Background

Information technologies have been vital during the COVID-19 pandemic. Telehealth and telemedicine services, especially, fulfilled their promise by allowing patients to receive advice and care at a distance, making it safer for all concerned. Over the preceding years, professional societies, governments, and scholars examined ethical, legal, and social issues (ELSI) related to telemedicine and telehealth. Primary concerns evident from reviewing this literature have been quality of care, access, consent, and privacy.

Objectives

To identify and summarize ethical, legal, and social issues related to information technology in healthcare, as exemplified by telehealth and telemedicine. To expand on prior analyses and address gaps illuminated by the COVID-19 experience. To propose future research directions.

Methods

Literature was identified through searches, forward and backward citation chaining, and the author’s knowledge of scholars and works in the area. EU and professional organizations’ guidelines, and nineteen scholarly papers were examined and categories created to identify ethical, legal, and social issues they addressed. A synthesis matrix was developed to categorize issues addressed by each source.

Results

A synthesis matrix was developed and issues categorized as: quality of care, consent and autonomy, access to care and technology, legal and regulatory, clinician responsibilities, patient responsibilities, changed relationships, commercialization, policy, information needs, and evaluation, with subcategories that fleshed out each category. The literature primarily addressed quality of care, access, consent, and privacy. Other identified considerations were little discussed. These and newer concerns include: usability, tailoring services to each patient, curriculum and training, implementation, commercialization, and licensing and liability. The need for interoperability, data availability, cybersecurity, and informatics infrastructure also is more apparent. These issues are applicable to other information technologies in healthcare.

Conclusions

Clinicians and organizations need updated guidelines for ethical use of telemedicine and telehealth care, and decision- and policy-makers need evidence to inform decisions. The variety of newly implemented telemedicine services is an on-going natural experiment presenting an unparalleled opportunity to develop an evidence-based way forward. The paper recommends evaluation using an applied ethics, context-sensitive approach that explores interactions among multiple factors and considerations. It suggests evaluation questions to investigate ethical, social, and legal issues through multi-method, sociotechnical, interpretive and ethnographic, and interactionist evaluation approaches. Such evaluation can help telehealth, and other information technologies, be integrated into healthcare ethically and effectively.

中文翻译：

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回顾健康信息技术的伦理、法律和社会问题和评估：远程医疗/远程医疗和 COVID-19

背景

在 COVID-19 大流行期间，信息技术至关重要。远程医疗和远程医疗服务尤其兑现了承诺，让患者能够远程接受建议和护理，让所有相关人员都更加安全。在过去的几年里，专业协会、政府和学者研究了与远程医疗和远程医疗相关的伦理、法律和社会问题 (ELSI)。从回顾这些文献中可以明显看出，主要关注的是护理质量、访问、同意和隐私。

目标

识别和总结与医疗信息技术相关的伦理、法律和社会问题，例如远程医疗和远程医疗。扩展先前的分析并解决 COVID-19 经验所揭示的差距。提出未来的研究方向。

方法

通过搜索、正向和反向引用链以及作者对该领域的学者和作品的了解来识别文献。审查了欧盟和专业组织的指导方针以及 19 篇学术论文并创建了类别，以确定它们解决的伦理、法律和社会问题。开发了一个综合矩阵来对每个来源解决的问题进行分类。

结果

开发了一个综合矩阵，并将问题分类为：护理质量、同意和自主权、获得护理和技术、法律和监管、临床医生责任、患者责任、关系变化、商业化、政策、信息需求和评估，子类别充实了每个类别。文献主要涉及护理质量、访问、同意和隐私。其他确定的考虑因素很少讨论。这些和更新的问题包括：可用性、为每位患者量身定制的服务、课程和培训、实施、商业化以及许可和责任。对互操作性、数据可用性、网络安全和信息基础设施的需求也更加明显。这些问题适用于医疗保健中的其他信息技术。

结论

临床医生和组织需要更新的远程医疗和远程医疗保健道德使用指南，决策者和政策制定者需要证据来为决策提供信息。新实施的远程医疗服务的多样性是一项正在进行的自然实验，为开发基于证据的前进方式提供了无与伦比的机会。该论文建议使用应用伦理学、上下文相关的方法进行评估，该方法探索多种因素和考虑因素之间的相互作用。它提出评估问题，通过多种方法、社会技术、解释和民族志以及互动评估方法来调查伦理、社会和法律问题。这种评估可以帮助远程医疗和其他信息技术以合乎道德和有效的方式整合到医疗保健中。