This document outlines several key ethical issues in telemedicine practice including maintaining patient confidentiality and avoiding harm, obtaining informed consent, establishing fees, maintaining accurate records, and ensuring access to healthcare. It also discusses privacy concerns regarding personal information disclosure and storage as well as technological risks associated with telemedicine like equipment quality and inadequate guidelines.

2. Key ethical issues in the practice of Telemedicine
generally includes;
 Confidentiality
 Avoiding harm.
 Defining Professional Relationship.
 Obtaining informed consent.
 Establishing fees and financial arrangements.
 Providing services to patients served by other
professionals.
 Maintaining records and data.

3.  Basic right of an individual to not have personal
information disclosed to others without that
individual’s express informed consent.
 Information disclosed should be limited required only
to fulfill the specific purpose.

4.  Any patient who is visiting health care centre should
be treated professionally.
 Any type of harm either physically or mentally should
be avoided.

5.  Patients have a right to expect that doctors will not
disclose any personal information which they learn
during the course of their professional duties unless
patient gives permission.

6.  When patients give consent to disclosure of
information about them, doctor must make sure that
they understand what will be disclosed, the reasons for
disclosure and the likely circumstances.
 Patient should have opportunity to withhold
information.
 Reliable health workers.

7.  Health care should be provided to everyone.
 Keeping in view the financial condition of patient.
 If required make arrangement of donation for patient.
 Consultant, doctors and paramedics fees.

8.  Healthcare centre facilities are for everyone who
approaches it.
 Avoid doctor/consultant monopoly.

9.  Record history, physiological parameters before and
after treatment.
 Keeping informed the patient or attendant about the
data that has been taken.
 Clinicians, by virtue of the trust placed in them by the
patient,can access the information in the record for
the benefit of the patient.
 Clinicians cannot, except under special circumstances,
deny the patient access to the medical information.

10. There are three main rationals;
 keeping information related to an individual in strict
confidence, for example, medical history of a patient.
 collecting anonymous data for statistical analysis, for
example, by conducting a healthcare survey; it is
vitally important to ensure that any data collected
cannot be used to identify a person or where it comes
from.
 Data Integrity; incorruptibility of data.

11. Internet privacy and confidentiality can be violated and
exploited in some of the following ways;
 Forwarded Mail
 E-mail address logs.
 Snippets of information compiled from multiple
sources.
 Other Intrusions

12.  Many people falsely assume that when they contact a
health care provider, their personal e-mail will go only
to the intended recipient.
 E-mail is routed through multiple servers from the
point of origination to the point of recipient.
 All these servers are potential points where e-mail can
be tapped.

13.  Websites can automatically capture and permanently
store e-mail addresses into log files.
 Any Web site manager can easily gather email
addresses from viewers, build a mailing list, and send
e-mail solicitations for commercial products.
 Patient could be targeted by embarrassing or
otherwise undesirable advertising campaigns without
any easy means of removal from such lists.

14. Four main technological risks are;
 Quality of images
 Lack of suitable equipment
 Malfunctioning equipment
 Inadequate Guidelines

15.  Poor communication.
 Limited Ability.
 Poor Training.
 Improper Delegation.
 Unclear Responsibility.

16.  Backup is the process of making exact copies of the
data in another storage medium so that the data can
be retrieved in the event of a loss or failure of the
original copy.

17.  Many devices are available for making a network more
secure that may include purpose built devices or
software installed on a computer.
 Security can be performed of different types such as ;
 identifying an individual user,
 granting access to part or all of a system,
 logging activities during a session,
 filter incoming and outgoing data based on types,
 origin or destination,
 inclusion of certain keywords, etc.

18.  Ace Allan, Marlene M. Maheu "E-Health, Telehealth
and Telemedicine", 2001, Jossey Boss Inc., A Wiley
Company.
 A.C. Norris, "Essentials of Telemedicine and Telecare",
2002, by John Wiley & Sons Ltd.
 Bernard Fong, "Telemedicine Technologies", 2011, by
John Wiley & Sons Ltd.
