Informed consent for telemedicine in South Africa : a survey of consent practices among healthcare professionals in Durban, KwaZulu-Natal : research
| Author | M. Mars,C. Jack |
| DOI | 10.10520/EJC145974 |
| Date | 01 October 2013 |
| Published date | 01 October 2013 |
| Pages | 55-59 |
55 November 2013, Vol. 6, No. 2 SAJBL
Telemedicine is ‘the use of medical information exchanged from one
site to another via electronic communications for the health and
education of the patient or healthcare provider and for the purpose
of patient care’.[1] It is a component of the broader field of eHealth,
‘the use of information communication technology (ICT) for health’.
[2]
Telemedicine can be live or synchronous, as in a video-conferenced
consultation, which may be supplemented by the use of diagnostic
devices such as electronic stethoscopes, otoscopes, dermatoscopes,
etc.[3] It can also be asynchronous, as in store-and-forward telemedicine,
where for example photographs are attached to an email containing
the patient’s history and clinical findings, or posted to a secure website
for later interpretation by another physician.[4]
Telemedicine is seen as a cost-effective and efficient means of
delivering healthcare to under-resourced areas. It would be a boon
to the African region, which the World Health Organization reports
has an average of 25 doctors per 100 000 people, with 25 of the 48
countries surveyed having ≤10:100 000 people. In comparison, the
global average is 139:100 000 people and Europe has 333:100 000
people.[5] Telemedicine has the potential to help us overcome the
extreme shortage of doctors, improve access to quality care in rural
areas, and reduce the costs of patient transfer for specialist referral.
Cross-border, international telemedicine will facilitate this.[6]
Regulators see telemedicine as something new, unproven and
therefore more risky, requiring regulation in order to protect both
patients and doctors.[7] The first teleconsultations were conducted
by telegraph in Australia in 1874[8] and the telegraph was used for
health purposes in the American Civil War.[9] Telephonic consultation
meets the definition of telemedicine, and the first published report
of a consultation over the telephone was 3 years after its invention
in 1879.[10] Einthoven transmitted electrocardiograms over the
telephone in 1905, and Brown developed an electronic stethoscope,
with tele-auscultation performed in 1910.[11] Radio has been widely
used to provide medical services to ships at sea and to people on
remote islands since 1920.[9] Teleradiology was first achieved in
1948 and by the 1950s closed circuit television was being used for
education, as well as for group therapy in the psychiatric service in
Nebraska, US.[9] Clearly telemedicine is not new – rather we have
forgotten the past and fail to equate the daily use of the telephone
in the health sector with telemedicine. Telemedicine regulation, if
required, should address gaps in existing regulations.
Most of the ‘problems’ we face today are also not new. Aronsen[11]
reviewed the first 100 years of papers on the use of the telephone
in medicine published in the Lancet. He noted that, ‘The Lancet
carried many entries dealing with the high cost of subscribing to
the telephone, the poor quality of service, the absence of privacy
occasioned by the unwarranted interception of phone conversations
by the police, delays in installations of telephones for new customers,
the tardiness in restoring a defective instrument to service and so on.’
Little has changed.
South Africa (SA) recently adopted a National eHealth Strategy
which includes telemedicine.[12] The Health Professions Council of
South Africa (HPCSA) has been working on guidelines for the practice
Informed consent for telemedicine in South Africa: A survey
of consent practices among healthcare professionals in
Durban, KwaZulu-Natal
C Jack, BMedSc (Hons), LLM; M Mars, MB ChB, MD
Department of TeleHealth, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa
Corresponding author: C Jack (jackc1@ukzn.ac.za)
Background. The Health Professions Council of South Africa is drafting guidelines to regulate the practice of telemedicine. These emphasise
the need for signed informed consent for all aspects of the consultation process, including data transmission and storage.
Objective. To survey current practices relating to gaining informed consent both in routine clinical practice and when using information
communication technologies (ICT).
Methods. A cross-sectional descriptive study was undertaken using a self-administered questionnaire. It surveyed healthcare professionals’
habits and practices of obtaining informed consent in clinical practice scenarios and when using the telephone, fax and email for
communication and healthcare provision.
Results. A total of 193 doctors and 207 nurses completed the questionnaire. Fewer doctors took written consent than nurses, with a range of
2.6% when examining a patient to 8.3% when ordering a special examination. A significant difference was observed for all activities. Of the
67.4% doctors and 50.7% nurses who faxed patient information, only 35.3% of doctors and 42.9% of nurses obtained informed consent to do
so and less than half of those obtained written consent. Few used email to send patient information, with specialists being most likely to do
so among doctors (p<0.0001). Of all healthcare professionals who used email, 40.7% obtained informed consent to do so.
Conclusions. Written informed consent is not routinely obtained from patients during clinical examination or when using ICT for the transfer
of patient information. The issue of informed consent for telemedicine remains unresolved in South Africa.
S Afr J BL 2013;6(2):55-59. DOI:10.7196/SAJBL.287
RESEARCH
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