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Handbook of WMA Policies
World Medical Association ⏐ S-2009-04-2009
WMA STATEMENT
ON
GUIDING PRINCIPLES FOR THE USE OF TELEHEALTH
FOR THE PROVISION OF HEALTH CARE
Adopted by the 60th
WMA General Assembly, New Delhi, India, October 2009
DEFINITION
Telehealth is the use of information and communications technology to deliver health and
healthcare services and information over large and small distances.
PREAMBLE
The prevalence of telemedicine and telehealth in most countries in the world has led the
World Medical Association (WMA) to develop ethical guidelines for physicians who use
this modality to provide health care services. The WMA defines telemedicine as “the prac-
tice of medicine over a distance, in which interventions, diagnostics and treatment deci-
sions and recommendations are based on data, including voice and images, documents and
other information transmitted through telecommunication systems”. This could include
telephone and internet.
A broader telehealth definition brings into play the entire range of activities that support
the patient and the public in being healthy: prevention, promotion, diagnostics self-care
and treatment are all areas where physicians play an important role. It is this broader defi-
nition that the WMA endorses.
Telehealth/telemedicine helps eliminate distance barriers and improve equity of access to
services that otherwise often would not be available in remote, rural and increasingly ur-
ban communities. It is about transmitting voice, data, images, and information rather than
physically moving patients, health professionals and educators – thereby improving ac-
cess, timeliness and convenience and reducing travel costs. It also has the added benefit
that the patients more easily can become active participants in their own health and well-
being and are able to engage in educational programs aimed at fostering wellness from the
comfort, convenience and safety of their own homes. While this statement focuses mainly
on telehealth encounters between patients and health professionals, it should be noted that
another important aspect of telehealth is the use of tele-communication between health
professionals when providing health care.
The telemedicine/telehealth agenda will become an integral part of the larger eHealth
programs that most countries in the developed world are pursuing, as are many countries
in the developing world. More and more solutions are being introduced that provide the
ability to deliver care through an e-channel and therefore more physicians will have access
to this capability to provide care to their patients.
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S-2009-04-2009 ⏐ New Delhi
Telehealth
GUIDING PRINCIPLES
Duty of Care
While the practice of telehealth challenges the conventional perception of the physician-
patient relationship, there is a “duty of care” established in all telehealth encounters be-
tween the physician and the patient as in any healthcare encounter.
The physician needs to give clear and explicit direction to the patient during the telehealth
encounter as to who has ongoing responsibility for any required follow-up and ongoing
health care. Physician supervision regarding protocols, conferencing and medical record
review is required in all settings and circumstances. Physicians should have the capability
to immediately contact nonphysician providers and technicians as well as patients.
The physician needs to clarify ongoing responsibility for the patient with any other health
care providers who are involved in the patient’s care.
The legal responsibility of health professionals providing health care through means of
telehealth must be clearly defined by the appropriate jurisdiction.
Communication with Patients
The physician will take steps to ensure that quality of communication during a telehealth
encounter is maximized. Any significant technical deficiencies should be noted in the
documentation of the consultation.
The physician providing telehealth services should be familiar with the technology.
The physician should be aware of and accommodate the limitations of video/audio in the
provision of telehealth health care services.
The physician should receive education/orientation in telehealth communication skills prior
to the initial telehealth encounter.
The physician needs to determine to the best of his or her ability each patient’s appropria-
teness for, and level of comfort with, telehealth prior to or at the encounter, while recog-
nizing that this will not be possible in all situations.
The physician, to the extent possible, should ensure that the patient receives sufficient
education/orientation to the telehealth process and communication issues prior to their ini-
tial telehealth encounter.
Standards of Practice/Quality of Clinical Care
The physician must be satisfied that the standard of care delivered via telehealth is
“reasonable” and at least equivalent to any other type of care that can be delivered to the
patient/client, considering the specific context, location and timing, and relative avail-
ability of traditional care. If the “reasonable” standard cannot be satisfied via telehealth,
the physician should inform the patient and suggest an alternative type of health care
delivery/service.
The physician should use existing clinical practice guidelines, whenever possible, to guide
the delivery of care in the telehealth setting, recognizing that certain modifications may
need to be made to accommodate specific circumstances.
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Handbook of WMA Policies
World Medical Association ⏐ S-2009-04-2009
The physician should ensure that any modifications to clinical practice guidelines for the
telehealth setting are approved by the discipline’s clinical governing body or association.
The physician providing telehealth services should follow all relevant protocols and pro-
cedures related to: informed consent (verbal, written, and recorded); privacy and confi-
dentiality; documentation; ownership of patient/client record; and appropriate video/tele-
phone behaviours.
The physician providing telehealth services ensures compliance with the relevant legisla-
tion and professional guidelines of the jurisdiction from which the services are provided as
well as the jurisdiction from which the service is administered.
The physician providing telehealth services should possess the following: required skills
expected in the professional’s field of practice; competent communication skills; an under-
standing of the scope of service being provided via telehealth; orientation to and ability to
navigate the technology system and environment; an understanding of the telehealth
operational protocols and procedures; and an understanding of any limitations of the tech-
nology being used.
Clinical Outcomes
Organizations providing telehealth programs should monitor and continuously strive to
improve the quality of services in order to achieve the best possible outcomes.
Organizations providing telehealth programs should have in place a systematic method of
collecting, evaluating and reporting meaningful health care outcome data and clinical ef-
fectiveness. Quality indicators should be identified and utilized.
Patient Confidentiality
The confidentiality of patient information should be protected.
The health care organization and physician providing telehealth services should be aware
of, and ensure compliance with, relevant legislation and regulations designed to protect the
confidentiality of patient/client information and have its own confidentiality guidelines.
The health care organizations and the physician are encouraged to consult with legal
counsel and relevant professional licensing/regulatory bodies when determining confi-
dentiality policy.
Informed Consent
Relevant legislation and regulations that relate to patient decision-making and consent
should be applied.
To the extent possible, informed consent shall be obtained by the physician before starting
any service or intervention. Where appropriate the patient’s consent should be noted in the
documentation of the consultation.
Consent for telehealth should follow similar principles and processes as those used for
other health services.
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