The development of ethical guidelines for telemedicine in South Africa

Abstract

While telemedicine holds enormous promise for the provision of remote healthcare, it is not without its challenges. Recently, there has been a shift in the way in which healthcare is being practised globally. These new models of healthcare service provision ideally involve patients, doctors and machines working together, with few constraints imposed by geography, or national or institutional boundaries. The World Health Organization (WHO) defines eHealth simply as 'the use of information and communication technologies [ICT] for health'; [1] telemedicine, as a subset of eHealth, is the practice and delivery of healthcare over a distance using ICT. [2] The focus of this article is telemedicine. However, the term eHealth will be applied when speaking of the use of ICT in healthcare generally, and telehealth where this term is applied by others, or when a slightly more generic perspective (one that includes telemedicine) is required. Although largely beneficial, there is growing reflection on the legal and ethical challenges and complexities posed by these newly unfolding eHealth measures. [3,4] There is a need for guidance with regard to the eHealth landscape in South Africa (SA). It is understood that the emergence of telemedicine has created various legal and ethical dilemmas. [5,6] The broad ethical challenges are identified as: the changing nature of the traditional doctor-patient relationship; standards of care; quality of care; privacy; confidentiality; data protection; accountability; liability; consent; record-keeping; data storage; and authentication. While various legal, regulatory, and governance measures offer potential solutions and remedies for rights protection, the furtherance of ethical direction may be achieved through statutory bodies set up to promote and foster ethical compliance with normative healthcare standards. In SA, the Health Professions Council (HPCSA) spent several years developing the 'General ethical guidelines for good practice in telemedicine' (the HPCSA telemedicine guidelines), [7] a process which they found difficult. [8] Advances in technology and telemedicine have rendered several aspects of these guidelines, which focus largely on videoconference-based telemedicine, inappropriate. The guidelines are largely based on the World Medical Association (WMA)'s 2007 'Statement on the ethics of telemedicine' , which was rescinded in 2009, and replaced with a far more pragmatic statement on 'Guiding principles for the use of telehealth for the provision of healthcare' , which took recent advances in the field into account. [9] The field has since advanced further, with the growing use of mobile phones for telemedicine. The current shortcomings of the HPCSA guidelines need to be addressed if telemedicine is to meet the government's desire for telemedicine to improve both access to and quality of care for those in rural areas. This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

The worldwide impact of telemedicine during COVID-19: current evidence and recommendations for the future

“…Before COVID-19, telemedicine use was limited in South Africa, partly because of the lack of remuneration for telemedicine and, more importantly, the restrictive General Ethical Guidelines for Good Practice in Telemedicine in South Africa produced by the Health Professions Council of South Africa [ 20 , 21 ] . While their definition of telemedicine restricts it to communication between healthcare practitioners, doctor-to-patient consultation is allowed if there is an existing doctor-patient relationship.…”

A Survey of Telemedicine Use by Doctors in District Hospitals in KwaZulu-Natal, South Africa

“…It may also reflect concern that their response would show that they are not following the prescribed practice regarding consent and, thus, making themselves potentially liable for sanction if identified. Regardless, due to the apparent lack of awareness of the HPCSA’s General Ethical Guidelines for Good Practice in Telemedicine in South Africa (Booklet 10) [ 25 ], there are clear concerns about the intersection of reality and the requirements of the guidelines that need to be addressed [ 29 ].…”

Tele-audiology and preventive audiology: A capacity versus demand challenge imperative in South Africa

“…Ethical practice guides professional behaviour and is central to service delivery. Townsend and Scott (2019) outlined several current ethical challenges facing the implementation of telehealth practices in Africa. These include the fluidity of the doctor-patient relationship, privacy, confidentiality, data protection, accountability, liability, consent, record-keeping, data storage and authentication.…”