The document discusses informed consent in telemedicine. It defines telemedicine and the importance of confidentiality and privacy in telemedical information. Guidelines from the American Psychiatric Association and American Telemedicine Association emphasize competency of physicians and patients, informed consent, and security/privacy measures. Risks of telemedicine include technology disruptions and privacy breaches, while benefits include increased access and engagement. Legal and ethical issues around telemedicine include ensuring patient confidentiality, avoiding harm, obtaining informed consent, and maintaining data security.

1. Informed consent in telemedicine:
Confidentiality and privacy of
telemedicine
Dr Shazia Iqbal
Assistant Professor Obstetric and Gynecology &
Director of Medical Education Unit
Vision College of Medicine in Riyadh

2. Objectives
• Definion of telemedicine and Informed consent.
• Confidentiality and privacy of telemedical information
• Informed consent in telemedicine.
• APA andATA guidelines.
• Safety precaution of informed consent in telemedicine.
• Benefits of telemedicine.
• Risks and benefits of informed consent in telemedicine.
• Legal and ethical issues.

3. Definion of telemedicine
and Informed consent
• Telemedicine
 The most important term to
clarify is ‘telemedicine’ itself.
Telemedicine is the use of
telecommunications
technology and information
technology for clinical
services.
 A tool that makes healthcare
more accessible, cost-
effective, and that increases
patient engagement – is
telemedicine.

4. Bridging the gap

5. Confidentiality and privacy of
telemedical information
• A telemedicine consultation requires exchanging patient information;
thus, it must be done in such a way that the privacy and confidentiality of
that information are protected.
• Privately gathering the information means conducting the consultation in
such a way that no one else who is not supposed to be part of the
consultation can see the report or hear the conversation.
• Sending the information safely ensures that only those who are engaging
directly in the patient’s treatment will have the ability to access it.
• It is during this process that privacy measures, including the correct
application of automatic redaction software, come into play.
• Redaction
• Redaction refers to the editing and removing of information from documents, videos, or audio to
protect people’s personally identifiable information.

6. • Telehealth services pose threats to the privacy and protection of information about
patients’ health. Privacy threats include a lack of control over data collection, usage,
and sharing.
• Household telehealth devices and sensors designed for detecting falls, for example,
that capture and distribute information about household behaviors that a patient
prefers to keep private, such as substance use or that the house is unoccupied at a
particular time.
• Smartphone apps that share sensitive data with advertisers and other third parties,
such as location sensor data, in ways not expected by the users.
• The primary risk of protection is that of unauthorized data access during processing,
transmission, or storage. Any transfer or exchange has the risk of breaching security.
Confidentiality and privacy of
telemedical information

7. • HIPAA Regulations
• Standardize the transmission of information between health care providers
and payors ‣ Protect the privacy and security of health information
• Other Federal Protections
• Given the restricted applicability of HIPAA to patient-facing telehealth
services, its protections do not extend to knowledge obtained from most of
the digital tools that patients receive. Additional federal laws provide some
protection, however.
• Where a telehealth system acts as a medical device, it may also be regulated
by the Food and DrugAdministration ( FDA).The FDA does not tackle
privacy concerns explicitly but focuses on protection insofar as it affects the
safety of medical devices.

8. Patient
Confidentiality/HIPAA
• Examples of issues withTelemedicine/Telehealth can create
increased risk exposure:
• Interoperability in cooperating locations' systems could increase risks (breach; medical
errors)
• Interruptions in connectivity mid-examination/procedure
• Differences in operational procedures and technology implementations could increase risk
exposure
• Treatment could be viewed by unauthorized individuals without patient knowledge or
permission
• Electronic communications could be hacked by unauthorized individuals
• Locally stored PHI could be accessed or altered by people with system-level privileges.

10. Informed consent
in telemedicine
• In telehealth, informed consent is used
to explain what telehealth is, lay out
the expected benefits and possible
risks associated with it to a patient,
and explain security measures.
• It often requires a written form which
needs to be signed by the patient
and/or oral acknowledgement that is
noted in the patient’s record.
• Informed consent is a process that is used
to educate patients about treatments
and procedures, their potential benefits
and risks, and alternative options.

