Legal Perspectives on Telemedicine Part 1: Legal and Regulatory Issues

Telemedicine is defined as the remote delivery of clinical care services through audio-visual conferencing technology. A shortage of care practitioners combined with an aging population with disproportionately increasing care utilization patterns has created a "perfect storm," which since the late 1990s has propelled telemedicine as a potential solution to bridge this supply/demand and access gap. In critical care approximately 20% of nonfederal adult intensive care unit (ICU) beds in the US today are supported by some form of tele-ICU coverage. The literature has shown with increasing clarity during the last decade that correct tele-ICU implementation improves outcomes and has the potential to significantly improve the financial performance of health care systems. As is often the case in technology-driven innovations, the legal and regulatory framework has been moving slower than the clinical adoption of this new care delivery model, which is true not just in critical care, but in other medical specialties as well. This 2-part series focuses on legal perspectives on telemedicine. The first part discusses legal and regulatory challenges of telemedicine in general, with a more in-depth focus on tele-ICU. The second part will discuss the effects of telemedicine implementation on medicolegal risk, using the litigious critical care environment as an example.