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In the evolving field of telemedicine, health care providers and systems have paid attention to issues such as technology and reimbursement. But there has been less focus on ensuring that telemedicine can meet the same goals for quality as in-person care. What might be the distinctive safety concerns and unintended consequences of telemedicine? For example, while virtually meeting with a patient in their own home may offer convenience and provide valuable clinical context, it may also undermine privacy. The following adapted excerpt from the IHI Telemedicine: Ensuring Safe, Equitable, Person-Centered Virtual Care white paper explores the issue of privacy and offers recommendations to help ensure it.
Privacy is paramount in any health care interaction and telemedicine is no exception. There are several aspects of privacy that are unique to telemedicine that present both challenges and potential advantages. Cybersecurity risk is one challenge that applies to telehealth more broadly. Data security and privacy breaches are a very real risk with telemedicine services, so it is essential to establish safeguards at the system level to minimize telemedicine cybersecurity risks. While some risks can be addressed by updating privacy policies, the exchange and safe storage of patient health information is critical to maintaining patient privacy and trust in telemedicine services. The American Medical Association created a useful overview on the importance of cybersecurity.
In video-enabled visits, the patient’s home environment may be visible to the provider. Although this can also have clinical benefits, some patients may feel that their private space is being invaded. Some patients may have difficulty finding a private space for the virtual visit, which could compromise their privacy in a different way, as others in their household may be privy to the interaction. In such circumstances, patients may be reluctant to share sensitive information.
Some people may not have the technological infrastructure at home to support a televisit and thus use public places such as libraries or their workplace to attend visits, which poses obvious privacy challenges. The same is true for people who are experiencing homelessness. All of these issues risk exacerbating inequities because the challenges are greatest for people with the fewest resources. Education and support in the use of virtual backgrounds and use of headphones, for example, presents an opportunity to provide patients with the means to control their privacy.
Conversely, some patients may feel that they have more privacy and a sense of security conducting the visit in their own environment. Especially for those who have experienced medical trauma, it might be more comfortable to engage in a televisit in a location where they feel safe as opposed to in the hierarchical and unfamiliar setting of a hospital or a doctor’s office. This could mean that individuals who avoid in-person visits to medical facilities might seek care via telemedicine. There are also legal aspects related to patient privacy and health care organizations must consider local, state, and national laws regarding informed consent and patient rights. The Health Resources & Services Administration, an agency of the US Department of Health and Human Services, developed a list of resources to guide organizations in obtaining informed consent. The expert panel convened to develop the Telemedicine: Ensuring Safe, Equitable, Person-Centered Virtual Care white paper noted that informed consent is not just a legal consideration; it needs to be built into the telemedicine design itself. Well-executed informed consent is driven by respecting the patient’s rights and role as a partner in the delivery of care, and thus, ultimately, is a determinant of patient safety.
To learn more — including additional recommendations for improving telemedicine download the free Telemedicine: Ensuring Safe, Equitable, Person-Centered Virtual Care white paper.
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IHI Patient Safety Congress (May 16–18, 2022) – Join in-person or virtually