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Ethical guidelines in telemedicine

Creación: Comité permanente de médicos europeos (Comité Permanent des Médecins Européens, Standing Committee of European Doctors, CPME)
Fuente: Comité permanente de médicos europeos
Lengua original: Inglés.
Copyright del original inglés: No
Adopción: Abril de 1997
Traducción castellana: No
Comprobado el 16 de mayo de 2002


Ethical guidelines in telemedicine


The term telemedicine refers to the practice of medicine over a distance. In telemedicine, interventions, diagnostic and treatment decisions and recommendations are based on data, documents and other information transmitted through telecommunication systems.

Authorisation - competence

Telemedicine is one way of practising medicine which may provide opportunities and increase possibilities to effectively use available human and materiel resources. The possibilities offered by telemedicine must be open to all doctors over geographical borders.

Physicians practising telemedicine must be authorised to practise medicine in the country or state in which they are located and must be competent in the field of medicine in which they are practising it. When practising telemedicine directly with the patient, the doctor must be authorised to practice medicine in the state where the patient is normally resident or the service must be internationally approved.

Patient - doctor relationship

The use of telemedicine must not adversely affect the individual patient-doctor relationship which, as in all fields of medicine, must be based on mutual respect, the independence of judgement of the doctor, autonomy of the patient and professional confidentiality. It is essential that the doctor and the patient can reliably identify each other in a telemedicine consultation.

Preferably, all patients seeking medical advice should see a doctor in a face to face consultation, and telemedicine should be restricted to situations in which a doctor can not be physically present within acceptable time. The major application of telemedicine is the situation in which the treating doctor seeks another doctor's opinion or advice, at the request of or with the permission of the patient.

Where a direct telemedicine consultation is sought by the patient, it should normally only take place when the doctor has an existing professional relationship with the patient, or has adequate knowledge of the presenting problem, such that the doctor will be able to exercise proper and justifiable clinical judgement.

In an emergency, such judgements may have to be based on less than complete information, but in these instances the danger to the health of the patient will be the determinant factor in providing advise or treatment.

The responsible physician

The doctor asking for another doctor's advice remains responsible for treatment and other decisions and recommendations given to the patient.

When practising telemedicine directly with the patient, the doctor assumes responsibility for the case in question.

The doctor performing medical interventions via telemedical techniques is responsible for those interventions.

Quality, security and safety in telemedicine

A doctor practising telemedicine is responsible for the appropriate quality of his/her services. He/she must not practise telemedicine without ensuring that the equipment necessary for the telemedical services rendered is of sufficiently high standard and adequately operational.

The doctor must carefully evaluate the data and other information he/she has received. Medical opinions and recommendations can only be given and medical decisions made if the quality and quantity of data or other information received is sufficient and relevant for the case in question.

When performing medical interventions over distance, the doctor must secure the presence of sufficient and adequately trained personnel assisting the patient and his/her continuing care.

Patient documents

All doctors practising telemedicine must keep adequate patient records and all cases have to be properly documented. The manner of patient identification shall be recorded, as well as the quantity and quality of data and other information received. Findings, recommendations and telemedical services delivered shall be adequately documented.

Medical ethics, patient consent and confidentiality

The principles of medical ethics which are binding upon the profession shall also be followed in the practice of telemedicine.

Normal rules of confidentiality and security also apply to telemedicine documentation. Storing or transmission methods may be used only where confidentiality and security can be guaranteed.

Patient data and other information may only be transmitted to a doctor or other health professional on the request or with the informed consent (permission) of the patient and to the extent approved by him/her. The data transmitted must be relevant to the problem in question.

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