1. Ethical issues: vulnerability of telemedicine encounters to privacy and security risks (Shilpa et al., 2021)
1.1. Anticipated Issues
1.1.1. Patient privacy concerns: Risk of data breaches in online communication platforms.
1.1.2. Confidentiality in non-clinical settings: Patients participating from home may face breaches of confidentiality.
1.2. Potential Ramifications
1.2.1. Loss of trust in teletherapy services
1.2.2. Legal repercussions due to non-compliance with HIPAA
1.3. Approaches to Resolve
1.3.1. Use secure, HIPAA-compliant teletherapy platforms
1.3.2. Educate patients on securing their environment during sessions (e.g., private space, secure Wi-Fi)
1.3.3. Ensure compliance with the Digital Imaging and Communications in Medicine format (Shilpa et al., 2021)
2. Financial issues: the lack of significant reimbursement from Medicare, several state Medicaid programs, and commercial insurance plans (Shilpa et al., 2021)
2.1. Anticipated Issues
2.1.1. Cost of technology setup: High upfront costs for equipment, software, and secure platforms.
2.1.2. Reimbursement challenges: Some insurance companies may not fully reimburse teletherapy sessions.
2.2. Potential Ramifications
2.2.1. Providers may face financial loss or avoid teletherapy altogether.
2.2.2. Patients may face higher out-of-pocket costs.
2.3. Approaches to Resolve
2.3.1. Advocate for broader telehealth insurance coverage
2.3.2. Utilize cost-effective teletherapy solutions
2.3.3. Expanding the insurance plans to cover the reimbursement of teletherapy (Shilpa et al., 2021)
3. Legal issues: large variations in rules, regulations, and guidelines for practice
3.1. Approaches to Resolve
3.1.1. Seek multi-state licensure (e.g., through the Interstate Medical Licensure Compact)
3.1.2. Stay up-to-date with state and federal telehealth regulations
3.1.3. Providers should be aware and complaint with state and federal legal requirements while adopting safe practices (Shilpa et al., 2021)
3.2. Potential Ramifications
3.2.1. Inability to treat patients in different states
3.2.2. Legal penalties for non-compliance
3.3. Anticipated Issues
3.3.1. Licensing across state lines: Many therapists may face restrictions on providing services outside their licensed regions.
3.3.2. Regulatory compliance: Ensuring teletherapy adheres to local and national laws.
4. Adoption issues: data fragmentation, heterogeneity, complexity and uncertainty (Kotzias et al., 2022)
4.1. Anticipated Issues
4.1.1. Resistance from providers: Therapists who prefer in-person sessions may be resistant to change.
4.1.2. Lack of proper training: Some therapists may not be well-versed in teletherapy technologies.
4.2. Potential Ramifications
4.2.1. Reduced quality of care during virtual sessions
4.2.2. Decreased adoption of teletherapy tools
4.3. Approaches to Resolve
4.3.1. Provide ongoing teletherapy training and workshops
4.3.2. Highlight the benefits of teletherapy, such as increased patient access
5. User issue: the lack of suitable hardware or network access, digital skills, etc (Rettinger & Kuhn, 2023)
5.1. Anticipated Issues
5.1.1. Digital literacy among patients: Not all patients are comfortable using technology.
5.1.2. Technology access: Some patients may lack access to stable internet or devices for teletherapy.
5.2. Potential Ramifications
5.2.1. Inequality in access to teletherapy services
5.2.2. High no-show rates for teletherapy appointments
5.3. Approaches to Resolve
5.3.1. Offer technical support before and during sessions
5.3.2. Explore partnerships for providing affordable devices or internet services to underserved populations
5.3.3. Develop and use video software that meets the needs of all patients and providers (Rettinger & Kuhn, 2023)