse and narratives about eHealth

Doctor won't see you now: changing paradigms in mountain medicine.

The evolution in communication and digital technologies is revolutionising the practice of medicine. A physician is now able to oversee provision of healthcare at a distance. In this paper, we argue that practice of telemedicine is an essential and evolving aspect of high altitude and expedition medicine. We acknowledge the lack of international consensus, limited legislation as well as possible reservations towards telemedical practice. Given some unique social and medical aspects of participation in remote, high altitude expeditions we propose a number of guiding principles for those involved in provision of telemedical services for such endeavours.

[Legal considerations of telemedical care]. / Rechtliche Rahmenbedingungen der telemedizinischen Versorgung.

Telemedical methods are on the rise in patient care. In addition to the actual changes for both sides in the physician-patient relationship, the use of information and communication technology also involves legal challenges. This article deals with the legal framework of telemedical care. Thereby the article discusses the prohibition of remote treatment (§ 7 Abs. 4 MBO-Ä) and the question to what extent the omission of a telemedical method of treatment can fulfill a medical breach of duty. A distinction must be drawn between the question as to whether telemedical monitoring shall be executed and the question how to use telemedical systems, in order to mitigate liability risks for the physicians. The physician can for example violate his/her medical duties by not sufficiently informing the patient about all essential circumstances concerning the consent, by not adequately monitoring the functioning of the telemedical devices, or by not reacting fast enough to telemedical occurrence reports. All this may lead to a case of liability.

Transforming Gastroenterology Care With Telemedicine.

Health care is changing rapidly, so we must change with the times to develop more efficient, practical, cost-effective, and, importantly, high-quality methods to care for patients. We teach medical students that optimal patient care requires face-to-face interaction to collect information on the patient's history and perform the physical examination. However, management of many patients-especially those with chronic diseases-does not always require physical examination. Telemedicine offers an opportunity to take advantage of technology while leveraging the progressive push toward efficiency and value but also requires the belief that excellent patient care is not always provided in person. Telemedicine can include a variety of aspects of patient care adapted to be performed remotely, such as telemonitoring, tele-education, teleconsultation, and telecare. All of these have been evaluated in gastroenterology practice and have demonstrated feasibility and patient preference but have produced mixed results regarding patient outcomes. By combining telemedicine tools and new care models, we can redesign chronic disease management to include fewer in-person visits when patients are well yet increase access for patients who need to be seen. This change could lead to higher-value care by improving the experience of care, decreasing costs, and improving the health of the population. Barriers include reimbursement, licensing, and fear of litigation. However, if we hope to meet the needs of patients within our changing health care system, telemedicine should be incorporated into our strategy.

Connecting the disconnected: Preliminary results and lessons learned from a telepsychology initiative with special management inmates.

The use of telepsychology, such as videoconferencing (VC) systems, has been rapidly increasing as a tool for the provision of mental health services to underserved clients in difficult to access settings. Inmates detained in restrictive housing appear to be at an increased risk of experiencing emotional and behavioral disturbances compared to their general population counterparts, yet they are less likely to receive appropriate treatment due to security constraints. The primary purpose of this article is to describe the process of implementing a novel telepsychology intervention specifically designed to offer group therapy to high-security, administratively segregated inmates. In addition, preliminary results on treatment and therapeutic process outcomes in a sample of 49 participants are reported. Although some evidence indicated that telepsychology was less preferred than in-person sessions, group differences on measures of psychological functioning and criminal thinking were not found across 3 conditions (telepsychology, in-person, and a no-treatment control). Furthermore, a number of limitations associated with program implementation and study design suggest that results be interpreted with caution and should not be used to discount the use of telepsychology as a viable treatment delivery option. Recommendations for future development and evaluation of telepsychological programs are discussed within the context of correctional settings and beyond. (PsycINFO Database Record

Teledermatology and clinical photography: safeguarding patient privacy and mitigating medico-legal risk.

Capturing clinical images is becoming more prevalent in everyday clinical practice, and dermatology lends itself to the use of clinical photographs and teledermatology. "Store-and-forward", whereby clinical images are forwarded to a specialist who later responds with an opinion on diagnosis and management is a popular form of teledermatology. Store-and-forward teledermatology has proven accurate and reliable, accelerating the process of diagnosis and treatment and improving patient outcomes. Practitioners' personal smartphones and other devices are often used to capture and communicate clinical images. Patient privacy can be placed at risk with the use of this technology. Practitioners should obtain consent for taking images, explain how they will be used, apply appropriate security in their digital communications, and delete images and other data on patients from personal devices after saving these to patient health records. Failing to use appropriate security precautions poses an emerging medico-legal risk for practitioners.

Medical board wages war over telephone treatment.

In a case working its way through Texas courts, Teladoc argues that a face-to-face meeting is unnecessary for new patients. Teladoc provides telephone patient consultations, claiming that a phone call with a licensed physician can serve as a convenient supplement when patients don't have the time or money to see their primary care doctors. Some physicians say a phone conversation is not enough to properly diagnose and treat a patient with whom the physician is unfamiliar.