In a rapidly changing world where technological developments happen on a daily basis, it is only logical that advanced telecommunications and computer technologies are used to improve health care and expand access to health services. The necessity to provide high quality and accessible medical attention was highlighted with the COVID-19 pandemic where interpersonal interactions were minimised to reduce contagion. Governments needed to provide a quick response to the high-volume demand and rapidly expanded telemedicine services^4,5. Telecommunications posed a solution to harness the power of technology and connectivity to transmit knowledge from the healthcare worker right to the patient’s home⁶.

Telemedicine can be defined as “the use of electronic information and communication technologies to provide and support health care when distance separates the participants”². It consists of the virtual interaction, synchronous or asynchronous, between the physician and the patient; whereas telehealth (a term commonly used interchangeably with telemedicine) is the flow of information^6,7. One of the first telemedicine experiences can be traced all the way back to the 1860s, where the telegraph and morse code were used during war to transmit messages from wounded soldiers to the medical teams³. Major inventions followed including the radio, telephone, and television, but it wasn’t until the 20th century that they were repurposed to provide medical care (e.g., to assist sailors when at sea or to provide training to healthcare students). With the age of connectivity starting during the 2000s, telemedicine rapidly expanded with the creation of telephone networks, use of satellites and space technology, and the development of the internet. This rapid evolution allowed telemedicine companies to grow exponentially and evolve into more efficient services³.

With the dependency of telecommunication during the COVID-19 pandemic, an unparalleled opportunity has been presented to consider not only the ethical and legal issues, but also the social concerns that these services bring foward^4,6,7.

Firstly, is an informed consent needed before each telemedicine consult? Will the patient-physician relationship be altered? What are the privacy and confidentiality concerns? How do we identify patients? Do we trust that the patients are who they say they are? Is the patient’s autonomy being respected? How do healthcare providers document each consultation and where will that data be stored? What is the risk of misdiagnosing during a virtual visit? These represent some of the many ethical and legal questions posed that were overshadowed by the urgency of the pandemic.

Secondly, in terms of the main social issues that need to be address, international organisations and governments need to argue and decide whether a low socioeconomic country should spend part of their money on improving telemedicine services rather than on, for example, agricultural insecurity, water safety or education. Health equity and access is a major topic to address, especially for the elderly, disadvantaged and minorities with no access to technology or to an effective connectivity network⁴. How do we reduce these disparities, whilst agreeing on local guidelines to protect the patient’s health and information?

Several guidelines and codes of ethics have been drafted to address these concerns^1,8. However, these guidelines cannot be unanimously adopted by every country due to cultural and socioeconomic differences as well as local stakeholder’s viewpoints⁷. Not all of these questions have answers, and telemedicine services appear to be so vulnerable in every aspect. But is clear that in those countries in which telemedicine is a step forward, efforts need to be put into establishing guidelines that address quality and relationships, access, consent, and privacy; regulatory policies and regulations need to include issues of cybersecurity, licensure, liability, and malpractice⁷.

References

1. American Medical Association (2021). AMA Telehealth quick guide. Accessed 10 July 2020 from https://www.ama-assn.org/practice-management/digital/ama-telehealth-quick-guide
2. Institute of Medicine (US) Committee on Evaluating Clinical Applications of Telemedicine; Field MJ, editor. Telemedicine: A Guide to Assessing Telecommunications in Health Care. Washington (DC): National Academies Press (US); 1996. 1, Introduction and Background. Available from: https://www.ncbi.nlm.nih.gov/books/NBK45440/
3. Jagarapu J, Savani RC. A brief history of telemedicine and the evolution of teleneonatology. Seminars in perinatology. 2021;45(5). doi:10.1016/j.semperi.2021.151416
4. Kaplan B. Ethics, guidelines, standards, and policy: telemedicine, covid-19, and broadening the ethical scope. Cambridge quarterly of healthcare ethics: cq : the international journal of healthcare ethics committees. 2022;31(1):105-118. doi:10.1017/S0963180121000852
5. Kaplan B. Revisiting health information technology ethical, legal, and social issues and evaluation: telehealth/telemedicine and covid-19. International journal of medical informatics. 2020;143:104239-104239. doi:10.1016/j.ijmedinf.2020.104239
6. Nittari G, Khuman R, Baldoni S, et al. Telemedicine practice: review of the current ethical and legal challenges. Telemedicine and e-health. 2020;26(12):1427-1437. doi:10.1089/tmj.2019.0158.
7. Shafizadeh H, Larijani B, Mojtahedzadeh R, Shamsi Gooshki E, Nedjat S. Initial drafting of telemedicine’s code of ethics through a stakeholders’ participatory process. Journal of medical ethics and history of medicine. 2021;14:24-24. doi:10.18502/jmehm.v14i24.8184

World Medical Association (2020). Statement on the Ethics of Telemedicine. Accessed 10 July 2022 from https://www.wma.net/policies-post/wma-statement-on-the-ethics-of-telemedicine/