The Practice of Telemedicine: Medicolegal and Ethical Issues
Lateef, Fatimah, Ethics & Medicine
Generally, the medicolegal position of doctors in telemedicine (TM) consults is similar to telephone, fax, email, or communications by letters. All these amount to the provision of advice from a distance but where the usual standards of care and skills must apply. Patients permission, ethics and confidentiality issues still predominate, whilst right to privacy and autonomy must be maintained. TM places obligations on both distant and local providers. With time, the patient (also the consumer here) must become more educated about the nature, purpose, and use of equipment as well as both what TM can offer and its limitations. Any potential breaks in confidentiality must be addressed to enhance the level of patient satisfaction and maintain excellent standards in healthcare.
With all the challenges facing the healthcare industry today, the burgeoning old and new mix of diseases, increasing public and patient expectations, as well as the evolution of technology, it appears healthcare personnel cannot run away from practising some degree of telemedicine. The gradual birth of telemedicine can be traced to advances in electronic modes of communications, radio, television, and personal computer usage.1,2
Telemedicine literally means the practice of "medicine at a distance", beyond geographical boundaries, i.e. the delivery of healthcare and the exchange of health information across distance. It encompasses diagnosis, treatment, prevention, continuing education, research, and evaluation. TM allows rapid access to shared and remote medical expertise by means of telecommunications and information technology, no matter where the patient or relevant information is located.1'3,4 It can enhance communications up and down the healthcare pyramid (Fig 1). 1
TM should be differentiated from telecare, which is defined as the provision of nursing and continuing support to patients at a distance, and telehealth, which is public health services delivered at a distance to people who are not necessarily unwell. All three have the common basis of requiring telecommunications networks.
Practice of Telemedicine
Today, there are many modalities of TM already in use and in different applications:3'5
1. Pre-recorded: this information is used in teleradiology, telecardiology, teledermatology, and telepathology
2. Real-time: this can be in the form of images (eg. telepathology, teleradiology, and emergency medicine) or videos (eg. telepsychiatry, teledermatology, teleENT, emergency medicine, tele-oncology and teleneurology). It is also applied in prehospital medical care in which paramedics communicate with doctors and medical control for advice and conveyance of information
3. Tele- education: this can be at different levels such as undergraduate, post-graduate, instruction for residents and trainees as well as part of continuing medical education for doctors and healthcare professionals
TM can be classified according to:
1. The type of interaction, i.e. between patient and doctor, between doctors or different specialists, or
2. The type of information being transferred, i.e. data, text, still images ( radiological images like X-Rays and scans or clinical photos) or moving images (video). These data and information can be pre-recorded and then transmitted or transmitted directly in real time.
The essential components of the TM system which will help to ensure it works and is sustainable, include:
a. Adequate and suitable personnel who are trained, familiar, and have ownership of the system and programmes,
b. The relevant technology, which will have to take into account the type of information to be transmitted, the speed of transfer, the quality as well as size of information to be transmitted, and
c. One or several champions for the programme. These are trained persons committed to oversee the system and encourage others as well as keep them motivated. …