When telemedicine consultations are being done in the emergency department, the security and integrity of the patient’s protected health information understandably often isn’t the highest priority.
Weaknesses in data integrity become apparent almost immediately as data is entered into the electronic health record system, but a patient’s identity may not yet be validated. As more information is found, it may not be as accurate as processes dictate, but the reality is that patient care comes first.
A bigger identity problem arises in the non-emergency telehealth environment when an individual without insurance using the identity of a buddy—perhaps even the friend’s insurance card—to get treatment, says Ralph Derrickson, president and CEO at Carena, a telemedicine vendor serving 160 hospitals.
“It is common for those with access to services to help those without services,” Derrickson explains. That’s when “the weaknesses in our systems are exposed. But it is not done for malicious gain.”
Still, that represents a serious patient safety issue, he adds. The patient in front of the physician may have allergies of which the physician is not aware, because those conditions do not show up in the electronic health records system, but the physician may go ahead and prescribe medications that may not be appropriate for the patient in front of him.
Sometimes, a patient with an established telemedicine relationship with a physician will help a sick friend by misleading the doctor—for example, he may say that he believes he has a sinus infection, and if the physician agrees after a consultation, he may write a prescription, and the patient will then give the medication to the friend.
To avoid doctor-shopping via telemedicine, physicians should have a process to authenticate the patient, Derrickson contends.
The process includes running an insurance eligibility check, confirming the name, address, date of birth and Social Security number. If the patient has been seen before, the doctor can ask a series of questions on prior medical history to determine if patient responses match what is in the medical records. If not, the patient may be trying to get medication for another person.
“You need to take time to have a conversation and make sure you know who the patient really is and provide the right information,” Derrickson counsels. “But most patients just want help and to give good information.”
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