13. • Table 1: Basic parts of an informed consent for telemedicine

14. • Figure 1: Steps of recording informed consent via WhatsApp

15. APA and ATA guidelines
• Collaboration between the American Psychiatric Association (APA) and the AmericanTelemedicine
Association (ATA).
• The ATA is the principal organization bringing together telemedicine practitioners, healthcare
institutions, government agencies, vendors and others involved in providing remote healthcare
using telecommunications.
GUIDELINES FRAMEWORK
• Administrative
• Organization & responsibilities
• Health professional & responsibilities
• Clinical
• Not how to practice, diagnose etc.
• How to conduct traditional practice in the context ofTH encounter
• Technical
• Devices & equipment
• Security & privacy
• Minimum technical standards

16. APA and ATA guidelines
Competency of physician
Competency of patient
administrations, specialized
Abilities and participation
informed consent
Cautious and progressing
evaluation
Crisis arranging
Protection, security,
confidentiality and risk
management
Documentation

17. Safety precaution of informed
consent in telemedicine
• Whether developing a separate informed consent process or
modifying an existing process to cover telehealth, healthcare
providers should consider including the following elements :
• The names of all involved healthcare providers with their credentials
and locations, as well as any other staff that may help facilitate the
telehealth service.
• A description of the telehealth service that will be performed and the
technology that will be used.
• Alternative options for treatment and care.
• Any risks specifically related to the electronic nature of the care delivery
(e.g., technology disruptions, failures, or limitations).
• Specific security and privacy measures that have been implemented, as
well as any increased privacy risks relative to the telehealth technology.
• A plan for ongoing care, including details about who is responsible for
various aspects of the patient's care.
• A plan for alternative care in the case of an emergency or technological
malfunction.

18. Risks and benefits of informed
consent in telemedicine
• Patient has an option to withhold or withdraw consent
at any time without affecting the right to future care or
treatment.
• The potential risks consequences and benefits of
telemedicine.
• All existing confidentiality protections apply.

20. Legal and ethical issues
1.Confidentiality
• Each patient has basic right not to have
personal data disclosed to others
without his/her permission.
• It is required to make sure that the
confidential information of patient can’t
be disclosed.
2.Avoiding harm
3.Informed Consent
• When the patient give permission to the
doctor to disclose his/her personal
information and physiological
parameters then doctor should have to
know the reasons of disclosing the
information and what data will be
revealed.
4.Establishing fees arrangements
5.Service accessibility
6.Maintaining data

21. References
• Ahmad, Raja & Salah, Khaled & Jayaraman, Raja &Yaqoob, Ibrar & Ellahham, Samer &
Omar, Mohammed. (2020).The Role of BlockchainTechnology inTelehealth and
Telemedicine. 10.36227/techrxiv.12967748.
• Qazi, Sahar &Tanveer, Khushnuma & Elbahnasy, Khaled & Raza, Khalid. (2019). From
Telediagnosis toTeletreatment: The Role of Computational Biology and Bioinformatics in
Tele-Based Healthcare. 10.1016/B978-0-12-816948-3.00010-6.
• • American Psychiatric Association.Telemental health viaVideoconferencing.
• https://vsee.com/what-is-telemedicine/
• https://www.cchpca.org/policy-101/?category=informed-consent
• https://caseguard.com/articles/doctor-patient-confidentiality-and-privacy-in-telehealth/
• https://www.medpro.com/telemedicine-informedconsent
• Himel Mondal1, Rudrashish Haldar2, Shaikat Mondal3
1 Department of Physiology, Bhima Bhoi Medical College and Hospital, Balangir,
Odisha, India
2 Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of
Medical Sciences, Lucknow, Uttar Pradesh, India
3 Department of Physiology, Raiganj Government Medical College and Hospital,
West Bengal, India

22. Thank you for
your time