Beyond real time: The next chapter in digital health

Jennifer Schoenthal, Virtual Care underwriter at Beazley

The surge in take-up of telehealth services in the United States since the onset of COVID-19 has largely been driven by more real-time doctor-patient virtual consultations, which in many ways offer patients a proxy for the face-to-face interaction they would get at a hospital or physician’s office. But where many in this space are turning their attention to is how to integrate asynchronous – or ‘store and forward’ – care more widely, to provide remote monitoring and diagnosis using apps, wearables and other technologies.

Asynchronous care has been used for some time to transfer medical information electronically outside of real time; for example, sending a patient’s x-rays from one country for overnight analysis by a specialist physician in another, through to the launch of the first drug containing an inbuilt sensor that tracks tablet ingestion via a smartphone. [1] The potential for this form of care to play a greater role in the care and management of chronic conditions has been recognized. A study published by Massachusetts General Hospital in 2018, for example, used asynchronous online interactions to support hypertension patients with blood pressure management, which were found to improve responsiveness and safety outcomes. [2]  Without the need for live interactions, it offers the potential of greater convenience and flexibility in service delivery across time zones. And for many, it is today looking like the next frontier in telehealth. 

Managing new risks

Alongside significant potential benefits, the added ‘distance’ that it creates from the patient also raises new and interconnected risks for health providers, from additional professional liability risks to privacy and security issues, which both healthcare organizations and their insurers must consider.

Asynchronous care by its nature enables monitoring using technology and AI however, from a liability perspective health providers retain responsibility for assessing the data and intervening when required. Not only that, providers need to ensure the technology is functioning as it ought in order to protect the patient’s health, especially when it is running unmonitored for often long periods of time. Attention must be paid to ensuring the patient is using the correct equipment or technology platform and is fully informed in how to use it. These fresh liability exposures along with wider medical malpractice risks associated with bodily injury need to be managed and understood. A health professional can potentially be held to the same standard of care when providing care asynchronously as would be applied to an in-person healthcare setting.

To make sure patients are on board with this form of remote healthcare, it is important that they are reassured that increased technological intervention does not compromise either their safety or their health or personal data.   

Managing data securely

The introduction of asynchronous care is likely to raise additional concerns around the privacy and security of data being transmitted electronically. Professionals using telehealth receive considerable amounts of data from a variety of sources and on a sporadic basis, which they are expected to access, triage and respond to appropriately and within a reasonable timeframe. It will often require a patient to enter and download data and other material via a secure portal, which may include completing an interactive medical questionnaire. Consequently, patients need firm assurance that data is being stored and protected securely. Providers must therefore develop and maintain robust data security policies and procedures and have appropriate risk management and transfer measures in place.   

Data and technology risks in asynchronous care delivery include:

  • Failure to intervene
  • Poor data information capture due to patient or technology error
  • Failure to communicate, store and protect information appropriately
  • Poor interpretation and diagnosis of data
  • Incorrect treatment based on flawed input data, technology failure or professional failure
  • Failure of AI patient profiling
  • Data breach & privacy compromise
  • Business interruption due to cyber threat
  • Regulatory breach 

Changing regulatory and reimbursement structures which include asynchronous care within the definition of telehealth, more comfort around the use of new technologies, and patients who are more willing to conduct their healthcare online, all have the potential to drive growth in this area.

Add the potential benefits in dealing with a variety of patients and treatment needs, asynchronous care is likely to become a mainstay in the development and growth of telehealth in both the US and internationally. However, it brings additional complexities and interconnected risk factors to the delivery of virtual care services that health providers in this space understand and should work with their brokers and specialist insurers to address.               

[1]https://www.fda.gov/news-events/press-announcements/fda-approves-pill-sensor-digitally-tracks-if-patients-have-ingested-their-medication

[2]https://www.healthleadersmedia.com/innovation/asynchronous-virtual-visits-save-time-provide-effective-care

Disclaimer:   The information set forth in this document is intended as general risk management information. It is made available with the understanding that Beazley does not render legal services or advice. It should not be construed or relied upon as legal advice and is not intended as a substitute for consultation with counsel. Beazley has not examined and/ or had access to any particular circumstances, needs, contracts and/or operations of any party having access to this document. There may be specific issues under applicable law, or related to the particular circumstances of your contracts or operations, for which you may wish the assistance of counsel. Although reasonable care has been taken in preparing the information set forth in this document, Beazley accepts no responsibility for any errors it may contain or for any losses allegedly attributable to this information.

About the author:

Jennifer underwrites a wide range of risks found within the miscellaneous healthcare sector including categories such as healthcare staffing, home health, behavioral health, chemical detox, tissue/blood banks, organ procurement organizations, contract research organizations (CROs), correctional healthcare, medi-spas, occupational health, dialysis clinics, ground and air ambulances. Jennifer is the lead underwriter and manager of the Beazley Virtual Care product, a pioneering insurance policy that covers all organizations involved in the provision of telemedicine/telehealth. Prior to joining Beazley Jennifer worked for a Program Manager, who is a Lloyd's of London coverholder, developing programs for Allied Health, Products Liability and Medical Spas. She has over 20 years market experience with 12 of those years focusing on Professional Liability.

Jennifer Schoenthal
Jennifer Schoenthal

Underwriter - Miscellaneous Medical & Life Sciences