Medicolegal Sidebar: Telemedicine—New Opportunities and New Risks

Hoaglin, Michael C.; Brenner, Lawrence H.; Teo, Wendy; Bal, B. Sonny

doi:10.1097/corr.0000000000001856

Cited by 5 publications

(1 citation statement)

References 5 publications

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“…31 Indeed, one concern related to telemedicine is the challenge of diagnosing and treating patients without direct observation and the corresponding risk of litigation. 32 Until orthopaedic telemedicine consults are more widely adopted, the true risk of misdiagnosis or inappropriate triage based on virtual evaluation will not be known. Aside from legal concerns, the current reimbursement model typically centers around "fee-forservice," and an orthopaedic surgeon may not be incen-tivized to facilitate care of a patient at an external ED.…”

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confidence: 99%

A Telemedicine Solution to Minimize Unnecessary Emergency Department Transfers for Low-acuity Pediatric Orthopaedic Patients: A Model for Cost Minimization

Maheu,

Shih,

LeBrun

et al. 2023

J Am Acad Orthop Surg

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Introduction: Unnecessary emergency department (ED) transfers represent a notable source of excess costs and misutilization of healthcare resources, particularly with management of acute pediatric musculoskeletal injuries. This study used institutional data to create a model investigating the expected costs of a formal peer-to-peer telemedicine intervention designed to triage pediatric orthopaedic transfers, which we hypothesized would decrease healthcare costs by minimizing unwarranted ED-to-ED transfers. Methods: In this retrospective modeling analysis, 350 pediatric orthopaedic trauma patients transferred to two in-network referral hospitals from outside facilities were identified and stratified into three groups representing how patients theoretically optimally could have been treated. Group 1 patients required ambulance transfer, group 2 patients required ED-level care but no ambulance transfer, and group 3 patients did not require ED-level care. Base case estimates for the proportions of patients in each group, probability of ambulance transport, and direct costs of care for each patient were derived from the database. A decision tree was developed to evaluate the expected costs of two triaging strategies: (1) transfer everyone or (2) triage first using e-consultation. Probabilistic sensitivity analyses were used to determine how the results of the decision analysis varied across ranges of cost and probability estimates. Results: In the base case analysis, the telemedicine triage strategy was cheaper than the transfer-all strategy ($4,858 versus $6,610). In a 2-way sensitivity analysis comparing cost of a telemedicine visit and proportion of telemedicine triaged patients requiring ambulance transport, the telemedicine triage strategy remained cheaper than the transfer-all strategy across almost all possibilities for both variables. Additional potential benefits of triage before transfer, such as decreased length of time to completion of ED visit, cost to the family, and patient comfort and satisfaction, were not incorporated into this analysis. The potential for misdiagnosis related to telehealth and its potential costs were not included. Discussion: We revealed substantial cost savings for the healthcare system from implementing a telehealth platform for peer-to-peer consultation when considering patient transfer for musculoskeletal trauma. Initial peer-to-peer e-consultations cost less than reflexive ambulance transfer in most situations. Level of evidence: Economic Level V

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Section: Figurementioning

confidence: 99%

A Telemedicine Solution to Minimize Unnecessary Emergency Department Transfers for Low-acuity Pediatric Orthopaedic Patients: A Model for Cost Minimization

Maheu,

Shih,

LeBrun

et al. 2023

J Am Acad Orthop Surg

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Technology-enabled cure and care: An application of innovation resistance theory to telemedicine apps in an emerging market context

Kautish

Siddiqui

et al. 2023

Technological Forecasting and Social Change

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Assessing women's and health professionals' views on developing a midwifery‐led mobile health app intervention in pregnancy: A descriptive qualitative study

Dai,

Min,

Sun

et al. 2024

Journal of Advanced Nursing

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AimsTo explore women's and health professionals' views on the development of a midwifery‐led mHealth app intervention in antenatal care and their demands for app functionality.DesignDescriptive qualitative research was utilized.MethodsIn total, 15 pregnant or postpartum women were interviewed via in‐depth interviews and 10 health professionals including obstetricians, midwives and obstetric nurses were invited to participate in a focus group discussion (FGD). All interviews and the FGD were analysed using qualitative content analysis.ResultsFour key themes emerged from the data, including (1) limitations of current maternity care services; (2) potential benefits for mHealth app‐based midwifery care; (3) possible challenges for providing midwifery care through mHealth apps and (4) suggestions and needs for developing a midwifery‐led mHealth app. Participants agreed on the potential need of developing a midwifery‐led mHealth app in antenatal care to increase access to midwifery care services and to meet women's diverse needs. Participants preferred to develop professional, reliable, full‐featured and interactive mobile applications. The main functions of midwifery‐led mHealth apps included personalized assessment and health education, self‐monitoring and feedback, data sharing and interactive functions. Women mentioned that online communication and consultation with midwives could help them receive continuous support outside facilities. Health professionals expressed it would be of great convenience and timeliness to send personalized messages to women and to inform them of healthy lifestyles during pregnancy. The challenges included a shortage of human resources, medico‐legal risks associated with mHealth and data security risks.ConclusionsThis study explores the individual views and functional needs of target users and healthcare providers for developing a midwifery‐led mHealth app in antenatal care, which will serve as a reference for future application development.ImpactOur study has important and practical implications for guiding the development of future midwifery‐led mHealth app interventions.Patient or Public ContributionNo patient or public contribution.

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Medicolegal Sidebar: Telemedicine—New Opportunities and New Risks

Cited by 5 publications

References 5 publications

A Telemedicine Solution to Minimize Unnecessary Emergency Department Transfers for Low-acuity Pediatric Orthopaedic Patients: A Model for Cost Minimization

A Telemedicine Solution to Minimize Unnecessary Emergency Department Transfers for Low-acuity Pediatric Orthopaedic Patients: A Model for Cost Minimization

Technology-enabled cure and care: An application of innovation resistance theory to telemedicine apps in an emerging market context

Assessing women's and health professionals' views on developing a midwifery‐led mobile health app intervention in pregnancy: A descriptive qualitative study

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