At its annual meeting on June 13, the American Medical Association (AMA) adopted ethical guidelines for the use of telemedicine, affirming the organization’s support of the use of telemedicine technologies within the confines of certain ethical principles. The guidelines were adopted after several years of debate and solidify AMA’s support for providing medical care via telehealth technologies.
At an AMA meeting in November 2015, during which the proposed guidelines were discussed, AMA Chief Executive Officer James Madara acknowledged the new “remarkable tools” now available in the digital health space. The guidelines are a show of support from the AMA for the technological innovations that are reshaping the physician-patient relationship and the manner in which health care is delivered in the 21st Century, recognizing that such technological changes do not alter physicians’ fundamental ethical responsibilities.
The recommendations contained in the guidelines include the following:
Managing Conflicts of Interest
- Physicians should disclose any financial or other interests in the telehealth/telemedicine application or service used by the physician and should manage or reduce potential conflicts of interest.
- Physicians should provide objective and accurate information when producing content for mobile health applications or services.
Privacy and Security
- The telehealth application or services must have appropriate protocols to protect the security of patient information and prevent unauthorized access to such information both throughout the electronic encounter and during any subsequent provision of care.
- Physicians should inform users about any limitations resulting from care being provided via telemedicine, advise patients on how to arrange for follow-up care when medically indicated, and encourage users to inform their primary care physicians about the telemedicine consultation.
Standards of Care
- Physicians should uphold the standards of professionalism expected for in-person interactions and adhere to applicable law governing the practice of telemedicine.
- Physicians should be proficient in the use of relevant technologies.
- Given the inability to conduct a physical examination, physicians should ensure that they have sufficient information to make well-informed clinical recommendations.
- Physicians should be “prudent” in carrying out evaluation or prescribing medications by confirming the patient’s identity, confirming that telemedicine services are appropriate given the patient’s circumstances and medical needs, evaluating the appropriateness and safety of any prescription, and documenting the diagnostic evaluation and prescription.
- When physicians would otherwise be expected to obtain informed consent, physicians should tailor the informed consent process to provide information about telemedicine features.
- Physicians should promote continuity of care and information sharing with the patient’s primary provider or other specialists.
Professional Organizations/Health Care Institutions
- Through their professional organizations and health care institutions, physicians should support refinement to telemedicine technologies, advocate for policies to improve access to telemedicine services, and monitor the telemedicine landscape.
The guidelines will be incorporated into the AMA’s Code of Ethics by amending Opinions E-5.025, “Physician Advisory or Referral Services by Telecommunication,” and E-5.027, “Use of Health-Related Online Sites.” In the press release announcing the new guidelines, AMA Board Member Jack Resneck, MD summarized a main goal of the guidelines, stating, “[p]hysicians who provide clinical services through telemedicine must recognize the limitation of the relevant technologies and take appropriate steps to overcome those limitations.”