- The American Medical Association is once again ready to wade into telemedicine ethics.
After punting the issue last June and again in November, the AMA’s House of Delegates will begin debate this weekend on guidelines that define “the ethical practice of telemedicine.” One of the primary sticking points is whether a physician and patient can have an appropriate relationship online or through a mobile device, or whether the two should first meet in person.
In a report issued in advance of the AMA’s annual meeting next week in Chicago, the AMA’s Council on Ethical and Judicial Affairs says new technologies and platforms have made it difficult for physicians to know where their responsibilities lie in treating patients from a distance.
"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," it adds. "Although physicians’ fundamental ethical responsibilities do not change, the continuum of possible patient-physician interactions in telehealth/telemedicine give rise to differing levels of accountability for physicians. All physicians who participate in telehealth/telemedicine have an ethical responsibility to uphold fundamental fiduciary obligations and to protect privacy and confidentiality."
Last November in Atlanta, the AMA board couldn’t come to an agreement on the Ethical and Judicial Affairs Council’s proposal, which had sought to define a valid relationship as one that can be conducted “in person or virtually through real-time audio and video technology.”
Several delegates, echoing the hard-line stance taken by medical boards in Texas and Arkansas, have argued that a physician and patient should first meet in person.
“There is no requirement here of any form of inpatient, face-to-face interaction,” Arlo Weltge, MD, PhD, MPH, an AMA alternate delegate from Texas, said at the November meeting. “For physical diagnosis, there needs to be a physical exam that can be done either with an initial face-to-face, or it can be done with a presenter who is seeing the patient in consultation.”
Those opposing the proposed standards took issue with requirements that physicians inform their patients of the limitations of telemedicine and provide advice on arranging follow-up care. They also questioned whether different guidelines are needed for specialists, such as pathologists and radiologists.
Other issues discussed included protecting patient privacy and information during a telemedicine visit, ensuring that care is coordinated after the visit, disclosing any financial interest by the provider in the telemedicine platform, and determining whether the platform being used – phone, online or video – is appropriate when prescribing medications.
While there’s no guarantee the AMA will vote on a proposed set of guidelines next week, Forbes recently reported that some AMA members are pressuring the association to take a stand. They “are worried about the proliferation of telehealth and are hopeful there will be a vote on the council’s report given the number of patients engaging online with providers of medical care and mental health services,” the magazine stated.