Dana Orquiza

Dana Orquiza

Today, we celebrate and honor the courageous men and women who have made sacrifices to serve and protect our nation.  It is great that we have a day to recognize these patriotic individuals since gratitude is something that can be neglected in our daily, hectic lives.  Today, I am reflecting upon our nation’s veterans, the changing delivery of healthcare in today’s environment and a new generation of healthcare risks associated with expanding technology.


Telemedicine at the VA

The Veterans Health Administration (VA) provides healthcare to 8.76 million veterans annually. The challenges faced by the VA, as well as all healthcare organizations, is improving quality care, expanding access and changing the delivery of healthcare in the face of economic pressures. This year, the VA spent approximately $500 million on telehealth services.


Considering the vast number of veterans spread throughout the nation, telehealth provides a “system of care without walls”. The VA’s goal is to “treat the whole person, not the symptoms or diseases” and assist veterans with making better informed decisions that improve their health and ultimately quality of life“.


Currently, the VA is piloting a study for seriously injured veterans post 9-11 using iPads loaded with ten healthcare applications.  The VA’s goal is to get veterans actively engaged and integrated in their medical care.


The applications allow veterans to communicate with their healthcare provider, refill prescriptions and review their medical record, including vital signs, labs and radiology reports.  Access, engagement and efficiency, rather than convenience, appears to be the focus since the VA wants veterans to be able to access care “no matter where they live”.


E-Care Video Visits at Stanford Hospital & Clinics

The VA’s pilot study lead me back to the telemedicine program at our organization.  In September of this year, Stanford Hospital & Clinics launched a program similar to the VA, ECare Video Visits. The program is specifically designed to provide convenient, non-critical patient care accessible by fingertip.


The web-based video conference is integrated into primary care processes where patients virtually interact with their care providers, rather than traditional in-office visits. Access and convenience is attractive for those who are relatively healthy and live active, busy lives.


Now, what’s next with Obamacare and Telemedicine? 

According to a CMS publication and the Affordable Care Act (ACA), the use of technology will promote preventative care to achieve overall wellness.  With Medicare paying over $17 billion each year for chronic readmission problems , the government hopes to improve healthcare by lowering readmission rates through the use of technology. “Previous demonstrations have shown that providers working together in well-resourced health care systems can drive down costs and improve the quality of care, but until now this approach has not been available to community health centers serving vulnerable populations working with more limited resources.”


Today, there are approximately 17 states that have telemedicine laws.  Two years ago, California’s governor reduced barriers to telemedicine when he signed a new telehealth law effective January 1, 2012.  (California Medical Association, CMA Legal Counsel, January 2013). This law removed arduous requirements that made healthcare practitioners subject to additional standards for informed consent and medical records.   (California Medical Association, CMA Legal Counsel, January 2013).


The new law defines telehealth as  “the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at a distant site.  Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.


New Risks for Telemedicine?

As a patient and tech enamored individual, I am thrilled about the possibilities of healthcare at my fingertips and living life like the cartoon family, the Jetsons.  After all, I already log in my marathon miles and diet ratio of protein, fats and carbs using today’s hottest tech applications.


As a healthcare risk management professional, I feel that we have an even bigger iceberg to assess.  Telemedicine brings unique risk and liability issues that have not yet skimmed the surface.  Our ability to anticipate risks is limited and unfortunately can only be made more concrete once the devil in the details rears its ugly head;  similar to the journey made during the electronic health record transition.


Armed with current articles regarding telemedicine pilots, the latest risk management publications, and a white paper providing a summary of malpractice and patient safety risks related to telemedicine, I plan to venture onto the battlefields of telemedicine, which include informed consent, continuity of care, tech reliability and telepsychiatry.


Telemedicine is a double edged sword.  It can improve the delivery of healthcare through integration and by providing accessibility, but it may also bring injury and casualties if we are not diligent in our efforts. Similar to our soldiers who served and continue to serve our nation with great pride and heroism, I can only hope that the healthcare risk management profession continues to assist with providing safe, quality care to all patients each and every single time.


By Dana Orquiza, RN, BSN, JD

Dana Orquiza is a healthcare risk management professional whose experience includes working as a medical-surgical nurse for over 10 years and as an associate attorney specializing in medical malpractice defense. Dana currently serves as Assistant Vice President of Risk Management of The Risk Authority, and as a director of risk management at Stanford University Medical Center. Her combination of clinical experience and legal expertise is instrumental in providing innovative risk management solutions designed to effectively reduce risk and identify opportunities to increase value.