Does teleradiology increase malpractice liability for radiologists?

Medical malpractice cases involving teleradiology tend to be more severe and result in higher indemnity payments than other radiology malpractice claims, according to research published on 2 April in Radiology.

In a retrospective review of medical malpractice claims over a 12-year period, researchers from Harvard Medical School led by Dr. Adam Schaffer found that teleradiology claims were more likely to involve patient death, as well as indemnity payments (and higher amounts). The teleradiology cases also more frequently involved interprovider communication problems.

“These attributes of teleradiology claims underscore their impact within the medicolegal and patient safety landscape,” the authors wrote.

In an effort to assess the characteristics of teleradiology and nonteleradiology radiology malpractice claims, the researchers used Candelo -- a national database of medical malpractice claims – to gather data on claims between January 2010 and March 2022 in which telemedicine was coded as one of the contributing factors. They manually reviewed each of these claims to identify teleradiology cases.

Next, they compared those cases with nonteleradiology cases that had closed during the same period of time in which radiology was deemed to be the primary responsible clinical service, according to the researchers. There were 3,474 radiology malpractice cases and 135 teleradiology cases during the period.

Characteristics of malpractice claims
Radiology malpractice claims (nonteleradiology) Teleradiology malpractice claims
Patient death 685/3,474 (19.7%) 48/135 (35.6%)
Closed with indemnity payment 1,416/3,474 (40.8%) 79/135 (58.5%)
Median Indemnity payment amount $214,063 (€198,000) $339,230 (€313,000)
All differences were statistically significant.

Delving further into the data, the researchers also observed that cerebrovascular disease was more common diagnosis among teleradiology malpractice cases (9.6%) than regular radiology malpractice cases (3.6%). Furthermore, they determined that communication problems between providers were a more frequent problem in teleradiology cases (25.9%) than in radiology cases (12.6%). Those differences were also statistically significant (p = 0.02 and p < 0.001, respectively).

“Care provided by means of teleradiology warrants attention from patient safety officials,” the authors wrote. “Optimizing communication between the teleradiologist and on-site clinical team is one way to potentially enhance the safety of teleradiology care.”

They acknowledged several limitations to their study, including that its findings may not be fully nationally representative as it relied on a database that contains about 30% of all claims in the U.S. Other limitations include an imperfect comparison group, reliance on review of clinical summaries and not primary medical records, and the lack of detailed information about the institutions and physicians involved in the cases, according to the authors.

However, the researchers’ overall findings... “may give pause to groups or institutions that are considering engaging teleradiologist services, particularly in specialties of greatest liability and acuity, such as emergency radiology or neuroradiology,” wrote Jonathan Mezrich, MD, of Yale School of Medicine in an accompanying editorial.” Although the authors offered their analysis as guidance for radiologists to decrease the liability of teleradiology, it is conceivable that this study may provide useful ammunition for opponents of this staffing model, and it remains to be seen how this may impact utilization.”

The full article can be found here and the editorial can be found here.