Message Deleted? Resolving Physician-Patient E-mail through Contract Law

This article examines the impact of e-mail on the physician-patient relationship, and how contract law can resolve the uncertainties incumbent in this nascent form of communication. Significantly, courts have yet to indicate when the physician-patient relationship begins by e-mail, or to what extent e-mail affects the duties of the relationship. Instead of waiting for judicial guidance, physicians and patients can employ specialized contracts to clarify the role that e-mail plays in their relationship. As a result, more physicians and patients will regard e-mail correspondence as a valuable means of communication, and a tool for improving the quality of health care as well

PSRO update

Newsletter for Massachusetts physicians, providing updates on the development of Professional Standards Review Organizations (PSROs) as Medicare and Medicaid standards were established

Malpractice and Other Legal Issues Preventing the Development of Telemedicine

Even though most Americans have not heard of telemedicine, the federal government is already actively involved in developing a national telemedicine strategy. This note attempts to accomplish the following: demonstrate the urgent need of rural communities to gain access to adequate health care; clarify how telemedicine can provide enhanced health care to rural communities; and analyze the legal obstacles that have prevented, thus far, the most beneficial utilization of telemedicine. In particular, this note will examine how malpractice claims arising from telemedicine consultations might be resolved. An important issue to recognize at the outset, and one that consistently reappears throughout this discussion, is that health care and the tort claims that arise out of health care are normally defined by state law, but telemedicine is not restricted by state boundaries. The laws of the state where the patient resides or where the consulting physician resides could control an action, or federal law could preempt any state law

TraumAID: AI Support in the Management of Multiple Trauma

This paper outlines the particular demands that multiple trauma makes on systems designed to provide appropriate decision support, and the ways that these demands are currently being met in our system, TraumAID. The demands follow from: (1) the nature of trauma and the procedures used in its diagnosis, (2) the need to adjust diagnostic and therapeutic procedures to available resource levels, (3) the role of anatomy in trauma and the need for anatomical reasoning, (4) the role of non-specialists in managing trauma, and (5) the competing demands of multiple injuries and the consequent need for planning. We believe that these demands are not unique to multiple trauma, so that the paper may be of general interest to expert system research and development

TraumAID: Reasoning and Planning in the Initial Definitive Management of Multiple Injuries

The TraumAID system has been designed to provide computerized decision support to optimize the initial definitive management of acutely injured patients after resuscitation and stabilization. The currently deployed system, TraumAID 1.0, addresses penetrating injuries to the abdomen and to the chest. Our experience with TraumAID 1.0 has demonstrated some major deficiencies in rule-based reasoners that are faced with problems of both diagnosis and treatment. To address these deficiencies, we have redesigned the system (TraumAID 2.0), factoring it into two modules: (1) a rule-based reasoner embodying the knowledge and logical machinery needed to link clinical evidence to diagnostic and therapeutic goals, and (2) a planner embodying the global knowledge and logical machinery needed to create a plan that addresses combinations of goals. After describing TraumAID 2.0, we discuss an extension of the TraumAID interface (critique mode interaction) that may improve its acceptability in a clinical setting. We close with a brief discussion of management support in resource-limited environments, which is an important issue in the time-critical context of multiple trauma

Telemedicine and Integrated Health Care Delivery: Compounding Malpractice Liability

This Article considers how theories of medical negligence might be applied in the context of telemedicine and integrated delivery health plans. Part Two summarizes the history of telemedicine, its increasing breadth of application and opportunity and promise for the future. Part Three reviews traditional negligence principles and precedents and demonstrates how they might be applied when a telemedicine interaction results in negligence and harm to the patient. Part Four discusses evolving theories of shared liability applicable to health plans and managed care entities. Finally, Part Five demonstrates how shared liability theories will be applied to situations involving telemedicine technologies