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

Abstract

Objectives: To understand ethical issues within the telehealth domain, specifically how well established macro level telehealth guidelines map with micro level practitioner perspectives. Methods: We developed four overarching issues to use as a starting point for developing an ethical framework for telehealth. We then reviewed telemedicine ethics guidelines elaborated by the American Medical Association (AMA), the World Medical Association (WMA), and the telehealth component of the Health Professions council of South Africa (HPCSA). We then compared these guidelines with practitioner perspectives to identify the similarities and differences between them. Finally, we generated suggestions to bridge the gap between ethics guidelines and the micro level use of telehealth. Results: Clear differences emerged between the ethics guidelines and the practitioner perspectives. The main reason for the differences were the different contexts where telehealth was used, for example, variability in international practice and variations in the complexity of patient-provider interactions. Overall, published guidelines largely focus on macro level Keywords Ethics, telehealth, learning health system, informatics Yearb Med Inform 2020 http://dx.

REVISITING HEALTH INFORMATION TECHNOLOGY ETHICAL, LEGAL, and SOCIAL ISSUES and EVALUATION: TELEHEALTH/TELEMEDICINE and COVID-19

“…The authors, members of the International Medical Informatics Associations’ Telehealth Working Group from nine countries, examined cultural and regional differences, artificial intelligence and big data issues, comparison with face-to-face practice, and special populations as exemplified by elder care. Their key finding was a gap between these macro-level guidelines and micro-level practice priorities [ 41 ].…”

“…WHO, the National Institutes of Health, and the Gates Foundation were presumably hacked in April 2020 [ 43 ]. A newer concern relates to artificial intelligence and algorithms that may be unvetted or opaque, or result in conflicts of interest or unsavory biases [ 41 ].…”

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“…We used the WHO Health System model we described earlier, and our prior work research at comparing international telehealth implementation, to guide the analysis and to identify health system considerations for telemedicine use during critical response [ 9 , 17 , 24 , 25 ]. Our previous research and the WHO Health System model are complementary in that we identified specific issues related to telehealth implementation including different models of patient-centred connected health, the need to balance patient needs with technological capability, and emerging privacy needs that can arise from informal telehealth implementation, while the WHO model describes the broad concepts that comprise a health system.…”

Speech-Language Pathology and Audiology in South Africa: Clinical Training and Service in the Era of COVID-19

“…Furthermore, it streamlined the communication between health care sites and helped treat patients in a more holistic way. Kuziemsky et al (2020) Ethics Langkamp et al (2015) Telemedicine for children with developmental disabilities: A more effective clinical process than office-based care.…”

“…Furthermore, it streamlined the communication between health care sites and helped treat patients in a more holistic way. Kuziemsky et al (2020) Ethics in telehealth: Comparison between guidelines and practice-based experience – the case for learning health systems. IMIA Telehealth Working Group (WG) was made of more than 60 members from across the globe working in the telehealth arena as entrepreneurs, promoters, academics, and practitioners.…”