ABSTRACT:The aim of this policy statement is to provide a comprehensive review of the scientific evidence evaluating the use of telemedicine in cardiovascular and stroke care and to provide consensus policy suggestions. We evaluate the effectiveness of telehealth in advancing healthcare quality, identify legal and regulatory barriers that impede telehealth adoption or delivery, propose steps to overcome these barriers, and identify areas for future research to ensure that telehealth continues to enhance the quality of cardiovascular and stroke care. The result of these efforts is designed to promote telehealth models that ensure better patient access to high-quality cardiovascular and stroke care while striving for optimal protection of patient safety and privacy. INTRODUCTION Telehealth: Opportunity to Reduce the Costs and Burden of Cardiovascular Disease and StrokeThe United States finds itself at a pivotal moment in the history of medicine when the annual growth in US healthcare spending increased to 5.3% in 2014, up from 2.9% in 2013, after 5 consecutive years of historically low growth.1 Spending on federal healthcare programs continues to grow significantly.2 Regardless, the need to provide high-quality care continues. More than 85 million Americans (≈26% of the US population) suffer from cardiovascular disease (CVD), and nearly 7 million (2.2%) are stroke survivors. CVD and stroke cost the US healthcare system more than $320 billion and $33 billion, respectively, each year, and by 2030, annual costs of CVD and stroke are projected to balloon to nearly $1 trillion.3 Now more than ever, strategies are needed to increase the value of health care by increasing the quality of care and lowering costs.Enhancing patient access to care via telehealth is an important strategy to help address this challenge. Telehealth, as defined by Office for the Advancement of Telehealth, comprises the use of telecommunications and information technologies to share information and to provide clinical care, education, public health, and administrative services at a distance. 4 Telehealth is a broad term that encompasses many digital health technologies, including telemedicine, eHealth, connected health, and mHealth. Telehealth is a new method of enabling care delivery that has the potential to help transform the healthcare system, to reduce costs, and to increase quality, patient-centeredness, and patient satisfaction. [5][6][7] In particular, telehealth may increase access and convenience for patients with CVD and stroke.8 This is especially true for vulnerable patients with CVD or stroke who, because of their geographical location, physical disability, advanced chronic disease, or difficulty with POLICY STATEMENTSsecuring transportation, may not otherwise access specialty healthcare services. 6,7 Yet, telehealth is underused for the management of CVD and stroke, and several barriers to the successful implementation of telehealth interventions for CVD and stroke exist, including cultural, financial, and legal or regulatory const...

Telemedicine use has increased substantially in recent years, in part due to the COVID-19 pandemic. 1,2 Although patients and dermatologists have become more comfortable with telemedicine and its benefits, concerns remain regarding suboptimal diagnosis and management, image quality, internet access, patient triage, uncoordinated care by direct-to-consumer companies, and insurance coverage. 3 In dermatology, issues related to the diagnosis and management of skin cancer are among the most common malpractice claims and account for the largest sums awarded. 4 Although research suggests that telemedicine has a low risk for malpractice, 1 to our knowledge, the malpractice risk associated with the use of telemedicine for the of management skin cancer has not been studied. This study sought to assess all publicly reported cases of malpractice associated with the telemedicine management of skin cancer.Methods | This database study used only publicly available data and did not involve human participants. It was therefore exempt from review by the institutional review boards at Yale University and Massachusetts General Hospital and the requirements for patient informed consent.Using previously described methodologies, 1,5 we performed a search of the LexisNexis legal case database between January 15 and February 15, 2021, for all publicly reported cases from federal and state courts. A reported case includes any judicial action of a court, including judgments, rulings, opinions, dismissals, or other official actions. We searched for cases dated from January 1, 1950, to January 1, 2021, using 36 queries derived from relevant terms, including telemedicine, malpractice, and skin cancer (Figure).One of us (A.L.F.) reviewed the reported cases for their relevance to telemedicine. Cases were excluded if they did not involve medical practice allegations or if the medical issues did not pertain to the diagnosis or management of skin cancer. Cases were not limited by medical specialty.

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