This chapter reviews key debates about the meaning of telehealth and also considers how new and emerging systems in telehealth work to protect patient confidentiality, improve healthcare relationships, and diminish instances of compromised access and equity in the healthcare system. This chapter also looks at how these same telehealth systems could undermine those goals, making it important to assess the way in which these emerging technologies are implemented. Various technologies are examined to show how their implementation can ensure that their benefits outweigh their risks.
The growing use of information and communication technology (ICT) is producing widespread changes in society. One area in particular that is quickly being transformed by ICT is the field of healthcare. This is evident in the relatively new field of telehealth, which utilizes the Internet, electronic patient records systems, hand-held computers, among other types of ICT. Telehealth has great potential to improve the quality and provision of healthcare services, but there are a number of subtle ethical issues that should be considered as society moves forward with its use. The aim of this chapter is, therefore, to provide an ethical assessment of telehealth. The specific questions this chapter addresses are as follows:
What are the distributive justice implications of telehealth? Will medically underserved populations gain greater access to healthcare services? If so, what sorts of tradeoffs, if any, between access and quality will be required?
What are the implications of telehealth for provider-patient relationships? For example, will an increase in the quantity of provider-patient interactions lead to a corresponding increase or reduction in the quality of those interactions?
What are the implications of telehealth for medical privacy and patient confidentiality?
What are the future trends in telehealth and how will they affect patient care and the healthcare system in general?
In order to understand what telehealth is, it is necessary to understand its history and its meanings. The literal meaning of the word telehealth is health from a distance. Combining the word health with the Greek prefix tele, which means end, far off, or distance, produces this definition. We see similar combinations in the words telephone, which literally means, sound from a distance, and telegraph, which literally means writing from a distance.
Various definitions of telehealth are currently in circulation within the healthcare community. One common view of telehealth makes it synonymous with two-way audio-video systems that allow for interactive consults between patients and healthcare professionals. However, other definitions are equally common and may include the use of ICTs (e.g., computers) that capture, store, manipulate, and display medical data but not include the use of interactive communications between patients and healthcare providers. Consequently, a fax machine used to transmit patient medical information or the telemonitoring of a cardiac patient would not count as telehealth under the first definition but would under the second definition (Denton, 1993; Preston, 1994).
Although no universally accepted definition of telehealth exists, there is agreement that any definition of it must include at least three elements: (1) the use of ICT, (2) geographic distance between the participants, and (3) health or medical uses. On the basis of these three characteristics, the Institute of Medicine (IOM) defines telehealth/telemedicine in the following manner:
Telemedicine [telehealth] is the use of telecommunications and information technologies to share and to maintain patient health information and to provide clinical care and health education to patients and professionals when distance separates the participants. (Field, 1996, p. 27)
The IOM’s definition can be made more specific, depending on whether (a) emphasis is given to a particular technology (e.g., video conferencing or Internet) (b) a distinction is made between clinical and non-clinical applications, and (c) whether telehealth is conceived of as an integrated system of healthcare delivery rather than a mere collection of electronic tools.
Key Terms in this Chapter
Modernity: The social, economic, and technological forces that have shaped the contemporary provider-patient relationship.
Implantable Biosensors: Sensors that are directly embedding into the human body to monitor vital signs and to provide prosthetic functions, often in concert with smart home technology and larger telehealth networks.
Distributive Justice: A sub-field of ethics that deals with questions about access and the fair allocation of healthcare benefits and burdens among populations. More specifically, distributive justice in healthcare requires the application of fair standards that make quality healthcare available and accessibl e to persons in an efficient manner.
Physical Privacy: Refers to the restricted access that others have to our bodies, relationships, and living spaces.
Telehealth/Telemedicine: The use of ICT to share and to maintain patient health information and to provide clinical care and health education to patients and professionals when distance separates the participants.
Technological Fix: The temptation to employ technology as a panacea rather than to give oneself as a person in the process of healing patients.
Science of Healthcare: Standardized clinical practice guidelines, automated procedures, scientific evidence, and the employment of medical technology.
Smart Homes: The use of ITC to augment the range of services that homes can provide for their occupants without human assistance, for example, monitoring the time, frequency, and variety of a person’s activities, including how often a person is waking up and walking, using the toilet, or opening his medicine cabinet to take medication.
Art of Healthcare: Individual clinical judgements and intuitions of healthcare providers.
Confidentiality: The protection of private information, once it has been disclosed by a patient to a healthcare professional (e.g., during a medical examination or taking of a medical history). Confidentiality requires patients to give up their informational privacy.
Informational Privacy: Refers to the security of identifiable patient health information and clinical data found in patient records and in communications among healthcare professionals and patients.
Interconnectedness and Social Presence: The quality and feeling of communication exchange with other persons, with or without ITC.
Ethics: The descriptive and prescriptive study of what is right, wrong, good, and bad, of what ought and out not be done.