Telehealth Ethics

Fleming, David; Edison, Karen E.; Pak, Hon S.

doi:10.1089/tmj.2009.0035

Cited by 68 publications

(62 citation statements)

References 27 publications

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“…This foreseen reduction raises questions: how does the loss of physical proximity frustrate adequate diagnosing and what does this mean for palliative care at a distance [21,22]? How can sympathizing and empathizing with patients be maintained in teleconsultation, and how do patients experience this new proximity?…”

Section: Discussionmentioning

confidence: 99%

“…However, the respondents think this patient-centeredness comes at a cost: teleconsultations might upset the balance of involvement and professional distance, leading to loss of control over “boundaries between absence and presence” [25]. A shared freedom to initiate teleconversations is likely to transform expectations and obligations between professionals and patients [22,26]: when patients expect continuous access, professionals feel more obliged to be present and to respond quickly and accurately. It is a feeling that goes beyond their earlier advisory role.…”

Section: Discussionmentioning

confidence: 99%

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Transmural palliative care by means of teleconsultation: a window of opportunities and new restrictions

et al. 2013

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BackgroundAudio-visual teleconsultation is expected to help home-based palliative patients, hospital-based palliative care professionals, and family physicians to jointly design better, pro-active care. Consensual knowledge of the possibilities and limitations of teleconsultation in transmural palliative care is, however, largely lacking.This paper aims at describing elements of both the physical workplace and the cultural-social context of the palliative care practice, which are imperative for the use of teleconsultation technologies.MethodsA semi-structured expert meeting and qualitative, open interviews were deployed to explore professionals’ assumptions and wishes, which are considered to contain latent presumptions about the practice’s physical workplace and latent elements of the cultural-social context, regarding (1) the mediating potential of audio-visual teleconsultation, (2) how the audio-visual teleconsultations will affect medical practice, and (3) the design and usage of the teleconsultation technology. We used a qualitative analysis to investigate how palliative care professionals interpret the teleconsultation package in preparation. The analysis entailed open and axial coding techniques developed in a grounded theory approach.ResultsRespondents assume: 1. teleconsultation will hinder physical proximity, thereby compromising anamnesis and diagnosis of new or acutely ill patients as well as “real contact” with the person behind the patient; 2. teleconsultation will help patients becoming more of a pivotal figure in their own care trajectory; 3. they can use teleconsultation to keep a finger on the pulse; 4. teleconsultations have a healing effect of their own due to offered time and digital attention; 5. teleconsultation to open up an additional “gray” network outside the hierarchical structures of the established chain of transmural palliative care. This network could cause bypassing of caregivers and uncertainty about responsibilities; 6. teleconsultations lead to an extended flow of information which helps palliative care professionals to check the stories of patients and medical specialists.ConclusionsProfessionals assume teleconsultation co-defines a new patient–professional relationship by extending hospital-based caregivers’ perceptions of as well as attention for their patients. At the cost, however, of clinical and personal connectedness. Secondly, a hermeneutics is needed to carefully interpret teleconsultation images. Thirdly, teleconsultations transform caregiving cultures as formerly separated care domains collide, demanding a redefinition of roles and responsibilities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Transmural palliative care by means of teleconsultation: a window of opportunities and new restrictions

et al. 2013

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“…20 The framework for QM for telehealth in VHA aligns well with principles adopted elsewhere, 21 based on ascertaining the adequacy of the therapeutic practitioner-client relationship, providing and documenting care, clearly defining roles and responsibilities, ensuring consent, privacy, and confidentiality are of paramount importance, and other ethical and legal considerations. The ethical issues in telehealth are complex 22 and evolving. They include issues of equity of access to both traditional face-to-face services as well as to telehealth, and not only health disparities 23 are important but also issues associated with the digital divide.…”

Section: Specific To Cvtmentioning

confidence: 99%

The Design, Implementation, and Operational Management of a Comprehensive Quality Management Program to Support National Telehealth Networks

Darkins¹,

Foster²,

Anderson³

et al. 2013

Telemedicine and e-Health

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The Veterans Health Administration (VHA) is a large integrated healthcare system with a mission to care for over 5.6 million Veteran patients annually. VHA, like other healthcare organizations, is challenged with providing access to care to those it serves when they live at a distance from a physical site of care. VHA has embraced telehealth as a way of delivering care at a distance and increase access to specialty care services. Since 2003 VHA has developed large national telehealth networks that provided care to 497,342 patients in fiscal year 2012, who received 1,429,424 episodes of care, and is recognized as a national leader in this field. To ensure the safety and effectiveness of its telehealth networks in their delivery of care VHA has implemented a dedicated quality management (QM) program for telehealth. QM data for telehealth are reviewed at 3-month intervals, and the procedures and processes in place to support telehealth in VHA are assessed biannually in an internal accreditation process called "Telehealth Conditions of Participation." This collegial, nonadversarial process has ensured that all designated telehealth programs meet minimal standards and disseminate best practice. As a result of VHA's QM program, telehealth services in VHA meet consistently high clinical outcomes and have received no adverse Joint Commission citations. The Joint Commission regularly assesses patients managed via telehealth under its tracer methodology reviews.

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“…Telemedicine services in private homes as well as long term care facilities could provide such patients with high quality, cost-effective primary and specialty care. 27 …”

Section: Ethical and Legal Issues In Telemedicinementioning

confidence: 99%

“…46 Not obtaining consent that is informed by privacy and confidentiality issues may have dire consequences on many levels, including the patient’s dignity and autonomy, and the overall well-being of the patient and of the patient-physician relationship. 27 …”

Section: Ethical and Legal Issues In Telemedicinementioning

confidence: 99%

The Patient-Surgeon Relationship in the Cyber Era

Blake

Schwemmer

Sade

2012

Thoracic Surgery Clinics

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Synopsis From Laennec’s invention of the stethoscope in 1816 to the recently introduced Sapien transcatheter aortic valve replacement, the increasing complexity of health care technology has altered the relationship between patients and physicians, usually for the better. Telemedicine, the provision of medical services through electronic media, has dramatically changed how the patient and physician interact and how medical care is delivered. A consistent pattern of increased use of the Internet by patients and their families has been well documented. Patients clearly want more Internet interactions with clinicians in their quest for general information, prescription renewals, and such administrative matters as scheduling appointments. Despite privacy concerns, patients are generally satisfied that their communications and medical records are confidential and accurate. Physicians’ utilization of information technology has increased as the range of electronic devices and modes of communication has expanded. Many studies of physicians’ perceptions of electronic communication with patients have documented recognition of benefits as well as a consistent chorus of concerns about confidentiality, increased workload, inappropriate use, and medicolegal issues.

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Telehealth Ethics

Cited by 68 publications

References 27 publications

Transmural palliative care by means of teleconsultation: a window of opportunities and new restrictions

Transmural palliative care by means of teleconsultation: a window of opportunities and new restrictions

The Design, Implementation, and Operational Management of a Comprehensive Quality Management Program to Support National Telehealth Networks

The Patient-Surgeon Relationship in the Cyber Era

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