00 Moisil, Rogozea - Telemedicine WSEAS-CAMBRIDGE2009

8/6/2019 00 Moisil, Rogozea - Telemedicine WSEAS-CAMBRIDGE2009

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Telemedicine and ethical dilemmas

LILIANA ROGOZEA,

LUCIANA CRISTEA,

MIHAELA BARITZ,

VICTORIA BURTEA

Transilvania University of BrasovROMANIA

[email protected]

Abstract: Telemedicine is still under development and the main goal is to deliver medical care at distance. The

application of telemedicine and telecommunication – telematics – in the healthcare system is the privilege of the richcountries, where reliable and secure satellite connections are available at high speed transfer rate, and its use is limited

by the necessity to exist the highly sophisticated equipment. To facilitate telemedicine applications for all countries is

one of the goals for the next years. In the same time, educational programs in the field and ethical analyzes are not only

a trend for the next years but a real necessity. In this respect, in this paper, we will consecutively pay attention to theethical aspects of telemedicine correlate with patients, health care services, communication or biomedical literature.

Key Words: ethics, telemedicine, health care

1. IntroductionIn this paper we reflect the phenomena of telemedicine,

its implication and the common problems develop by

this new way in medicine.

Telemedicine can improve the lives of European

citizens, both patients and healthy people, and alsointegrate at a higher level the activities of health

professionals, while tackling the challenges of

healthcare systems. [1] (fig.1.) According to WHO

statement made in Geneva in December 1997:

“Telemedicine is the delivery of health-care services,where distance is a critical factor, by health-care

professionals using information and communication

technologies for the exchange of valid information far

diagnosis, treatment and prevention of disease and

injuries, and for the continuing education of health-care

providers as well as research and evaluation, all in the

interests of advancing the health of individuals and their

communities.” [10]

Figure 1.

European citizens are getting older and life expectancy

is greater because we are developing better and new

treatments and we can use better and better drugs. In that

context there are a greater number of people living withchronic diseases. Their health condition often requires

enhanced medical attention. Medical support may not beavailable in remote areas as easily or as frequently as

their health condition would require.

"Telemedicine can radically improve chronically ill

patients' quality of life and give people access to top

medical expertise. It is our duty to make sure patientsand health professionals can benefit from it," said

Viviane Reding, EU Commissioner for InformationSociety and Media. "At the same time, the provision of

remote healthcare services through ICT can optimize the

use of scarce human and financial resources in the

medical field." [10]

2. Changes in Health care environment?Introducing telemedicine could help doctors and

patients access health care from distance, but there are

also many considerable problems that must be solved in

order to successfully implement telemedicine in medicalsystems (fig.2).

There are a number of challenges generated bychanges done in the health-care environment like: [2, 4,

and 5]

population mobility and continuity of care,

increasing the number of female who work,

conflict between home care and care in specialunits,



necessity of distant monitoring of health status,

including between hospital and home,

the grievance of political and economical to reduce

the expenditure in health sector

increasing the role of bioinformatics and electronic

evidence

developing new concept of e-Health and evidence

based medicine

Figure 2.

In spite of some difficulties and barriers which can

appear, telemedicine could be a good opportunity for

helping people, especially because in the last decade weremark a lot of challenges in medicine, like: [7, 9]

increase the number of elderly people increase the morbidity by chronicle or

cardiovascular diseases, cancer, neuropathologies,

genetic diseases

change the spectrum of infectious diseases

developing international programs for diseases

prevention (epidemiology)

developing rehabilitation centers and home care

assistance.

Citizens/patients ask for more information and in future

also will increase the facilities to give to citizensaccurate, easy to understand and up to date information

about health, preventive disease and also about the

health system.The health system records challenges of healthcare providers (public and/or private) structures based on the

new philosophy of development this sector. The

directions are:

to improve quality and treatment for each person

to develop standards of care for patients and of life

for the citizens

to reduce costs

to use advanced diagnostic and therapeutically

technologies (CT, MRI, etc.) for a large number of patients/citizens

to develop a health promotion system

ICT and Telemedicine can contribute to win these

challenges by improving the level of health maintenanceand reducing costs. (fig.3)

Figure 3.

3. Telemedicine – medical aspectsTelemedicine (fig.4.) use ICT, in situations where the

health professional and the patient are not in the samelocation. Also it can be used when a doctor like to

receive an advise from other colleagues. In that context,

telemedicine encompasses a wide variety of services,like: telemonitoring, telepathology, teleconsultation, and

telesurgery. [9]

Figure 4.



The effects of using telemedicine could be:

re-organization and re-deployment of healthcareresources

increase quality of care for patients

a coherent partnership between patients, health

professionals, healthcare providers

optimize the patient's monitoring and treatment

protocols

4. Ethics and telemedicine.Telemedicine and its branches put a number of ethical

problems, which must be solved for giving a high levelof trust in these methods.

Virtual consultation, virtual libraries, telepharmachy,

teleradiology and of course, security issues are only fewelements connected with ethical dilemmas. [3, 9]

Figure 5.

