Legal, Ethical, and Regulatory Issues:
Hutcherson, MS, RN Abstract During the last century the world has become increasingly reliant on a variety of technologies to manage information needs. Escalation in deployment of remote technology to enhance health care, accompanied by expanded public and private reimbursement for distant care, indicates increasing acceptance of these technologies.
Yet many legal and regulatory questions regarding the provision of health care using these technologies remain. This article will discuss the foundations of telehealth nursing and address legal and regulatory issues emerging from this new practice modality.
Online Journal of Issues in Nursing. Health websites proliferated, ranging from those offering a wide array of health information to sites dedicated to specific disease entities.
Health-related information emerged as among the most frequently sought material on the Internet. Concurrently, more sophisticated electronic monitoring and assessment tools were developed, facilitating innovative approaches to remote monitoring of health status.
This remote monitoring capability resulted in creative approaches to disease management. Technology that gathers and electronically transmits patient data to the physician for evaluation holds promise for saving both patient and providers substantial dollars.
Escalation in deployment of remote technology to enhance health care, accompanied by expanded public and private reimbursement for distance care, indicates that the U. This article will discuss the foundations of telehealth nursing and addresses legal and regulatory issues emerging from this new practice modality.
As is often the case, adoption of innovative new approaches to care has occurred at a much more rapid pace than legal and regulatory questions have been answered. Constitution, each state is empowered to establish laws to protect the citizens of the respective state.
Thus the century old, state-based licensure structure is now being challenged by an exploding world of technology and entrepreneurial care delivery services which are completely impervious to the confines of invisible state borders. A component of this "public protection" mandate is the state responsibility for establishing standards for health care professionals who provide services for citizens of that state.
For almost a hundred years, America has had a firmly established system for issuing state-based licenses to health care providers, including authorization to practice within the boundaries of the state that issued the license. However, no state is empowered to grant authority for professional practice in another state.
Until recent years, licensure was not seen as an impediment to providing health care because the health facility, the health care provider, and the patient were almost always in the same location; and providers were licensed where the care was given.
With the advent of multistate delivery systems and nursing call centers, however, the nurse and the patient are often in different geographical locations.
Federal Involvement The Balanced Budget Act BBA of provided an impetus to the development of telehealth when it authorized Medicare telemedicine reimbursement under certain circumstances.
Additionally, substantial federal dollars were earmarked for telemedicine grants to determine the viability of telemedicine to increase access to quality health care services for the underserved through use of advanced telecommunications and information technologies by rural health providers.
Medicare currently pays for teleconsultation using two-way interactive video encounters as a substitute for "face to face" visits, but only if the patient is a part of the interactive video session. To assist with evaluation of the overall telemedicine environment, Congress mandated preparation of a comprehensive report analyzing the obstacles to the advancement of telemedicine.
The section of this report on legal and regulatory issue primarily addressed licensure with some discussion of liability. This article will address major barriers related to legal and regulatory issues of telehealth.
Other articles in the Online Journal of Issues in Nursing Topic of Teleheath address issues relating to payment, privacy, security and confidentiality issues.
Telehealth Practice The term telemedicine was originated by early international relief endeavors and fueled by technological advances of the space program.
The incorporation of distance care into health care practice produces terms, such as: The multiplicity of telemedicine applications ranges from POTS plain old telephone system to such high technology practices as remote surgery. The role of nursing is an integral component of telehealth practice.
Some telehealth programs are based almost entirely on provision of nursing care while others focus on enhancing the ability of physicians to provide diagnostic services. The three areas of greatest interest to nurses are: In discussing legal and regulatory issues, the terms telemedicine and telehealth may be used interchangeably, depending on the context - yet always referring to the practice of using electronic technology to provide patient care over distance.
In the Department of Health and Human Service Report to Congress, "telemedicine" referred to "the use of electronic communication and information technologies to provide or support clinical care at a distance.
In the Report to Congress, telehealth is defined as the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.
Although a myriad of legal and regulatory questions surround telehealth practice, at this point, lawsuits specifically indicating practice across state lines as a critical factor in the lawsuit have not been reported.
It is important to note, that most telehealth programs are acutely attuned to quality issues and patient care follow-up, and aggressively monitor the outcome of recommended interventions.
Patient satisfactions reports are consistently high. Telehealth Nursing Practice A major objective of the "restructuring" of the American health care system was to increase quality and access of care and to minimize cost. An outgrowth of these changes in the delivery system is the proliferation of nursing call centers that provide telephone triage, health information and referral services.
Some call center systems maintain large centralized operations serving multiple states, while others provide "off hours" support for clinics, small hospitals and medical facilities. This 24 hour access to health care resources has proven so popular that many insurance providers now provide all members with access to a nurse via an "" telephone number.PAPER 1 FOR "ANIL AGGRAWAL'S INTERNET JOURNAL OF FORENSIC MEDICINE AND TOXICOLOGY.
THE TITLE OF THE PAPER IS "Ethical and Legal aspects of Artificial Reproductive Techniques including surrogacy". THE JOURNAL IS THE WORLD'S FIRST ONLINE JOURNAL OF FORENSIC MEDICINE.
GIVES LATEST INFORMATION ON FORENSIC MEDICINE AND . The initial part constitutes ethical issues in marketing and subsequently the legal issues in marketing are discussed through focus on certain regulatory bodies. As a part of the overall discussion, the present paper has also attempted to understand the considerations of legal and ethical issues while formulating and implementing the marketing.
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Also, describe how Continental Airlines' website handles security, confidentiality, and International issues. Legal, Ethical, and Safety Issues in the Healthcare Workplace Learning Objectives health ethics, research ethics, and workplace bullying will be described in this chapter.
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