Applications and Current Medico-Legal Challenges of Telemedicine in Ophthalmology

Abstract

Background: The digital revolution is redesigning the healthcare model, and telemedicine offers a good example of the best cost-effectiveness ratio. The COVID-19 pandemic has catalysed the use of the telemedicine. The aim of this review is to describe and discuss the role and the main applications of telemedicine in the ophthalmic clinical practice as well as the related medico-legal aspects. Methods: 45 original articles and 5 reviews focused on this topic and published in English language from 1997 and 2021 were searched on the online databases of Pubmed, Scopus, Web of Sciences and Embase, by using the following key words: “telemedicine”, “privacy”, “ophthalmology”, “COVID-19” and “informed consent”. Results: Telemedicine is able to guarantee patient care using information and communication technologies. Technology creates an opportunity to link doctors with the aim of assessing clinical cases and maintaining high standards of care while performing and saving time as well. Ophthalmology is one of the fields in which telemedicine is most commonly used for patient management. Conclusions: Telemedicine offers benefits to patients in terms of saving time and costs and avoiding physical contact; however, it is necessary to point out significant limitations such as the absence of physical examinations, the possibility of transmission failure and potential violations of privacy and confidentiality.

Impact of the COVID-19 pandemic and COVID vaccination campaign on imaging case volumes and medicolegal aspects

“…In term of regulation, in Italy, the first provision dedicated to the implementation of Telemedicine services is represented by the Agreement between the Government and the Regions on the document containing “Telemedicine-National Guidelines”. guidelines are intended to respond to the need to standardize the experimental initiatives activated ( 25 ). According to a review by Solimini et al, the ethical and legal issues related to telemedicine services still need specific rules for the application to guarantee equitable access, quality of care and respect of patient privacy, data protection, and data protection sustainable costs ( 26 ).…”

Surfing the COVID-19 Tsunami with Teleophthalmology: the Advent of New Models of Eye Care

“…But it was not until the COVID-19 pandemic that teleophthalmology gained unprecedented attention. Lockdown orders, changes in national policies, regulations, and licensing privileges, as well as enhanced reimbursement incentives for telehealth services, drove its adoption on a larger scale [ 18 – 20 ]. In many countries, both governments and professional organizations recommended canceling non-urgent patient visits and procedures, closing retail optical shops, and leaving open only those services, such as eye emergency departments or centers, that were treating urgent or emergency vision-threatening diseases [ 1 , 20 ].…”

“…The exponential growth witnessed during these past 2 years was mainly fostered by allowing the use of communication solutions like WhatsApp, Facetime, or Doxymity [ 41 , 87 , 88 ], the possibility of seeing both new and established patients regardless of their location, and the relaxing of regulations for licensing and reimbursement due to changes in reimbursement policies by Medicare and private insurers due to the public health emergency [ 18 ]. However, as we see the water surge of the tsunami recede, so will the rate of utilization as the restrictions come back into place and the reimbursement policies change.…”

Effect of COVID-19 Lockdowns on Eye Emergency Department, Increasing Prevalence of Uveitis and Optic Neuritis in the COVID-19 Era

“…Prior to COVID-19 pandemic retinopathy of prematurity, diabetic retinopathy, and age-related macular degeneration were the mainstay of remotely controlled disorders in ophthalmology [ 13 , 14 , 15 ]. However, both the range of telemedicine tools (programs, devices) and the number of centers and doctors engaged in tele-visits, contributed to its development and providing care to patients with a broader spectrum of ocular disorders [ 16 , 17 , 18 ]. Nevertheless, some of the ocular disorders might not be properly diagnosed virtually, retina and choroid inflammations being the typical examples [ 12 , 17 , 19 ].…”