Pediatric Telehealth in the COVID-19 Pandemic Era and Beyond

Abstract

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Ethical and Legal Challenges of Telemedicine in the Era of the COVID-19 Pandemic

“…The concerns reported by the selected articles mostly pertain to the ethical and legal aspects (often interlinked), which were already highlighted in previous literature before the pandemic [7], but nevertheless remain crucial. These included the following: informed consent (information about the risks and benefits of remote therapy) and autonomy (87%), patient privacy (78%) and confidentiality (57%), data protection and security (74.%), malpractice and professional liability/integrity (70%), equity of access (30%), quality of care (30%), the professional-patient relationship (22%), and the principle of beneficence or being disposed to act for the benefit of others (13%) [1,6,8,10,11,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. Non-maleficence is the principle of preventing harm by actively promoting confidentiality, safety/safeguarding, and security.…”

“…Commentary Italy [1] Law/regulations/legal issues (83%) stress the absence or variation of the rules among countries and the need for guidelines/best practices or standardization of telemedicine services. In particular, the questions raised regarded the following aspects: costs of services and reimbursement, insurance coverage, virtual prescription of medications, accreditation, licensing, commercialization, recording (as an area of controversy), and evaluation of the effectiveness of the services such as health outcomes and delivery, in terms of quality and cost, individual experience, program implementation, and key performance indicators [1,6,8,10,11,16,19,[21][22][23][24][27][28][29][30][31][32]34].…”

“…Remote patients could either benefit or be disadvantaged by virtual care (e.g., lack of access to Internet, smartphones, or other technology should not prevent children from accessing their medical system) [10]. Indeed, the principle of justice includes equal access to care and fair distribution of the technology for marginalized communities [16].…”

“…With respect to the legal issues of virtual prescription of medication, recently highlighted by Curfman et al [10], it is worth noting that telepharmacy ("a form of pharmaceutical care in which pharmacists and patients are not in the same place and can interact using information and communication technology (ICT) facilities") also presents unresolved limitations (e.g., legal implications) [37]. In Italy, a recent investigation stressed the need for more efforts to be made by national public health stakeholders to better analyze the contribution of telemedicine services available in public pharmacies and to find the best solutions to implement this innovative technology as an established service [38].…”

“…On the other side, teleservices such as teleanalysis, previously avoided as they were considered unsafe because of security concerns, are now recommended given the contemporary situation of many analysts in the world now being forced to work online due to the COVID-19 pandemic emergency [8,9]. Indeed, in this particular situation, telemedicine services have proven indispensable in facing the emerging needs of health care in this specific context [10]. Many lives have been saved during the COVID-19 pandemic through the use of telemedicine services making it possible to avoid physical or face-to-face contact with medical staff, healthcare personnel or other health professionals and patients in hospitals and clinical or health settings (unless strictly necessary), and by possibly reducing the virus spread and preventing or minimizing the risks of contagion either for patients or healthcare personnel [11,12].…”