Ethical practice in Telehealth and Telemedicine

Abstract

This article summarizes the report of the American Medical Association's (AMA) Council on Ethical and Judicial Affairs (CEJA) on ethical practice in telehealth and telemedicine. Through its reports and recommendations, CEJA is responsible for maintaining and updating the AMA Code of Medical Ethics (Code). CEJA reports are developed through an iterative process of deliberation with input from multiple stakeholders; report recommendations, once adopted by the AMA House of Delegates, become ethics policy of the AMA and are issued as Opinions in the Code. To provide enduring guidance for the medical profession as a whole, CEJA strives to articulate expectations for conduct that are as independent of specific technologies or models of practice as possible. The present report, developed at the request of the House of Delegates, provides broad guidance for ethical conduct relating to key issues in telehealth/telemedicine. The report and recommendations were debated at meetings of the House in June and November 2015; recommendations were adopted in June 2016 and published as Opinion E-1.2.12, Ethical Practice in Telemedicine, in November 2016. A summary of the key points of the recommendations can be found in Appendix A (online), and the full text of the opinion can be found in Appendix B (online).

Development and Presentation of an Ethical Framework for Health and Medical Apps

“…A total of 32 references has been included in this review. (Figure 1) Of these, 18 references were journal articles, [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] seven reviews, [27][28][29][30][31][32][33] three systematic reviews, [34][35][36] two survey results from Australia 37 and the USA, 38 one study report from Germany 6 and one qualitative study from Australia. 39 For further discourse, the principles of biomedical ethics defined by Beauchamp and Childress function as ethical endpoints.…”

“…Numerous publications discuss the general risks and the involved ethical challenges. 6,9,13,15,17,[21][22][23]26,29,30 Figure 1. Flowchart for the identification of relevant literature.…”

“…6,9,10,12,13,15,16,20,21,22,25,26,30,31,37,38 In this context, privacy means having the individual right to be in control of the collection, use and transfer of personal data whereby the ways of delivering information should be communicated transparently. 10,12,13,16,20,31,32 The confidential handling of sensitive information can be ensured, for example by encryption via password or access authorisation by authorised persons. 10,14,23 Privacy includes data privacy, personal privacy and security.…”

“…This aspect is relevant in 13 references. 6,9,12,13,18,19,20,22,24,25,33,35,38 According consumer, society and payer representatives, health and medical apps have the potential to not only improve intersectoral cooperation by collecting and delivering information but also simplify the self-management of diseases, thus empowering the users and improving their quality of life.…”

Ethics in Telehealth: Comparison between Guidelines and Practice-based Experience -the Case for Learning Health Systems

“…We used the four questions to synthesize perspectives of telehealth practitioners (practice-based evidence) and a review of telehealth ethics guidelines from three sources: (1) 2017 AMA guidelines as reported by Chaet et.al. [21], (2) the 2014 telehealth component of ethics guidelines from the Health Professions Council of South Africa [22], and (3) the 2018 World Medical Association (WMA) statement on the ethics of telemedicine [9]. We selected these three documents as exemplars of written guidelines for telehealth ethics.…”