Telemedicine and implanted brain stimulation devices: a review of legal issues

Introduction : One recent development in telemedicine is the remote management of implanted brain stimulation technologies. Deep brain stimulation (DBS) is widely used to treat Parkinson’s disease and other movement disorders. Treatment requires optimal post-surgical programming of the device through numerous in-person visits. Remote programming is increasingly being used to address the risks and inconveniences of in-person programming adjustment. This review presents an overview of the legal issues that are associated with this telemedical innovation. Methods An authorship team comprised of health law experts from Canada and Germany and a clinician experienced in caring for patients with Parkinson’s disease was assembled for this review. The team identified the key areas of law applicable to remote management of DBS, and then used standard legal research methods to identify relevant legal issues, primarily using the jurisdiction of Ontario, Canada, as an example, with additional references to the laws applicable in the European Union and United States. Results Technological and clinical evolution toward the use of remote programming of DBS and adaptive or “closed loop” DBS raises important questions related to (1) privacy and data protection law, (2) cybersecurity and medical device regulation, (3) medical negligence and physician liability and (4) cross-border issues related to licensing, malpractice insurance and physician payment. Conclusions Remote programming of DBS offers many important advantages in improving access to care, reducing travel risks, and improving efficiency for patients, caregivers and clinicians. At the same time, this will involve modification of implanted devices influencing patient physiology as well as the exchange of significant amounts of information that bear upon patients’ physiological states. As a result, important ethical and legal questions should be considered in the development and deployment of remote DBS programming platforms.