The most important problems (fig.5) develop in the

telemedicine ethical fields are:

how is certificate the competence of medical doctors

involved in telemedicine

how is assure the confidence in telemedicine

how is achieved the confidence and acceptance of

telemedicine solutions by health professionals, patients and health authorities

how is assessed the efficiency of telemedicine

how are respected the rights and fundamental

freedoms

how is influence the health professional – patients

relationship

how safety are the patients records

remote real-time examination, remote real-timeassistance, remote robotic surgery

Telemedicine means to practice medicine at the distance,

but not at distance of competences. Foe example, inorder to certificate the quality of medical sites it

becomes obvious that it must be found a way to

certificate the competences of people who use

telemedicine services, and also to certify the quality of connection. [8]

Telemedicine consultation is one of the highchallenges for medicine today; the doctors must have

very good abilities, adequate knowledge and to accept

the virtual community. Tele-monitoring could be very

useful for people who live in inaccessible areas, butgenerating this process could be unwholesome.

Even if some computer scientists think that is possibleto have a maximum security of data used in e-Health,

unfortunately, our experience show that even most

secure systems can be broke. But, of course using

electronic data means to allow doctors to have access to

medical records and databases and, of course, to assurethe updating process of patients’ data.

Also are very important to development thetelemedicine into benefit patients and society, maketelemedicine information available to others, encourage

development the doctors specialist in telemedicine,

provide telemedicine services with a high accessibilityor use telemedical resources to acquire new knowledge,

to learn new skills, and maintain their levels of expertise

Recognized standard of telemedical care is an important

step for developing the future medicine. [6]

5. Ethics and telemedicine – few

dilemmas in students viewIn order to see how telemedicine is perceived by our medical students we have design a survey based on a

questionnaire. The study group comprises 174 studentswhich have a minimum of 18 and a maximum of 47

years. The study was realised in December 2008-

January 2009, in Transilvania University of Brasov andUniversity of Iuliu Haţieganu Cluj.

One of the questions addressed to medical students

was: In what scope we can use telemedicine? (fig. 6) They have the possibility to choose one or more

answers:

a. deliver the data between patients and doctors

b. for the isolate regions, for regions affected by war c. for developing mobile applications useful in

ambulance services

d. for developing the application which permitconsultation at home, facilitating the doctors access

and reducing the time until the consultation is

possible

e. to reduce the expenditure of medical offices.



9

21

6

7

4

17

2

4

5

9

4

9

3

1

8

13

8

2

9

11

1

1

14

2

4

0 5 10 15 20

a

b

c

d

e

ab

ac

ad

ae

bc

bd

be

cd

ce

de

abc

abe

abd

acd

ade

bcd

bce

abcd

abde

abcde

Figure 6.

The students think that is very important to use

telemedicine especially for the isolate regions

(geographical or political) this result being inaccording with the idea of medical doctors that

telemedicine could change the communication process between medical staff and patients and that it is better

to be used only if it is necessary.

One of the problem discuss with the student was: What

are the principal ethical problems developed by

telemedicine? The students were request (fig.7) to put

in order the next affirmation, from 1 to 5 (5 being the problem with biggest importance):

a. not knowing the competence of the person who usesthis facility

b. the change in the relation doctor-patients

c. confidentiality, reliability and security

d. possibility to obtain incomplete information,according with the level of education of patients or the people from their entourage

e. the manner of store and transfer of the informationregarding the patients

As it could be seen in the next graphic the biggest problem is sought to be the risk of loosing

confidentiality. Only on the second place is the

possibility to modify the relation between patient and

doctors. (fig.6)

41

64

24

29

16

35

21

43

36

39

34

25

35

36

44

35

25

29

46

39

29

39

43

27

36

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

e 16 39 44 39 36

d 29 36 36 46 27

c 24 43 35 29 43

b 64 21 25 25 39

a 41 35 34 35 29

1 2 3 4 5

Figure 7.

Another problem discuss was: Confidentiality in

telemedicine is in connection with ….? (fig.7)

a. to respect the patients rights so that the information

about the patient is to be known only by thedoctors or nurses involved in her/his treatment;

b. to assure the security of the information that is

transmitted;

c. to respect the confidentiality rules not only by the

medical professional group, but also by thespecialist in telemedicine involved in medical

activity.The majority of the students think that the greatest

problem in respect to confidentiality is to ensure that

confidentiality rules are respected not only by the

medical professional group but also by the other specialists in telemedicine which could be involved in

this process. (60%)Also, 17% of them think that confidentiality is in

connection with more than one problem, being a

complex process.The lowest percentage was obtained by answer b), to

assure the security of the way how is transmitted the

information. (fig. 8)

37

27

80

6 6

3

15

0

10

20

30

40

50

60

70

80

a b c a+b a+c b + c a+b+c

Figure 8.



8. ConclusionTelemedicine is for the e-patients, for the real ones or

for both?

Sharing the uneasiness is a good way for avoiding the

ethical problems and to use in a safe mode thecomputers and electronic facilities.

Telemedicine needs abilities in medicine, telecommu-nication and information technologies sectors, which

could be assure only in a multidisciplinary teamIn the same time, the team who analyzes the ethical

problems must be also interdisciplinary. Telemedicineapplications have to be developed by the doctors,

engineering and computers scientist together. [2] That

means that telemedicine must evolve as a stand alone

speciality, not only a medical competence. Even if theteam is interdisciplinary, the physician must understand

technical problems and the computer scientist must

understand medical terminology.The survey conducted among medical students, shows

that they have a good opinion about telemedicine, butvery few experience and real knowledge. The low percentage of interest obtained by the transmission

security issue is an indicator of the need to find a way

for students to assist to telemedicine experiments.

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