Legal and Ethical Issues of eHealth in SA Assessed in Thesis
PhD graduate in Telehealth, Dr Caron Jack, assessed legal and ethical issues around Telehealth, eHealth and mhealth communication technologies in her doctoral thesis.
The results of Jack’s study were significant. She found breaches of user or patient confidentiality when using Information and Communication Technology (ICT) for transferring patient information as well as non-compliance with current legislation due to the habits and practices of healthcare providers and users of the healthcare system. But this was mainly due to ignorance and not wilful behaviour.
Her novel study, the first of its kind in South Africa, formed part of her PhD at UKZN. The study concentrated on the potential implications the proposed clinical telemedicine guidelines from the HPCSA and clauses in the National Health Act of South Africa that apply to the doctrine of autonomous informed consent and confidentiality will have on effective legal and ethical implementations of telemedicine and mHealth within the South African setting.
The study revealed challenges with obtaining proper informed consent for telemedicine according to the legal definition as set out in the National Health Act and clinical guidelines from regulatory bodies.
Jack said proper informed consent could be defined as: ‘Written, informed consent given by the user to the healthcare provider for every aspect of that telemedicine encounter, based on full and frank disclosure of all material facts and the capacity of the user to understand these facts and either accept or refuse the healthcare service offered.
‘In 2012, the National Department of Health published an eHealth Strategy document for the public health sector. The main objective of the strategy was to provide a roadmap for achieving a well-functioning national health information system with the patient located at the centre.
‘Its aims were to provide a single, harmonised and comprehensive eHealth strategy that supports the medium-term priorities of the public health sector, paves the way for future public sector eHealth requirements and lays the requisite foundations for the future integration and co-ordination of all eHealth initiatives in the country (both public sector and private sector),’ said Jack.
One of the guiding principles of the strategy is to protect information security, confidentiality and patient privacy at all times. Through her study with 400 healthcare providers and 330 users of the healthcare system, Jack found that best practices in the use of eHealth did not always apply.
‘Legal and ethical guidelines for telemedicine and continuing professional development educational seminars for healthcare providers concerning ICT use in healthcare are needed to ensure that the practice of eHealth within the South African setting is performed in a legal and ethical manner and complies with current legislation,’ she said.
Jack’s study aimed to understand ICT use, security practices and informed consent practices among healthcare professionals in KwaZulu-Natal, using a bottom up approach. She investigated end user understanding of computer terminology within a telemedicine consultation and finally investigated cellular phone use and practices among users attending outpatient clinics in rural areas and those attending private healthcare facilities in urban areas in KwaZulu-Natal.
‘Ensuring users are provided with information of sufficient quality and quantity in their own language so they will be genuinely informed and able to make an autonomous choice as to their preferred treatment will require appropriate consent tools.
‘Telemedicine and the issue of informed consent for telemedicine remain controversial. Simply translating westernised informed consent templates into local language is not enough,’ said Jack.
eHealth and Mobile technology (mHealth) has provided an opportunity to revolutionise healthcare, especially in countries like South Africa that have the challenges of providing care in deep rural settings but also have a thriving telecommunications market.
According to Professor Maurice Mars, Head of UKZN’s Telehealth Department and Jack’s supervisor, the South African telecommunications market is the largest in Africa totalling R275 billion in 2006 but South Africa continues to descend down the international scales of competitiveness and e-readiness.
‘Broadband penetration is low and bandwidth is expensive. Mobile phones have given access to millions who were previously marginalised from personal communications and mobile phone penetration is estimated at 75% with approximately 90% of the country covered by mobile telephony. It is likely that mHealth will play an ever increasing role in medical informatics, telemedicine, surveillance and healthcare education in Africa,’ said Mars.
In 2012, the Health Professions Council of South Africa proposed that clinical, operational and ethical guidelines should be developed by the governing bodies or associations of the various clinical disciplines using information and communication technologies in the provision of healthcare with the aim that a regulated telemedicine environment would ensure improved access, service delivery and quality of care for rural communities in South Africa.
ICT use in healthcare includes telephone, fax, computers, personal digital assistants, smart phones, e-mail, the Internet, World Wide Web, tablet computers, videoconferencing, and diagnostic and patient monitoring devices, all of which are used to transfer information electronically.