Anticipating these problems, the World Medical Association had issued a Statement of Ethical Guidelines on the practice of Telemedicine in 2007 at Copenhagen, Denmark as outlined below:
1. Patient-Physician Relationship and Confidentiality:
i. The patient-physician relationship should be based on a personal encounter and sufficient knowledge of the patient’s personal history. Telemedicine should be employed primarily in situations in which a physician cannot be physically present within a safe and acceptable time period
ii. It is, essential that the physician and the patient be able to identify each other reliably when telemedicine is employed
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iii. Ideally, telemedicine should be employed only in cases in which a prior in-person relationship exists between the patient and the physician involved in arranging or providing the telemedicine service
iv. The physician must aim to ensure that patient confidentiality and data integrity are not compromised.
2. Responsibilities of the Physician:
i. A telemedicine physician should keep a detailed record of the advice he/she delivers as well as the information he/she received and on which the advice was based.
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ii. The physician must seek to ensure that the patient has understood the advice and treatment suggestions given and that the continuity of care is guaranteed.
iii. The physician asking for another physician’s advice or second opinion remains responsible for treatment and other decisions and recommendations given to the patient.
3. Quality of Care:
The possibility of weaknesses of telemedicine in emergencies must be acknowledged and quality assessment measures must be used regularly to ensure the best possible diagnostic and treatment practices in telemedicine.
4. Legislative Measures:
WMA and the National Medical Associations should encourage the development of national legislation and international agreements on subjects, related to the practice of telemedicine, such as e-prescribing, physician registration, liability and the legal status of electronic medical records.