Legal and Regulatory Issues
By collapsing distances, crossing borders, and creating new definitions of care and
new ways to deliver it, the psychotechnologies raise a confusing array of national and
international legal, regulatory, and reimbursement issues. This chapter is restricted
to aspects of privacy and confidentiality, security of information, regulation of health
care devices, electonic signatures, licensure, and reimbursement. These are the issues
of most immediate relevance to clinical practice.Our intention is to prepare professionals to examine specific details with their
local licensing bodies and regulatory agencies in order to determine how to organize their electronic practices. Professionals are advised to keep up with relevant
statements published by professional societies about evolving standards and practice
norms and to be aware of the latest official material published by their national government on telehealth. Such information is conveniently available in searchable format in the Code of Federal Regulations and the Federal Register (http://www.access.
). The Civic Research Institute (http://www.civicresearchinstitute.
) has issued a helpful compendium, Telemedicine Law and Practice for the United
, and offers additional information on its Web site (Schanz & Cepelewicz, 2001).
Consultation with an attorney who has special expertise in telehealth law is also advisable for certain purposes.
Privacy and confidentiality are central concerns about the use of technology in mental
health services, especially psychotechnologies related to telecommunication. Approximately 6.3 million Internet users decline to access online health information because
they worry about security and confidentiality (Cyber Dialogue, 2000). The Electronic
Privacy Information Center (EPIC; http://www.epic.org
) offers extensive information
about health-related and other privacy issues.Many professionals eagerly turn to e-mail to discuss difficult cases or to seek referrals for patients. The following two messages (edited to protect the patients) appeared
on a large e-mail forum for mental health professionals. As of this writing, both messages remain available in the online archive:
|1. ||Looking for a referral in the [MIDSIZE TOWN] [STATE] area, for a [AGE] year-old
retired [DIFFERENT STATE] [UNUSUAL VOCATION], Vietnam Vet, with mild to
moderate dysphoria and some (largely suppressed) PTSD. Stable, cooperative, no history
of drugs or violence needs basic psychopharm and intermittent support.|