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).
KEY WORDS
ethics policy telemedicine professionalism AMA (American Medical Association)Notes
Acknowledgements
This article was supported by the American Medical Association. This article summarizes a report written by the Council on Ethical and Judicial Affairs of the American Medical Association and was presented to the AMA’s House of Delegates and adopted in June 2016. The authors, on behalf of the Council, are grateful for input and comments provided by members of the AMA during the drafting stages of the report.
Author Contributions
Ms. Chaet, MSB, has access to all of the data used to prepare the report and takes responsibility for the integrity of the interpretation. American Medical Association.Study Concept and Design.All authors.Acquisition of Data.All authors.Analysis and Interpretation of Data.All authors.Drafting of the Manuscript.Danielle Chaet.Critical Revision of the Manuscript for Important Intellectual Content.All authors.
Compliance with Ethical Standards
Funding
The study was funded from the operating budget of the American Medical Association, which employs Ms. Chaet.
Conflict of Interest
The authors declare that they have no conflict of interest.
Supplementary material
References
- 1.Fox S, Duggan M. Health online. 2013. Available at: http://www.pewinternet.org/2013/01/15/health-online-2013/. Accessed 13 April 2017.
- 2.Kvedar J, Coye MJ, Everett W. Connected health: a review of technologies and strategies to improve patient care with telemedicine and telehealth. Health Aff. 2014;33(2):194–199.CrossRefGoogle Scholar
- 3.Doolittle GC, Spaulding AO. Providing access to oncology care for rural patients via telemedicine. J Oncol Pract. 2006;2(5):228–230.CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Miller TE, Derse AR. Between strangers: the practice of medicine online. Health Aff. 2002;21(4):168–179.CrossRefGoogle Scholar
- 5.Uscher-Pines L, Mehrota A. Analysis of teledoc use seems to indicate expanded access to care for patients without prior connection to a provider. Health Aff. 2014;33(2):258–264.CrossRefGoogle Scholar
- 6.Fleming DA, Edison KE, Pak H. Telehealth ethics. Telemed e-Health 2009;15(8):797–803.CrossRefGoogle Scholar
- 7.Hall JL, McGraw D. For telehealth to succeed, privacy and security risks must be identified and addressed. Health Aff. 2014;33(2): 216–221.CrossRefGoogle Scholar
- 8.Huesch MD. Privacy threats when seeking online health information. JAMA Intern Med. 2013; 173(19):1838–1840.CrossRefPubMedGoogle Scholar
- 9.Agha Z, Schapira RM, Purushottam W, et al. Patient satisfaction with physician–patient communication during telemedicine. Telemed eHealth 2009;15(9): 830–839.CrossRefGoogle Scholar
- 10.Health Resources and Services Administration. Telehealth. Available at: https://www.hrsa.gov/ruralhealth/telehealth/index.html. Accessed 13 April 2017.
- 11.Centers for Medicare and Medicaid Services. Telemedicine. Available at: https://www.medicaid.gov/medicaid/benefits/telemed/index.html. Accessed 13 April 2017.
- 12.American Telemedicine Association. Practice Guidelines for Video-Based Online Mental Health Services. Washington, DC: American Telemedicine Association; 2013.Google Scholar
- 13.Dixon RF, Rao L. Asynchronous virtual visits for the follow-up of chronic conditions. Telemed e-Health 2014;20(7):1–4.CrossRefGoogle Scholar
- 14.Ackerman MJ, Filart R, Burges LP, et al. Developing next-generation telemedicine tools and technologies: patients, systems, and data perspectives. Telemed e-Health 2009;16(10):93–95.Google Scholar
- 15.Cotet AM, Benjamin DK. Medical regulation and health outcomes: the effect of the physician examination requirement. Health Econ. 2013;22(4):393–409.CrossRefPubMedGoogle Scholar
- 16.Miller EA. The technical and interpersonal aspects of telemedicine: effects on doctor–patient communication. J Telemed Telecare. 2003; 9(1):1–7.CrossRefPubMedGoogle Scholar
- 17.American Telemedicine Association. A blueprint for telerehabilitation guidelines. Washington, DC: American Telemedicine Association; 2010.Google Scholar
- 18.American Telemedicine Association. Home telehealth clinical guidelines. Washington, DC: American Telemedicine Association; 2003.Google Scholar
- 19.Pellegrino ED. Professionalism, profession and the virtues of the good physician. Mt. Sinai J Med. 2002;69(6):378–384.PubMedGoogle Scholar
- 20.American Medical Association. Opinion E-10.01, fundamental elements of the patient-physician relationship. Code of Medical Ethics. 2012 Ed. Chicago: American Medical Association; 2012.Google Scholar
- 21.American Medical Association. Principles of medical ethics. Available at: https://www.ama-assn.org/sites/default/files/media-browser/public/ethics/principles-of-medical-ethics-20160627.pdf. Accessed 13 April 2017.
- 22.American Medical Association. Opinion E-5.027, use of health-related online sites. Code of Medical Ethics. 2012 Ed. Chicago: American Medical Association; 2012.Google Scholar
- 23.Demeris G, Charness N, Krupinski E et al. The role of human factors in telemedicine. Telemed e-Health 2010;16(4):446–453.CrossRefGoogle Scholar
- 24.Rippen H, Risk A. e-Health Code of Ethics. J Med Internet Res. 2000;2(2):e9. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1761853/. Accessed 13 April 2017.
- 25.Greysen SR, Garcia CC, Sudore RL, et al. Functional impairment and Internet use among older adults: implications for meaningful use of patient portals. JAMA Intern Med. 2014. Available at: http://archinte.jamanetwork.com/article.aspx?articleid=1873749&resultClick=3. Accessed 13 April 2017.
- 26.Fox S. Peer to Peer Health Care; February 28, 2011. Available at: http://www.pewinternet.org/2011/02/28/peer-to-peer-health-care-2/. Accessed 13 April 2017.
- 27.Lopez MH. Closing the digital divide: Latinos and technology adoption. 2013. Available at: http://www.pewhispanic.org/2013/03/07/closing-the-digital-divide-latinos-and-technology-adoption/. Accessed 13 April 2017.
- 28.Smith A. Older adults and technology use. 2014. Available at: http://www.pewinternet.org/2014/04/03/older-adults-and-technology-use/. 13 Accessed April 2017.
- 29.Smith A. African-Americans and technology use. 2014. Available at: http://www.pewinternet.org/2014/01/06/african-americans-and-technology-use/. Accessed 13 April 2017.