Ethically incorporating telehealth/telemedicine services into your practice

In states that permit online refractions, are there ethical considerations to the interaction of doctors of optometry with telehealth/telemedicine technology? How can doctors of optometry ethically incorporate its use into their practices to benefit patients?

In a new and thought-provoking case study by the AOA's Ethics and Values Committee available in the Ethics Forum, authors Kenneth Lawenda, O.D., and Robert Moses, O.D., explore those dilemmas created by the rise in telehealth/telemedicine services. Drs. Lawenda and Moses are past and current members, respectively, of the AOA Ethics and Values Committee.

The Ethics Forum provides an opportunity to review a hypothetical case study containing potential ethical challenges and includes suggestions on how one might handle the situation based upon the AOA Standards of Professional Conduct and Code of Ethics.

"These services can increase availability to specialty care for patients in rural and underserved areas, improve monitoring of patients with chronic disease, as well as providing education to patients thereby improving understanding and compliance," Drs. Lawenda and Moses write.

"Conversely, when telehealth services are improperly applied, care can become segmented, resulting in failure to diagnose concurrent health issues," they add. "Inappropriate technology inappropriately applied can lead to inappropriate care."

The case study covers such topics as patient protection laws, the proper and improper use of telehealth, the standard of care, preservation of the doctor-patient relationship, and attempts by optical retailers to undermine that relationship and undercut state telehealth laws. The case  study also lays out the AOA's Position Statement Regarding Eye and Vision Telehealth Services, approved by the AOA Board of Trustees in February 2017.

Committee members thought it was an important topic to tackle.

"With the introduction of this new technology, doctors will need to assess its value to enhance the care provided," Dr. Moses says. "These resources should not become a substitute for traditional, in-person care. Incorporating telehealth/telemedicine services must not lead to a reduction in the standard of care patients require and deserve."

Says Dr. Lawenda: "This subject needed to be addressed from an ethical standpoint. It's a topic that has been under the radar for many years. Doctors should have a better understanding of the ramifications and how best to discuss these issues with their patients and their peers. Through this case study, doctors will hopefully be able to better understand the pros and cons of telehealth/telemedicine and open further discussion on the topic."

The case concludes with a poll question: "Are you concerned that state boards or regulatory bodies may be putting patients at risk by not properly enforcing laws related to telehealth technology applications?"

Have ethical questions?

If you have any questions on ethics, please submit them to EthicsQuestion@aoa.org. The AOA Ethics and Values Committee will respond to your questions as soon as possible.

If you have an ethical challenge you wish to share, please submit a case description to ethics@aoa.org. The case description will be reviewed by the AOA Ethics and Values Committee and may be featured in a future Ethics Forum.