Thanks to the "information superhig...

Thanks to the "information superhighway" and the increasing use of telecommunications to deliver services, health care professionals are stand over againsted with new questions regarding the ownership, quality, and security of the electronic information that is created, transmitted, and eventually stored as a rise of these services. As health care connected views extend across state lines--even the globe--to provide services to patients, additional questions regarding professional licensure, reimbursement, and liability loom upon the horizon.

The meaning of this article is to discuss a of the legal issues that stand in front of today's health care professionals as they manage the many opportunities (and challenges) associated with the increasing use of telecommunications in the delivery of health care services, known as "telehealth." The time telehealth in this article can best be described as the delivery of health care services across distances by the agency of the use of telecommunications and interactive audiovisual capabilities.

TELECOMMUNICATIONS IN HEALTH CARE

across the years, telecommunications have evolv to the point that audiovisual and digital data can be transmitted to and from alien locations around the world. Just as teleradiology first made diagnostic services available to isolated communities, teleconferencing has provided meaningful opportunities for long-distance programs and consultations among and between health care professionals and their patients. modern developments in telesurgery, including the use of remote-controll robotic devices and artificial intelligence, have, to a limited stretch made emergency services available to victims during times of war or disaster.

Generally speaking, the transmission of information to alien locations requires one of many different models of technology, ranging from microwaves and satellite links to long-distance telephone lines and high-speed switching rules that depend on fiber-optic cable and computer modem Whereas a simple a whole permits a laboratory to transmit preoperative trial results to a busy surgery center a more elaborate rule that involves two-way video and audio capabilities would allow a patient's surgery for example, to be controll through a host of providers located in multiple, and sometimes separated locations. Despite its many benefits, however, telehealth raises many questions regarding the special management of patient care as well as the many sources of information that are created and transmitted as a proceed of these sweeping technologies.

INFORMATION MANAGEMENT

Legal and ethical requirements that defend a patient's privacy and the confidential nature of the patient's personal health care information cause all health care professionals to act prudently in the management of patient care services and related information rules These requirements become particularly important as health care bodys move toward a continuum of care that integrates a entertainer of satellite service locations and provider clumps that often require access to and use of confidential database systems

Existing laws tender only limited protection. Although state laws attempt to defend confidential patient care information and records, these laws may vary as they relate to different provider form into groupss within a given state, and more importantly, significant differences meet the eye from state to state. Given the increasing ne to transmit information across state lines--and uniform the globe--these inconsistencies and gaps single aggravate the situation further. Although federal laws of the like kind as the Privacy Act of 1974 and the Americans with Disabilities Act begin to address these issues, many inconsistencies and gaps will remain until Congres passes legislation similar to the initiatives introduced in past years (eg Medical Records Confidentiality Act of 1995 [S1360 104th Congres first session]; Fair Health Information Practices Act [HR 435 104th Congres first session, 1995]; Medical Privacy in the Age of of recent origin Technology Act [HR 3482, 104th Congres inferior session, 1996]).

Database user agreements that are used at health care systems and their medical staff members and other participating providers have become important in clarifying the many operating proceedings and safety measures that users must agree to for access to and use of a database. "Hold harmless" language also is included in these agreements to limit the system's liability for any unauthorized access, use, or disclosure at a particular user or united of the user's office personnel

LICENSURE

The general dominion about professional licensure is that out-of-state health care professionals who act as consultants to in-state practitioners may be imagineed to engage in the unauthorized practice of medicine if they are not licensed in the couple states. Consistent with this reasoning, many states have enacted specific requirements for out-of-state physicians who provide diagnostic or treatment services involving patients who are physically located within the particular state (Ken Admin Reg 100-26-1 [1995]; SD Codified Laws Ann 36-4-41 [1996]; Tex digest Ann Art 4495[b], 3.06[I][1] [West 1995]) To date, no states have passed legislation aimed at regulating the practice of nursing across state lines.