Telemedicine- Ethical Challenges and Issue

 

Telemedicine- Ethical Challenges and Issues

 

 

Abstract

Telemedicine is the term used for medical practices involving information technology. For example, the use of emails, video conferences, chats for the discussion of health conditions and medical prescriptions. It is of great importance as applying this technology; people don't need to physically meet up with doctors when there is a pandemic. It overcomes the geographical distance. But there are certain challenges and ethical issues that halt the implication of telemedicine technology. Out of which, the vague policies and the lack of proper regulation, data protection and confidentiality are the most important barriers in telemedicine technology. By improving the ethical issues and by having a clear format about telemedicine technology, we can greatly benefit from telemedicine even if we are in that geographical area where public health services are not common.

Keywords: Telemedicine technology, ethical issues, lack of regulation, confidentiality, data protection.

 

INTRODUCTION

Telemedicine is the use of audio, video and data communication in healthcare practices. It is the exchange of health information and medical practices through computerized communication for the improvement of a person’s health. Telehealth is a broader term encompassing the terms telemedicine, tele research and tele education [1] [2].

There is no proper definition of telemedicine. But it is the electronic connection between the patient and the health care professional. For example, use of email to schedule appointments, video conferences, online chats to discuss symptoms and issues, internet counselling and web counselling. In other words, telemedicine is to discuss health problems and to deliver health care at a distance rather than physically meetup with doctors [3][4],

Two main areas are covered by telemedicine arevirtual association between patient and the doctor and the treatment prescribed by the doctor and flow of information is the second approach covered by telemedicine [1]. In the 1970s, the term telemedicine was used in order to explain the condition in which patients are examined with the help of telecommunication equipment. Some of the equipment used in telemedicine technology are tele-statoscope, tele-electrocardiogram, tele biologic diagnostic equipment, tele auriscope, tele radiology, visit cameras, videoconferences equipment, diagnostic ultrasound, remote surgery and tele Spirograph[2].

The term telemedicine is broadly used now. Any use of communications technology related to health conditions also sometimes comes under telemedicine. Taking a more limited approach is useful; it would be used to describe situations in which either communication occurs between two medical providers or between a medical provider and a specific patient. The most common example for it is to contact a doctor to seek health advice or assistance or medical prescription on telephone. Considering this example, it is clear that in developing countries, having a functional telephone facility at every public health center will definitely play a promoting role in health services. This idea was implemented and success was reported. The Grameen Village Phone program, the Health Watch Project in Tamil Nadu and the Satellite PDA Project in Uganda proved the success rate and they demonstrated that in practice, there are no difficulty and barriers to achieve this objective [4].

There are certain advantages of telemedicine technology. In areas where proper health care is not sufficiently present, telemedicine has been proved to be very advantageous.Telemedicine passes the geographical barriers as physical meeting is not done in telemedicine technology [5].

Challenges associated with Telemedicine and telecare

There are certain ethical and legal barriers in the implication of telemedicine technology. These include confidentiality, vague policies, data protection and data management, patient’s consent and lack of equipment due to low profitability in this business.(Figure 1)

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 1: Ethical issues associated with Telemedicine Technology

 

1.      Health information of patients

In order to seek treatment, patients allow health-care professionals to obtain their sensitive health information and information related to other matters by having trust in them. It is their right to expect that their privacy will be protected and respected by health care professionals and they will act accordingly. They do so in confidence so the sensitive information which can result in identification of patients should not be opened or disclosed in front of anyone. Moreover, it is not ethical to use that information for some other purpose along with health service without the patient's consent. In some conditions, people may have a lack of trust, or they can be unaware that their health information is not disclosed so it is important to maintain the trust of patients taking part in work. Confidential services must be provided by health care professionals providing telemedicine services. But anonymous identity is not confidential. The health information can be published by telemedicine providers without the person being disclosed. Telemedicine service providers should have a knowledge of their duties and obligations related to disclosing health information. [6][7]

2.      Data Protection and Management

The data of the patients must be protected. There is a regulation which describes how to understand and manage personal data that is General Data Protection Regulation.In April 1999, a rule related to the quality of healthcare services was made by Trust and Health Authorities.  in this rule, they stated that physicians should be responsible for the quality of services provided by them and they have to report to Trust and health Authorities on daily basis. [12]

This is the responsibility of telemedicine service providers to use safe devices which should not do any harm to the patient and easy handling devices.  The doctor must pay utmost attention to the physician while giving the patient's health information and data to anyone. Regarding data protection, there are many hypotheses. One of the hypotheses focus on the anonymity of online data, another is that the personal data of a patient should be transmitted to other members of the telemedicine providers in encrypted language. During transmission of data of large groups of members of families, extra protection of data must be assured. However, a study showed that psychiatric patients in Australia, rather than discussing their problems with the health expert on video call, preferred a face-to-face meeting even if they had to wait for a long time. Everyone agrees that the health information and personal data is sensitive and violation of privacy can result in criminal and civil crime. So, it must be protected at maximum. But due to the lack of a universal format describing obligations for all, data protection is a main problem in implementing telemedicine and developing trust to patients. Moreover, because of lack of proper regulation, there is a great possibility of misusing the personal data.[1][5]

3.      Consent

Health care professionals can disclose the data where the patient gives consent for disclosing. For having consent by the patient, all the necessary information should be given to the patient. If he knows all the possible options and he is given a chance to choose, then there is a great chance of valid consent by the patient. By knowing the benefits and burdens about technologies and by having experience, he can change consent. New technologies can result in the risks which cannot be understood so it is ethical to inform patients about all the information regarding new technologies used in the treatment including its risks the valid consent can be either written or oral. The information can be used for treatment. But if you have to use that information for research purposes, you require consent by the patient. [6][5]

4.      Accuracy

It is the frequently ignored issue related to telemedicine technology. The health information provided by patients should be accurate as medical intervention has to be made on the basis of information provided. the patient may take incorrect reading which result in the prescription of inappropriate treatment by the doctor.[7]

5.      Lack of Regulations

Absence of proper laws and regulation regarding the implementation of telemedicine is a great difficulty. Healthcare regulations stated that there is the only act regarding telecare that is the Physician Act. According to this act, the treatment should not be prescribed by the physician without the examination of patients personally. Moreover, there is no clear regulation related to telemedicine and telecare which can properly describe telemedicine and telecare. There is no proper information regarding responsibilities, accountability of telecare providers and the participants. The present laws and regulations do not provide sufficient protection to the telemedicine providers. Further, there is a lack of equipment for the telemedicine services because due to the improper regulations, manufacturers are unwilling to design telemedicine equipment as there is only small-scale profitability of this business. Furthermore, the pliability of development of tele medicine equipment is also reduced by vague and inappropriate limitations. There is no obvious law or regulation. So, without the proper legislation, telecare services cannot be implemented rashly because legal disputes can be easily caused by medical practices. It becomes a problem to clear the duties and responsibilities. It is possible that patients participating in telemedicine service misunderstand that telecare would handle any future problem. Many of the physical measurement equipment for telecare generally do not have a standard. The production of equipment on small scale is not done by equipment manufacturers. As a result, there is a lack of tools used in telemedicine and telecare. [8][9][10]

Conclusion

By taking care of all the issues associated with telemedicine technology, we will be able to gain benefits of this emerging technology.

Conflict of Interest: none

 

 

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