Presented by:Syed Ghulam Dastagir Shah

13ME.TMED.07Mehran U.E.T Jamshoro Pakistan

Email: gd_jeelani@live.com

Ethical and Legal Aspects of Telemedicine

Key ethical issues in the practice of Telemedicine generally includes;

ConfidentialityAvoiding harm.Defining Professional Relationship.Obtaining informed consent.Establishing fees and financial arrangements.Providing services to patients served by other

professionals.Maintaining records and data.

Ethical Issues

Basic right of an individual to not have personal information disclosed to others without that individual’s express informed consent.

Patients’ privacy should be observed unless waived in rare instances.

Information disclosed should be limited required only to fulfill the specific purpose.

Confidentiality

Any patient who is visiting Telehealth centre should be treated professionally.

Any type of harm either physically or mentally should be avoided.

Avoiding Harm

Doctor present at remote site.

Consultant from faraway.

Patients have a right to expect that doctors will not disclose any personal information which they learn during the course of their professional duties unless patient gives permission.

Without this assurances, patients may be reluctant to give doctors the information they need in order to provide good care

Professional Relationship

When patients give consent to disclosure of information about them, doctor must make sure that they understand what will be disclosed, the reasons for disclosure and the likely circumstances.

Patient should have opportunity to withhold information.

Should not be disclosed to third parties.Release information as much as necessary.Reliable health workers.

Informed Consent

Health care should be provided to everyone.

Keeping in view the financial condition of patient.

If required make arrangement of donation for patient.

Consultant, doctors and paramedics fees.

Fees and Financial arrangements

Telemedicine centre facilities are for everyone who approaches it.

Avoid doctor/consultant monopoly.

Telemedicine for all

Record history, physiological parameters before and after treatment.

Keeping informed the patient or attendant about the data that has been taken.

Clinicians, by virtue of the trust placed in them by the patient,can access the information in the record for the benefit of the patient.

Clinicians cannot, except under special circumstances, deny the patient access to the medical information.

Maintaining records and data

There are three main rationals;keeping information related to an individual

in strict confidence, for example, medical history of a patient.

collecting anonymous data for statistical analysis, for example, by conducting a healthcare survey; it is vitally important to ensure that any data collected cannot be used to identify a person or where it comes from.

Data Integrity; incorruptibility of data.

Data Protection

Internet privacy and confidentiality can be violated and exploited in some of the following ways;

Forwarded MailE-mail address logs.Snippets of information compiled from

multiple sources.Other Intrusions

E-health Privacy Risks

Many people falsely assume that when they contact a health care provider, their personal e-mail will go only to the intended recipient.

E-mail is routed through multiple servers from the point of origination to the point of recipient.

All these servers are potential points where e-mail can be tapped.

Forwarded Mail

Websites can automatically capture and permanently store e-mail addresses into log files.

Any Web site manager can easily gather email addresses from viewers, build a mailing list, and send e-mail solicitations for commercial products.

Patient could be targeted by embarrassing or otherwise undesirable advertising campaigns without any easy means of removal from such lists.

E-mail Address Logs

A serious threat occurs when website managers begin sharing information with each other or specialized companies that compile information about specific individuals.

These information about income, age, gender, profession, education, hobbies, investments, insurance benefits and usage, medical records, etc.

This information can be used for such purposes as market research by advertisers to identify target audiences or for gathering mailing lists of names identified with specific buying patterns or needs.

Advertisements can then be individually directed.

Snippets of Information Compiled from Multiple Sources

CookiesOnline ForumHackingMalwarePhisherSpamNatural Phenomenon

Other Intrusions

Four main technological risks are;

Quality of images

Lack of suitable equipment

Malfunctioning equipment

Inadequate Guidelines

Technological Risks

Poor communication.

Limited Ability.

Poor Training.

Improper Delegation.

Unclear Responsibility.

Personnel Risks

Backup is the process of making exact copies of the data in another storage medium so that the data can be retrieved in the event of a loss or failure of the original copy.

Backup Data

Many devices are available for making a network more secure that may include purpose built devices or software installed on a computer.

Security can be performed of different types such as ;

identifying an individual user, granting access to part or all of a system, logging activities during a session, filter incoming and outgoing data based on

types, origin or destination, inclusion of certain keywords, etc.

Security Management

Laws are being enacted formerly at the state and federal levels and later at international level that promotes the rapid development of Telemedicine and Telehealth.

These include;Privacy Act of 1974.Copyright Act of 1976.Medical Records Confidentiality Act 1995.

Telehealth Law

Ace Allan, Marlene M. Maheu "E-Health, Telehealth and Telemedicine", 2001, Jossey Boss Inc., A Wiley Company.

A.C. Norris, "Essentials of Telemedicine and Telecare", 2002, by John Wiley & Sons Ltd.

Bernard Fong, "Telemedicine Technologies", 2011, by John Wiley & Sons Ltd.

 

References