The field of teleradiology is an undeveloped legal frontier, according to a healthcare attorney speaking at a SCAR special session to address the challenges and solutions long-distance providers experience.
"Teleradiology represents an exciting clinical vehicle and business venture, but there are numerous legal and licensing challenges and few settled answers," said Thomas Hoffman, associate general counsel for the American College of Radiology.
The traditional state-based legal framework under which medicine operates encumbers an otherwise promising medical and economic direction, he said. The young discipline has yet to generate many legal precedents.
Licensing and credentialing are among the first issues to surface. The question arises, for instance, whether the teleradiologist has to obtain credentials from every hospital in which images are generated, regardless of where the study is interpreted.
The answer appears to be yes. Massachusetts, for one, requires hospital credentials for hospital-based teleradiologists, whether they are reading hospital-generated images down the hall or on the other side of the globe, Hoffman said.
One panelist, Dr. Laurie Gutstein, a Nighthawk Radiology Services teleradiologist based in Sydney, Australia, said she has 45 state licenses and privileges at over 400 U.S. hospitals just to be safe.
The ACR recommends board certification to establish and maintain quality interpretation, according to Hoffman.
If licensing and credentialing are legal land mines, then liability is teleradiology's Bermuda Triangle, he said.
The key question to ask is whether a physician-patient relationship is established when images are interpreted 8000 miles away. The answer is yes if the teleradiologist is providing the official interpretation.
"For a consult, that's a different and more difficult legal question," he said.
Hoffman offered a take-home message to teleradiologists: "Don't interpret without insurance."
ACR has a white paper on international teleradiology issues available at www.acr.org.
