When Care Crosses Borders: The Legal Challenges of Global Telemedicine
The emergence of telemedicine offers promising benefits for patients on a global scale, particularly in remote areas with limited access to quality healthcare.[i] Telemedicine is the provision of health care services, clinical information, and education through a variety of technologies including the Internet, mobile phones and electronic medical records.[ii] Telemedicine has the potential to support equitable and universal access to quality health services, improve medical education, enhance efficiency and sustainability of health systems, and disease prevention.[iii] While the technical capability to connect patients on a global scale has been developed, it faces major obstacles that have hindered its global adoption, including fragmented licensing regimes, medical malpractice laws, and data privacy issues. To reconcile these issues, international cooperation is vital.
The first issue that telemedicine faces is fragmented licensing regimes. Licensing still remains a largely state-controlled operation, and fragmented regimes can lead to the accidental provision of unauthorized medical services.[iv] Although licensing regimes have begun to adapt to the emergence of telemedicine, there is still room for improvement. In the U.S., medical licensing is done on a state level and requires a treating physician to be licensed where a patient is located, with exceptions for out-of-state providers.[v] Internationally, most countries follow the same model and require a physician to hold a license in the territory where the patient is located.[vi] For example, if a patient in Maryland were to be treated by a physician located in the United Kingdom, the physician would be required to be licensed in Maryland.[vii] Steps have been taken to alleviate these hurdles and expand access; for example, the Interstate Medical Licensure Compact (IMLC) is an agreement among more than 40 states and territories in the U.S. to streamline the licensing process for physicians to practice in multiple states.[viii] The EU has implemented a similar system in which physicians can provide care for patients in member states subject to local compliance regulations.[ix] However, direct patient care across international borders remains rare.[x]
Additionally, jurisdictional issues arise around malpractice. Traditional malpractice law assumes a clear geographic location of care and a clear forum for litigation, both of which are disrupted by telehealth.[xi] Frequently, the question that arises is which law applies to the provider: that of the patient whose country the service is “received” or that of the country from which the service is provided?[xii] A recent European Court of Justice ruling clarified that telemedicine is governed by the law where the service provider is located.[xiii] In the U.S., choice of law in medical malpractice remains a complex analysis. While courts typically apply the law of the jurisdiction where the patient is located when the harm occurs[xiv], courts in different jurisdictions may also employ different conflict-of-laws rules requiring them to evaluate various factors—such as where the patient received care, where the provided is licensed, and where the injury occurred—which can lead to inconsistent and fact-specific outcomes.[xv]
Finally, major issues can arise regarding data privacy and how patient information is shared and protected. Telemedicine requires the transfer, storage and processing of a patient’s health data by electronic means.[xvi] When data moves across international borders, there may be inconsistencies in what is required to remain compliant with jurisdictional data regulations. For example, in the U.S., healthcare data is governed by HIPAA, whereas in the EU and EEA, it is governed by the General Data Protection Regulation (GDPR).[xvii] While HIPAA and GDPR have similar goals of keeping patient data protected, they differ in critical areas such as consent, breach notification, and risk assessment.[xviii] The typical approach in both regulatory regimes is that organizations are subject to whatever regulatory regime operates in the location of the patient, therefore, organizations not located in the U.S. may still be subject to HIPAA.[xix] This mismatch in regulatory compliance may create problems for providers; for example, GDPR requires reporting breaches within 72 hours, no matter the scale of the breach, whereas HIPAA requires notification within 60 days and only applies if the breach affects more than 500 people.[xx] A provider or organization may be HIPAA-compliant but may be violating GDPR. These overlapping regimes can create significant compliance burdens that may deter providers, especially smaller ones, from engaging in telemedicine practice.
Telemedicine has the potential to benefit millions worldwide. While medical malpractice jurisdictional issues will likely remain a complex analysis best left for the courts, international licensing regimes and telehealth data regulations could mitigate the aforementioned roadblocks to telemedicine adoption. Realizing telemedicine’s beneficial potential in practice will require meaningful coordination between global technology and local legal frameworks. Without it, telemedicine cannot be effectively implemented at scale, and its benefits will remain underutilized.
Regina Openshaw is a staff member of Fordham International Law Journal Volume XLIX.
[i] See Shreya Kolluri et al., Telehealth in Response to the Rural Health Disparity, 10(3) Health Psych. Rsch. 37445 (2022).
[ii] See Abid Haleem, Mohd Javaid, Ravi Pratap Singh & Rajiv Suman, Telemedicine for Healthcare: Capabilities, Features, Barriers, and Applications, 2 Sensory Int’l 100117 (Jul. 24, 2021), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8590973/.
[iii] See Summary of International Telemedicine Guidelines, Telehealth Certification Inst.: Telehealth Explorer Blog (Mar. 22, 2026), https://www.telementalhealthtraining.com/legal-updates/summary-of-international-telemedicine-guidelines.
[iv] See Sandra Oparah, Irene Sagay, Augustine Onyeka Okoli & Opeoluwa Oluwanifemi Ajayi, Telemedicine and Medical Jurisdiction: Legal Boundaries and Licensing Conflicts Across State Lines in Telemedicine, 1 Int’l J. Multidiscip. Rsch. & Growth Eval. 163 (2020).
[v] See id. at 164.
[vi] See Telehealth Certification Inst., supra note 3.
[vii]See Pa. Dep’t of State, Interstate Medical Licensure Compact, https://www.pa.gov/agencies/dos/department-and-offices/bpoa/boards-commissions/medicine/interstate-medical-licensure-compact (last visited Mar. 2, 2026).
[viii]See id.
[ix]See id.
[x]See Kathleen Munstermann-Senff, Katharina Häberle & Karolina Lange-Kulmann, Telemedicine without Borders? ECJ Creates New Scope, Taylor Wessing (Sept. 16, 2025), https://www.taylorwessing.com/en/insights-and-events/insights/2025/09/telemedicine-with-out-borders.
[xi]See Nick Ouritski, Injury Claims Against Telehealth Providers: When Remote Medical Advice Causes Harm, Alan Ripka (Sept. 29, 2025), https://alanripka.com/injury-claims-against-telehealth-providers-when-remote-medical-advice-causes-harm/.
[xii]See Doctor’s Weight Loss Centers, Inc. v. Blackston, 487 Md. 476, 319 A.3d 1102 (2024) (holding that law of the state where the injury occurred governs in medical malpractice cases).
[xiii]See UJ v. Österreichische Zahnärztekammer, Case C-115/24, Judgment of the Court (Fourth Chamber) of 11 Sept. 2025, ECLI:EU:C:2025:694.
[xiv]See Sherihane Bensemmane & Rita Baeten, Cross-border Telemedicine: Practices and Challenges, OSE Working Paper Series No. 44 (Oct. 2019), https://www.ose.be/sites/default/files/publications/Bensemmane_Baeten_2019_OseResearchPaper44.pdf
[xv]See Ralph Preite & Kyriaki Christodoulou, Choice of Law in Tort and Compliance Actions, IX Legal (Feb. 20, 2024).
[xvi]See Natalie Calderon, HIPAA vs. GDPR Compliance: What’s the Difference, MedStack (Oct. 18, 2023).
[xvii]See id.
[xviii]See id.
[xix]See id.
[xx]See id.
This is a student blog post and in no way represents the views of the Fordham International Law Journal.