Trust in Telemedicine: Online Ethics, Security and Data

As online medical technology spreads - seemingly limited only by cost, health-care cutbacks, or technological questions of available bandwidth - challenging issues of patient privacy and liability follow in its trail, writes Melanie Egan.

One of the pioneers of telemedicine in this country, John Mitchell, managing director of John Mitchell and Associates, is involved in a range of initiatives, including aged care using telemedicine in Victoria, diabetic and renal telemedicine between South Australia and the Northern Territory.

He identifies problem areas as "privacy and confidentiality, professional liability, ethical standards, fee payment, and legal issues".

"Concerns of patient privacy centre on the environment in which the equipment is located so that it maintains patient and client privacy," said Mitchell. It is also important, he said, "processes are in place for storage and ownership of medical information obtained via telemedicine, and video taping and the storage of video tapes."

Protocols to protect the confidentiality of private health information, need to be developed, he said, and "with specific additions for some applications".

Liability and malpractice

Diagnostic errors are generally the largest category of malpractice claims. In an ever-more litigious society, and with the presenters of current affairs programs waiting like vultures for good doctors to make bad decisions, it seems that health-care professionals increasingly need to practice defensive medicine.

Liability issues are raised, said Mitchell, in the context as to whether medical decision-making using telemedicine is as reliable as face-to-face contact. He refers, however, to precedents where the risk of legal action is lower where the practitioner maintains an advisory role rather than a patient-doctor relationship.

Ethical standards

The electronic broadcast of a medical or video teleconferencing changes the nature of the doctor-patient relationship. Mitchell suggests each telemedicine application involving clinical care should provide care to the same standard, of ‘best practice’, as in a face-to-face situation.

Fee payment

The fees issue mainly relates to medical practitioners. At present, Medicare provides a medical benefit for a service provided by a medical practitioner to a patient in the same location. There is no fee structure for a telemedicine consultation.

Most applications are within the public health system and do not require reimbursement. But payment becomes an issue when private practitioners are involved, Mitchell said.

"The issue of fee payment is complex, involving control over the extent of utilisation and level of health care expenditure." It may become more complicated as the government renegotiates the Medicare agreement next year.

Legal issues

Legal issues such as licensing and accreditation "arise when telemedicine applications involve a practitioner providing clinical care to a person in another state, where the practitioner is not registered", said Mitchell. In the US, where this question is an ongoing debate, the American Medical Association has recommended that the state medical boards promote full and unrestricted licensure for physicians who wish to practise telemedicine across state lines.

In Australia, however, all states recognise most professional registrations without re-examination, he said.

Excerpts from article written by Melanie Egan and published in Medical Imaging & Monitoring, May 1997, pp. 24-25.