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Exploring the AMA’s Ethical Guidelines for Telemedicine

Posted by Michael Greiwe, MD | May 2, 2019 |
Michael Greiwe, MD

 

One of the ethical considerations in any scientific endeavor is just because we can, does it mean that we should? In the case of technology advancement in healthcare, there are ethical considerations when using digital tools. For example, patient privacy and care quality are all part of the ethical practice of medicine when driven by technology. Establishing best practices when using digital tools has been overseen by the American Medical Association (AMA), an organization that has long sought to protect healthcare outcomes as well as the clinical lives of the physicians they serve.

Not surprisingly, the ethics of leveraging telehealth via a virtual house call, versus the traditional on-site method of clinical treatment has been reviewed and commented upon by the AMA. We can look to this organization for guidelines on how to best interact with patients in these new digitally driven virtual settings.

Here’s what the AMA has to say about the ethical practices surrounding offering clinical care with telehealth tools.

Telehealth and Its Impact on The Doctor-Patient Relationship

Exploring the AMA’s Ethical Guidelines for Telemedicine

 

“Innovation in technology, including information technology, is redefining how people perceive time and distance. It is reshaping how individuals interact with and relate to others, including when, where, and how patients and physicians engage with one another.”
AMA’s Code of Medical Ethics Opinion 1.2.12

The systemic changes facing American healthcare providers today include our responses to patient populations that live longer with more chronic diseases than at any other time in our history. These changes put more pressure on healthcare providers to provide closer and more frequent care management and coordination.

Telehealth technology offers clinical care teams new ways to communicate with patients and coordinate their care. Digital technology is something our patients are increasingly comfortable with, and studies show most Americans feel right at home discussing their care electronically via text, email, video conference, or other smartphone-enabled applications.

While the technology can help engage patients in new ways, and increase communication with clinicians, it can also be used to connect disparate care teams so that care continuity is improved.

But questions remain precisely because these newer ways of providing care are so technology-centric. The patient-physician relationship is based on the clinical effectiveness of a face-to-face encounter. Medical best practices center on a face-to-face complete history and physical and most reimbursement models both honor and require these behaviors. Physicians are taught in medical school that the entire basis of clinical care delivery is subject to the trust inherent in these visits as a stage for establishing empathy and the trust necessary to provide effective care.

But what’s happening today is the opportunity for telemedicine to extend access to care, stretching treatment to a broader population at a time when widespread staffing shortages are expected to strain an already-overburdened system. Medical providers have an opportunity to change accepted practice, in part because our own patients prefer the convenience of a virtual visit over the time and money spent traveling to meet the doctor on his or own “turf.”

Given the changes caused by telehealth “disruption,” the AMA sought to develop a new code of ethics governing the use of these technology tools. What is the AMA’s take on the doctor-patient relationship in light of the growth of telemedicine?

Code of Medical Ethics for Telemedicine

“Yet as in any mode of care, patients need to be able to trust that physicians will place patient welfare above other interests, provide competent care, provide the information patients need to make well-considered decisions about care, respect patient privacy and confidentiality, and take steps to ensure continuity of care.”
AMA’s Code of Medical Ethics Opinion 1.2.12

No matter how the care is delivered, physicians and other clinical care providers have the same responsibility to their patients. However, using these technology tools does potentially change the level and types of ethical accountability for clinical providers.

The AMA suggests the following guidelines for the ethical delivery of healthcare services via telemedicine technologies:

  • Financial disclosures
    First, the AMA suggests that the healthcare provider disclose the financial or other interests they have in the telehealth too.
  • Data security
    The clinician should have also taken steps to ensure the security of patient data being shared via telehealth technology. Tools should be HIPAA-compliant, emails should be encrypted, and data should be breech-protected to help mitigate the risk of protected health information being shared online.
  • Service limitations
    The provider should inform the patients about any limitations on the services provided. This should include explaining how they anticipate providing follow-up care to the patient if it is required.
  • Care coordination
    They should also inform their patients that they should notify their primary care provider about the clinical services received via the telehealth visit. (This guideline is particularly relevant for those “dial-a-doc” primary care online health services that leverage a network of clinical providers.)
  • Professional standards
    The AMA recommends that clinical providers uphold the same standards of ethics, professionalism, and care delivery as in any other clinical encounter.
  • Use of telehealth tools
    Further, the AMA suggests that, like any tool the healthcare provider uses in the course of care delivery, the clinical caregiver must be thoroughly and properly trained in the use of the technology.
  • Recognize and overcome technology limits
    Caregivers should also take steps to overcome any limitations on providing care via the new technology. The must, “ensure that they have the information they need to make well-grounded clinical recommendations when they cannot personally conduct a physical examination.”
  • Ensure proper care delivery
    Finally, the AMA recommends the clinical provider take additional steps to ensure the patient’s identify and efficacy of the treatment protocols before prescribing medications. Thorough documentation of the encounter and the best practices related to informed consent must be followed, along with providing information on treatment options. The AMA recommends, “Patients and surrogates should have a basic understanding of how telemedicine technologies will be used in care, the limitations of those technologies, the credentials of health care professionals involved, and what will be expected of patients for using these technologies.”

The AMA remains a strong supporter of telehealth technologies. They recognize that organizations like OrthoLive seek to connect patients with doctors in new ways to improve health outcomes.

If you are an orthopedic provider seeking to improve healthcare outcomes, talk with the team at OrthoLive to determine if our low-cost, HIPAA-compliant technology tool is right for you.



 

Topics: "telehealth", "telemedicine", AMA, American Hospital Association, hospital, ethics

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