Privacy Consent and Legal Issues, Essay Example

Legal, Privacy, and Consent Issues in the Canadian Telestroke Program

Rapid medical treatment in the wake of acute strokes increases the likelihood of favourable patient outcomes.  This is especially true in the case of ischemic strokes, which make up 80% of all stroke cases, wherein the identification of eligible patients and subsequent treatment can achieve positive benefits up to 270 minutes after symptoms are exhibited (CADTH, 2008).  This need for immediate action and the difficulty in achieving such a response in rural and remote areas of the country were primary reasons behind the development of Canada’s Telestroke program.  Working in conjunction with intervention strategies such as community education programs, dedicated stroke centers, and emergency room protocols, Telestroke utilizes telecommunications devices and electronic information processing to facilitate remote assessments of stroke patients (Demaerschalk, 2010).  Although this has been a vital means of providing patients with improved care, and allows for physicians to receive support from consulting neurologists, this burgeoning technology lacks a comprehensive framework meant to specifically address legal, privacy, and consent issues as they relate to Telestroke (deBustos et al., 2009).

One of the greatest barriers to the successful implementation of Telestroke across Canada stems from a lack of consistency in the delivery of this service.  As stated by deBustos and colleagues (2009), although telemedicine has major and positive implications for the treatment of stroke, the use of this service remains limited and fragmented, with many initiatives acting as “no more than one-off, small-scale projects that are not integrated into healthcare systems” (p.36). Lateef (2011) notes that many practitioners, especially those in the United States, remain reluctant to actively access and utilize teleheath applications for fear of exposing themselves to malpractice charges.  The strength of telehealth lies in its ability to bridge physical distance through the application of new telecommunications technologies, thus allowing healthcare practitioners to provide their services without the constraint of distance and national borders (Thompson, 2010).  However, the “cross-border provision of telemedicine services requires legal clarification on an international basis” (deBustos et al., 2009, p.38) in regards to licensing, accreditation, and governing jurisdiction of healthcare professionals.

The issue of patient privacy in relation to telehealth services remains a distinct concern, in part because the rapid pace of technological change compromises the ability of policymakers, healthcare providers, and patients to adopt and become aware of a standard approach to privacy issues.  Bauer (2002) notes that privacy and the control of information are not necessarily synonymous, especially in the context of medical interventions which require immediate responses in order to improve the patient’s chance of survival. The need for emergency medical care may override patient concerns about confidentiality and autonomy, creating situations in which the ethical implications of stroke interventions may remain unclear (Lateef, 2011). However, as Garg (2009) articulates, choices must be made when it comes to the security of telehealth systems due to resource and practical constraints.  Privacy must sometimes be sacrificed in order to provide the physical safety and security that comes from the rapid and accurate transmission of healthcare information, especially in remote locations where time is of the essence.

As demonstrated in Bauer’s (2002) discussion of autonomy, control, and privacy in a healthcare context, the issue of informed consent lacks a clear cut approach in a telehealth context.  The monumental task of ensuring that voluntary informed consent is acquired “for each and every disclosure of patient health information […] could require an enormous expenditure of human and financial resources that would, in turn, retard the pursuit and actualization of other medical goals” (Bauer, 2002, p. 140).  However, in regards to new technologies such as videoconferencing and Internet applications, there exists the opportunity to obtain consent from patients in an easily-documented form, thus lessening the potential legal ramifications for healthcare practitioners (Demaershalk et al., 2009).  This could lead to an increased willingness to utilize Telestroke amongst practitioners who have expressed discomfort regarding the ethical and legal implications of Telestroke and other telehealth applications.

Telecommunications applications such as the Internet have redefined the relationship between healthcare providers and patients (Thompson, 2010) and have created unique opportunities to improve the life expectancies of stroke patients. However, in order for Telestroke to remain sustainable in the long-term, it is vital that practitioners and policymakers direct their attention to the many unresolved issues surrounding consent, privacy, and the legal implications for healthcare practitioners. These barriers must be overcome in order for trust and acceptance of the available technologies to be developed, which in turn will lead to a system which will better meet its full potential (deBustos et al, 2009). A comprehensive standards of practice that can be utilized both within Canada and internationally will assist in further popularizing this unique and effective mode of stroke treatment, thus ensuring that patients in remote areas receive the same level of healthcare available to their more urban counterparts.

References

Bauer, K. (2002). The ethical implications of telemedicine and the internet for home healthcare. Unpublished Doctoral Dissertation. University of Tennessee, Knoxville.

Canadian Agency for Drugs and Technologies in Health (CADTH). (2008, Jan.). Telehealth for acute stroke management (telestroke): Systematic review and environmental scan. HTA, 37: 1-13. Retrieved from www.cadth.ca/media/pdf/456_Telestroke_to_e.pdf

deBustos, E.M., Moulin, T., & Audebert, H.J. (2009, Jun. 18). Barriers, legal issues, limitations, and ongoing questions in telemedicine applied to stroke. Cerebrovascular Diseases, 27(4): 36-39. doi: 10.1159/000213057.

Demaerschalk, B.M., Miley, M.L, Kiernan, T.E.J., Bobrow, B.J., Corday, D.A., Wellik,   K.E. … & Richemont, P.C. (2009, Jan.). Stroke telemedicine. Mayo Clinic Proceedings, 84(1): 53-64. doi:10.4065/84.1.53

Demaerschalk, B.M. (2010, Oct. 5). Telemedicine or telephone consultation in patients with acute stroke. Springerlink. Retrieved from             http://www.springerlink.com.cat1.lib.080/content/15669639814nq00r/fulltext.pdf

Garg, V. (2009, May). Security concerns in telecare and telemedicine. Unpublished Masters Thesis. Purdue University, West Lafayette.

Lateef, F. (2011). The practice of telemedicine: Medico-legal and ethical issues. Ethics and Medicine, 27(1): 14-24.

Thompson, N.M. (2010, July). A study of web-based family medicine malpractice law of eastern region of the United States. Unpublished Dissertation. University of Phoenix, Phoenix.