Insights

Challenges of Telemedicine & Digital Medical Records: Unique Problems Impacting Casualty Claims & Injury Assessment

J.S. Held Acquires Shechter & Everett to Expand Forensic Accounting Capabilities for Family Law Disputes in Florida

Read More close Created with Sketch.
Home·Insights·Articles

Introduction

While telemedicine visits and digital health records have brought about significant improvements in healthcare accessibility and efficiency, they also present unique challenges in the context of casualty claims and injury assessment. Our practice has seen a significant uptick in telehealth visits within casualty claims. Many of these visits involve making significant judgement calls and decisions within the absence of a physical exam. In addition, some of the “visits” are phone conferences in which the health care provider does not visually see the injured party.
This article gives a detailed exploration of these challenges and calls for updating or creating new procedures, technologies, and legal approaches that promote more precise assessments of injuries.

Telemedicine Visit Challenges

A. Quality of Examination:

  • Limited Physical Examination: Telemedicine may not allow for a comprehensive physical examination, making it difficult to accurately assess the full extent of injuries.
  • Dependence on Patient's Reporting: Telemedicine relies heavily on patient self-reporting, which can lead to inaccuracies if the patient lacks medical knowledge, understates injuries, or if there is intentional exaggeration.

B. Technology Constraints:

  • Connection and Equipment Issues: Poor internet connection or inadequate equipment can hinder the effectiveness of a telemedicine visit, affecting the quality of the injury assessment.

C. Security Concerns:

  • Privacy and Confidentiality: Ensuring secure connections and maintaining patient confidentiality during virtual visits can be a complex task, potentially leading to legal issues in casualty claims.

D. Potential Bias and Fraud:

  • Questionable Objectivity: The absence of a physical examination might lead to biased assessments, particularly if a medical provider is aligned with a specific party in a claim.
  • Fraudulent Claims: Telemedicine could potentially facilitate fraudulent injury claims, as physical verification becomes more challenging.

Challenges to Digital Health Records

A. Accuracy and Integrity:

  • Inconsistent Records: Digital health records can vary across different medical systems and providers, leading to inconsistencies that make injury assessment more complex.
  • Data Integrity: Ensuring the integrity of digital health records is crucial. Tampering or accidental alteration can misrepresent the nature and extent of injuries.

B. Privacy and Security:

  • Data Breaches: The storage and transmission of digital health records can be vulnerable to hacking and unauthorized access, which can have legal ramifications in casualty claims.
  • Compliance with Regulations: Navigating various privacy regulations like HIPAA in the United States can make handling digital records in the context of casualty claims complex.

C. Interoperability:

  • Lack of Standardization: Different healthcare systems may use various formats and standards for digital records. This makes it challenging to compile and analyze data for injury assessment.
  • Integration Challenges: Incorporating digital health records from various sources into a unified system for evaluation may present technical hurdles.

Conclusion

Telemedicine visits and digital health records have introduced both opportunities and challenges in the injury assessment of casualty claims. While they have streamlined many processes, the potential for quality concerns, technological constraints, security issues, and inconsistencies in records adds layers of complexity to the process. Adapting to these challenges requires careful consideration of these factors and possibly the development of new protocols, technologies, and legal frameworks to ensure accurate and fair injury assessments.

Acknowledgments

We would like to thank Kari Williamson for providing insight and expertise that greatly assisted this research.

Kari Williamson, BS, RN, LNCC, CCM, leads J.S. Held’s Medical Bill Review & Nurse Consulting services. Kari is frequently invited to speak and publish as a leader in the legal nurse consultant field on emerging medical-legal and insurance claims issues, such as data mining, bill audits, medical reviews, internal or external medical assistance, claims education, and new ways to measure and improve outcomes. She writes for a variety of national and regional insurance and legal publications and often speaks to law firms, insurance groups, and other industry organizations.

Kari can be reached at [email protected] or +1 615 398 5229.

Find your expert.

This publication is for educational and general information purposes only. It may contain errors and is provided as is. It is not intended as specific advice, legal, or otherwise. Opinions and views are not necessarily those of J.S. Held or its affiliates and it should not be presumed that J.S. Held subscribes to any particular method, interpretation, or analysis merely because it appears in this publication. We disclaim any representation and/or warranty regarding the accuracy, timeliness, quality, or applicability of any of the contents. You should not act, or fail to act, in reliance on this publication and we disclaim all liability in respect to such actions or failure to act. We assume no responsibility for information contained in this publication and disclaim all liability and damages in respect to such information. This publication is not a substitute for competent legal advice. The content herein may be updated or otherwise modified without notice.

noun_Download_747989_000000 Created with Sketch. Download PDF
You May Also Be Interested In
Perspectives

Case Study: "Red Flags” in a Soft-Tissue MVA Claim

The nurse reviewer in this case study observed a pair of patterns in the medical records for a Motor Vehicle Accident (MVA) that helped to serve as mitigate points in favor for the insurance adjuster...

Perspectives

Case Study: When An Injury Claim Is Made Without An Injury

The claimant in the following case was a 57-year-old restrained driver who was sideswiped while driving next to a semi-tractor trailer attempting to move into her lane. The claimant alleged that the accident caused significant...

Perspectives

How Mental Illness Can Affect Post-Date of Loss Physical Health and Recovery

Pre-Date of Loss anxiety or mental illness can have a profound impact on post-accident or injury recovery. In fact, long-term anxiety, depression, and other mental health issues can play a significant role in how an...

 
INDUSTRY INSIGHTS
Keep up with the latest research and announcements from our team.
Our Experts