Transcript Internetable Health Care in a Borderless Society

Internetable Health Data in a
Borderless Society
Presented by:
Renato M.E. Sabbatini, PhD
Director, Center for Biomedical Informatics
Chairman of Medical Informatics, Medical School
State University of Campinas
Brazil
A Few Facts
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Internet has dissolved geographical
boundaries, but not political ones
Community standards and legislation varies
a lot from place to place
A borderless networked society is a totally
new experience and removes empowerment
of traditional communities
The Fundamental Issue
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The existence of interactive global networks has
made possible, for the first time, the practice of
medicine across borders, without physical contact
between patient and health care provider;
The ethical and legal issues are tantalizing and
remain largely unsolved because they require
international law and court of justice.
Statement
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Accountability of users and liability of
information providers are probably the two
most important issues to resolve if
computer-mediated communication is to
become the accepted and most prevalent
form of communication on the electronic
superhighways of tomorrow.
Anne Wells Branscomb
A Possible Scenario
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Dr. X, from the USA, teams up with Dr. Y, from
an African country, to carry out clinical trials with
a large malpractice potential, using experimental
drugs and/or devices.
All clinical data belongs to Dr. X;
The costs are much lower than in the USA;
Dr. X is never required to leave the USA;
Dr. X is safe from prosecution in the country
where the study was performed
The Practice of Medicine
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[a]ny person shall be regarded as practicing
medicine or surgery . . . who shall
diagnose or attempt to diagnose, treat or
attempt to treat, operate or attempt to
operate on, or prescribe for or administer to,
or profess to treat any human ailment,
physical or mental, or any physical injury to
or deformity of another person [.]
Main Types of Distance
Medical Practice
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Patient education
Patient screening and referral
Clinical case discussion
Second-opinion consultation
Distance diagnosis and therapy
“Advantages” of International
Telemedicine
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Avoidance of malpractice liability
Avoidance of drug/device regulation
Avoidance of human research ethics
Avoidance of database copyright issues
Another Free-for-All Scenario
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Dr. Y, from a Latin America country, offers
high quality email and chat-based
psychiatric advice to American patients, at
20 dollars per consultation.
He is being forced out of business by cutrate cybertherapists from the former East
block, who are charging 5 dollars only.
Economic Advantages of
International Telemedicine
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Expansion of the market base
Capture of more private practice
Avoidance of capitation and related issues
Decrease in costs
Added value in health insurance plans
(international second opinion)
Telemedicine is Beneficial
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Distance medicine technology enables greater
continuity of care by improving access and
supporting the coordination of activities by a
clinician.
Electronic Communication With Patients.
Evaluation of Distance Medicine Technology.
E. Andrew Balas, MD, PhD; Farah Jaffrey, MSc; Gilad J.
Kuperman, MD, PhD; Suzanne Austin Boren, MHA; Gordon D.
Brown, PhD; Francesco Pinciroli, LEE; Joyce A. Mitchell, PhD
JAMA 278(2): 152-159, 1997.
Main Barriers to Telemedicine
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Reimbursement for Telemedicine
Services
Licensure and Credentialing
Medical Malpractice Liability
Confidentiality
What We Need
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The Global Information Infrastructure needs
a new framework, or rather a set of new
frameworks, regarding the generation,
storage, use and transmission of information
across borders
The general framework will be construed
with basis on local frameworks
A Framework for GII
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a unifying vision;
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a code of ethics;
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guidelines for fair use;
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management structures; and
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law-enforcement coordination.
A Framework for GII
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a unifying vision;
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a code of ethics;
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guidelines for fair use;
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management structures; and
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law-enforcement coordination.
Workable in an
international setting,
within a community
Presently unworkable
in an international
setting
Some Guidelines
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A distinction should be made between
moral responsibility and legal responsibility
The sender of the message rather than the
messenger is responsible for the content of
the message
Any electronic community should promote
awareness of the moral standards it requires
for behavior within its own boundaries
Mark Frankel (AAAS)
Borderless Issues
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The collection, use, reuse and
communication of data determines issues
such as data governance, property and
confidentiality
The absence of international laws and
proper court of justice twarts the legal
enforcement of moral/ethical desiderata
There is a need to define better the social
goals of a global information infrastructure
International Issues
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The status of regulations and legislation in
different countries
How to enforce standards and quality of care
Data governance in an international scale:
– disclosure and retention of patient data;
– copyrights of medical database
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Protection of patient confidentiality in an
international scale
Possible Solutions
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Special licensing procedures for
professionals from other countries involved
in telehealth procedures
Adherence to universal patient data
protection standards
An international advisory committee of
experts in telemedicine law and ethics
Codes of Conduct for
Medical Sites
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The Health on the Net Foundation
http://www.hon.ch
Medical Matrix
http://www.medmatrix.org
The HON Code of Condut for
Medical Websites
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Medical advice is provided by qualified professionals only
Information is provided to support not to replace patient
care
Patient confidentiality is respected according to the rules of
the country where the information is located
Information is supported by clear reference to its source
Claims for benefit or performance is based on evidence
Contact and authorship information is provided
Sponsorship is clearly identified
Advertisement policy is stated and the information
provided by is clearly separated from the rest
Desirable Codes of Ethics
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The public and private use of networked
information should be defined only by its
owners
Intellectual ownership and copyrights
should be respected for all materials
available through the Internet
Data may be altered or added only by its
owners
Internet Resources
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Center for Telemedicine Law
http://www.ctl.org/
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NLM BioethicsOnLine Search
http://www.healthgate.com/AMA/search.html
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Arent Fox Telemedicine Home Page
http://arentfox.com/telemedicine
University of Wisconsin’s Bioethics On-Line
http://www.mcw.edu/bioethics/
MedWeb’s Bioethics
http://www.gen.emory.edu/medweb/medweb.html
Contact
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Renato M.E. Sabbatini
[email protected]
http://nibgw.unicamp.br
Center for Biomedical Informatics
State University of Campinas, Brazil
PO Box 6005, ZIP 13081-970
Voice (0055 19) 239-9800 ext. 141
Fax (0055 19) 788-4717