From Pandemic Necessity to A Primary Mode of Care: Assessing Safety in Telemedicine

Before the world changed as we know it in 2020 as the COVID-19 virus swept the globe, the option of delivering care virtually was relatively underutilized. Many clinicians were novices to delivering care virtually and navigating the inability to perform a full physical examination. Between 2019 to 2021, the CDC reported telemedicine technology use across office-based physicians went up from 15.4 percent to 86.5 percent, and now, telemedicine has swiftly transitioned from a secondary option to one of the primary modes of care. Despite the tremendous influence virtual care has on health care access in general, the technology still presents access barriers, in some cases exacerbating disparities of care, and its necessary increased use raised concerns surrounding medical errors in telemedicine.

As we recede further from the peak of the COVID-19 pandemic, we use medical malpractice data as a key measure of the effect of telemedicine on patient safety. Reflecting on discussions from just one year ago, it appears an anticipated surge in telemedicine malpractice cases has still not materialized according to CRICO’s national Candello database.

Looking at cases involving teleradiology, virtual visits and consults, remote patient monitoring, and all other clinical data transmission, asserted claims have been on the decline since 2015. From 2010 to today, less than 300 cases out of over 150,000 involved these telemedicine factors.

Although various statutes of limitations allow several years for claims to be made, these data suggest that malpractice claims involving virtual care during COVID-19 may not materialize as initially feared. However, deeper dives into the data reveal the severity associated with virtual care cases across certain disciplines.

Notably, teleradiology presents a heightened risk for error in the data as discussed in a study conducted by Adam C. Schaffer, MD, MPH, and colleagues. Between January 2010 and March 2022, 135 closed cases in the Candello database involved teleradiology, representing a significant proportion of the asserted cases presented above. The team found cases involving teleradiology were more likely to have higher clinical and financial severity compared to standard radiology cases.

Certain specialties, like telestroke and teleneurology, also face heightened risks due to the critical nature of physical examinations for these conditions and the time-sensitivity of the treatment decisions. For instance, a study published in Neurology Clinical Practice in June 2024 reported that 51 percent of providers believed if the teleneurologic examination were conducted in person, it may have altered their assessment and care plans.

Telemedicine can improve access to care, especially when it comes to providing specialty care to rural areas. However, ongoing efforts are needed to ensure that virtual care remains safe and equitable for all patients.

For example, significant work has been put toward strategies to overcome barriers to virtual care, such as language and technology access. One such effort is the ADVOCATE initiative (Advancing Digital and Virtual Opportunities for Care Access Translates to Equity), a collaboration between Mass General Brigham and Mount Auburn Hospital (part of Beth Israel Lahey Health). This project aimed to identify and create solutions to barriers in the virtual care space, such as developing patient tutorial videos and provider toolkits for best practices.

By learning from data, experiences on the ground, and leveraging technological advancements, we can enhance the quality and safety of telemedicine, making it a sustainable and integral part of modern health care.

Additional Resources

• Video Series: What Not to Do: Telehealth Lessons Learned

• Course: Navigating Virtual Care: Tackling Challenges for Optimal Safety: This CRICO course includes more details on the ADVOCATE initiative and other virtual care projects and is eligible for a maximum of 1AMA PRA Category I Credit.™

• Case Study: A Mismanaged Virtual Visit