CC BY-NC-ND 4.0 · Yearb Med Inform 2020; 29(01): 044-050
DOI: 10.1055/s-0040-1701976
Special Section: Ethics in Health Informatics
Working Group Contributions
Georg Thieme Verlag KG Stuttgart

Ethics in Telehealth: Comparison between Guidelines and Practice-based Experience -the Case for Learning Health Systems

Craig E. Kuziemsky
1  Office of Research Services and School of Business, MacEwan University, Edmonton, Alberta, Canada
Inga Hunter
2  School of Management, Massey University, New Zealand
Shashi B. Gogia
3  Society for Administration of Telemedicine and Healthcare Informatics (SATHI), New Delhi, India
Sriram lyenger
4  University of Arizona College of Medicine, USA
Gumindu Kulatunga
5  Postgraduate Institute of Medicine, University of Colombo, Sri Lanka
Vije Rajput
6  General Practitioner, Stonydelph Health Centre, Tamworth, UK
Vignesh Subbian
7  College of Engineering, The University of Arizona, USA
Oommen John
8  George Institute for Global Health, University of New South Wales, New Delhi, India
Araujo Kleber
9  NUTES Universidade Federal de Pernambuco, Brazil
Humberto F. Mandirola
10  Hospital Italiano de Buenos Aires, Argentina
Jose Florez-Arango
11  Texas A & M Health Sciences Center, USA
Najeeb Al-Shorbaji
12  eHealth Development Association of Jordan, Jordan
Sushil Meher
13  All India Institute of Medical Sciences, India
Jai Ganesh Udayasankaran
14  Sri Sathya Sai Central Trust, India
Arindam Basu
15  School of Health Sciences, University of Canterbury, New Zealand
› Author Affiliations
Further Information

Publication History

Publication Date:
17 April 2020 (online)


Objectives: To understand ethical issues within the tele-health domain, specifically how well established macro level telehealth guidelines map with micro level practitioner perspectives.

Methods: We developed four overarching issues to use as a starting point for developing an ethical framework for telehealth. We then reviewed telemedicine ethics guidelines elaborated by the American Medical Association (AMA), the World Medical Association (WMA), and the telehealth component of the Health Professions council of South Africa (HPCSA). We then compared these guidelines with practitioner perspectives to identify the similarities and differences between them. Finally, we generated suggestions to bridge the gap between ethics guidelines and the micro level use of telehealth.

Results: Clear differences emerged between the ethics guidelines and the practitioner perspectives. The main reason for the differences were the different contexts where telehealth was used, for example, variability in international practice and variations in the complexity of patient-provider interactions. Overall, published guidelines largely focus on macro level issues related to technology and maintaining data security in patient-provider interactions while practitioner concern is focused on applying the guidelines to specific micro level contexts.

Conclusions: Ethics guidelines on telehealth have a macro level focus in contrast to the micro level needs of practitioners. Work is needed to close this gap. We recommend that both telehealth practitioners and ethics guideline developers better understand healthcare systems and adopt a learning health system approach that draws upon different contexts of clinical practice, innovative models of care delivery, emergent data and evidence-based outcomes. This would help develop a clearer set of priorities and guidelines for the ethical conduct of telehealth.