Telemedicine has been growing by leaps and bounds over the past decade, moving beyond teleradiology to include a broad range of specialties such as neurology, infectious diseases, and psychiatry. However, this expansion has not been without controversy, as highlighted by the American Medical Association’s (AMA) recent adoption of guidance for the ethical practice in telemedicine.
Over the past three years, the AMA’s Council on Ethical and Judicial Affairs worked on developing guidance for ethical practice in telemedicine. Finally, on June 13, 2016, the AMA announced that it has adopted new ethical guidelines to aid physicians and the telemedicine industry in ensuring safe and effective doctor-patient interactions through telemedicine as an alternative to the traditional in-person interaction at a medical office or hospital. This development augurs well for the idea that the AMA is finally embracing telemedicine.
According to a press release announcing the adoption, AMA Board Member Jack Resneck, M.D. said at the AMA Annual Meeting that "Telehealth and telemedicine are another stage in the ongoing evolution of new models for the delivery of care and patient-physician interactions." He went on to state that "[t]he new AMA ethical guidance notes that while new technologies and new models of care will continue to emerge, physicians’ fundamental ethical responsibilities do not change." According to the release, Dr. Resneck also highlighted that physicians must recognize the technological limitations involved in telemedicine, and take the steps necessary to overcome them to ensure that physicians have "the relevant information they need to make well-grounded recommendations for each patient."
The three-year guideline development process took as long as it did because a significant number of AMA members were uncomfortable with outlining a framework for physicians that centered on technology versus the traditional in-person physician-patient relationship. This has been a contentious issue that has effectively impeded efforts to raise the profile of telemedicine in states such as Arkansas and Texas. The debate centers around whether a physician can truly establish a meaningful relationship with a patient when the patient is in a remote location, accessible to the physician only via video technology.
Although the debate is far from over, the AMA notes in its press release that the guidelines for the ethical practice of telemedicine “permit physicians utilizing telehealth and telemedicine technology to exercise discretion in conducting a diagnostic evaluation and prescribing therapy, within certain safeguards.”
The AMA guidelines for telemedicine counsel that physicians using telehealth should, among other things:
- Inform patients regarding the limitations of the technology;
- Advise patients on how to arrange for follow-up care;
- Encourage patients to inform their primary physician when they’ve been treated via telehealth; and
- Support policies and initiatives that promote access to telehealth or telemedicine services for all patients who could benefit from receiving care electronically.
The AMA expects to publish the AMA ethical guidelines for telehealth soon.