The risk of doing nothing

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The rapidly growing digital healthcare market is under the spotlight. With the world trying to tackle the surge of coronavirus cases, the UK government is looking to use more technology-led services to support patients (particularly those in isolation) and to help ease pressure on doctors’ surgeries and hospitals.  

We consider whether the insurance industry needs to reshape its product and service offering for a new risk environment created by greater use of technology in healthcare provision. 

Phenomenal growth 

Virtual care or digital health encompasses a broad range of new technology-led medical and lifestyle services, covering everything from medical diagnostics and remote monitoring, fitness trackers and apps that empower consumers to make better decisions about their health, right up to robotic surgery.  

As technological capabilities explode, so the global digital health market is experiencing phenomenal growth, with the sector predicted to mushroom from $86bn in 2018 to over $500bn by 2025, of which 5 percent ($28.3bn) will be in the UK.  

According to the Topol Report, an independent study produced last year on behalf of the UK’s secretary of state for health and social care to look at the future of health in the UK, there will be an “inexorable increase” in demand for healthcare services as people live longer and do so with more chronic and long-term conditions.  

The report also revealed UK government plans to deploy technology to relieve pressure on frontline medical practitioners – technology that is likely to now be fast-tracked as the Covid-19 pandemic ramps up and the government looks to relieve some of the pressure that the spread of the virus is having on the UK’s already stretched healthcare system. 

Inherent risk  

But while the benefits of adopting technology-led services are clear, they are not without risk. Inserting technology between patient and medical provider adds a layer of complexity and can increase the risk of misdiagnosis, or compromised quality of care should something go wrong. A recent example showed the very real and significant risk posed when there is a glitch in the system. 

Last November a device providing real-time blood glucose monitoring for people suffering from type 1 diabetes, which warns patients via an app when their blood sugar levels climb too high or drop too low, suffered an overnight service outage.  

The incident meant the service stopped monitoring blood glucose levels or issuing warnings. Many patients only discovered the fault hours later when physical finger prick tests showed blood glucose had dropped to dangerously low levels, potentially causing seizures and loss of consciousness.  

Had patients who are reliant on the app for self-management of their condition experienced bodily injury, the doctor who recommended its use and the device manufacturer and/or designer could have faced claims for clinical negligence compensation. 

Such claims are a concern both for medical practitioners and virtual care tech firms. Traditional medical malpractice (medmal) and clinical negligence wordings do not generally cover claims for bodily injury arising from a failure relating to technology within a product that a healthcare professional has recommended to patients.  

Likewise, tech liability policies do not routinely provide specific cover against claims for bodily injury.  

Misdiagnosis concerns  

There is also a concern that virtual diagnostics could heighten the risk that symptoms could be missed that would have been spotted in a traditional physical examination, or that insufficient or inaccurate information and data could be supplied, which could result in an increased risk of a misdiagnosis. 

One trial conducted on tele-dermatology (“Choice, Transparency, Coordination, and Quality Among Direct-to-Consumer Telemedicine Websites and Apps Treating Skin Disease”, by Jack S Resneck Jr, MD; Michael Abrouk; Meredith Steuer, MMS; et al, published in The Journal of the American Medical Association) revealed the extent of remote consultation misdiagnosis risks.  

In the trial, researchers posed as patients with prepared medical histories and various skin conditions. Although a correct diagnosis was provided in 77 percent of the presented cases, the study was critical of the quality of care with many diagnoses being proffered “without reasonable attempts to ask basic medical history follow-up questions”. 

Often, consultation and diagnosis were conducted and given on the basis of a single photo shared by the patient. Worryingly, in three cases the doctors advised the patient that their nodular melanoma, an aggressive skin cancer, was benign.  

While some of these problems are as much about process shortcomings as they are about technology, they highlight how lack of physical presence could increase the risk of error.  

Clearly, misdiagnosis is not limited to virtual care, but if a diagnosis hinges on a photograph being uploaded or a patient supplying data such as their heart rate or blood glucose level, the medical professional needs to ensure that the readings are accurate, the technology is functioning properly and that they have sufficient evidence to work from. 

Re-thinking insurance 

From an insurance market perspective, the challenge is that this new risk environment crosses many traditional insurance siloes – such as medmal, tech liability, errors and omissions, data privacy and cyber security risk.  

Such complexity creates a danger that insurance programmes could be no more than a patchwork of policies underwritten by disparate insurance wording technicians.  

The new medmal and tech liability risk landscape requires a depth of understanding of the scope of coverage required and the ability to identify coverage gaps, particularly when more than one policy is being purchased from different carriers to make up the programme.  

If the insurance industry is to respond effectively to the challenges, it needs to get to grips with the plethora of new virtual care business models and risk profiles that are emerging.  

With this in mind, Beazley chose to ditch the traditional siloed approach to underwriting and create a modular, but integrated, Virtual Care product package that provides cover for all medical professional and medical technology risks including cyber.  

The modular approach enables the insured, guided by their broker, to pick and choose the coverages that they need now, and add other ones on as their business or service range develops. This approach offers greater certainty for underwriter, broker and insured that there are no hidden gaps in the coverage.   

In addition, by tapping into our cyber experience, we are also able to offer a range of services to the insured as part of the Virtual Care package, including access to legal advice, IT forensics and crisis communications services to improve claim management and help reduce the risk of litigation.  

The London insurance market is uniquely positioned to develop comprehensive and innovative products that support the medical practitioners and technology firms developing new e-healthcare solutions. But as the coronavirus pandemic builds, the time to act is certainly now.  

As motivational speaker Denis Waitley once said: “There is only one risk you should avoid at all costs, and that is the risk of doing nothing.” 

Andrew Page is an international healthcare underwriter at Beazley 

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