At a recent South African Telemedicine Conference, UKZN PhD student, Ms Caron Jack’s presentation scooped first prize. Her study titled, “Informed Consent for Telemedicine in South Africa: Clinical Practice versus the Legislators” aimed to understand whether in a developing country, written informed consent is obtained by healthcare professionals when transferring clinical information about a patient through telephone, fax or e-mail communication tools. In other words, how relevant would it be, in a developing world, to regulate telemedicine?
Due to the growing shortage of health practitioners in developing countries, telemedicine is regarded as a new, efficient way of offering medical services. However, regulators feel that telemedicine presents many ethical challenges. The Health Professions Council of South Africa (HPCSA) has 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. It is proposed that a regulated telemedicine environment would ensure improved access, service delivery and quality of care for rural communities in South Africa.
The proposed HPCSA guidelines suggest that for every telemedicine encounter, written, informed consent should be given by the patient to the clinician for every aspect of that telemedicine encounter, based on full and frank disclosure of all the material facts. This would include the transfer of patient records, storage of information, clinical examinations and consultation with another practitioner electronically. Through her study, which consisted of 400 healthcare professionals from the private and public sectors in the province of KwaZulu-Natal, Jack found that the majority of healthcare professionals only obtained verbal consent from the patient when transferring clinical information, referrals to other specialists, clinical examinations and ordering investigations.
She concluded that the imposition of signed informed consent by regulators would impede telemedicine use. ‘Legislation should be enabling and not obstructive. In a country like South Africa, regulators assume that every citizen, including healthcare workers and patients, is technologically literate and that every one of our 11 official languages contains words for technology and data security measures employed by telemedicine,’ Jack said.
Jack has recently published a study titled, “Language, Cultural Brokerage and Informed Consent: Will Technological Terms Impede Telemedicine Use?” Her findings suggest that a direct translation of most computer terminology into isiZulu is very limited. She concluded that the lack of a lexicon of technological and computing terms in a language may well make it impossible to meet the full legal requirement for valid informed consent, as set out by the HPCSA.
‘Ensuring that patients are provided with information of sufficient quality and quantity in their own language, to ensure that they will be genuinely informed and able to make an autonomous choice as to their preferred treatment will require appropriate consent tools,’ said Jack. ‘Telemedicine laws and the issue of informed consent for telemedicine remain controversial,’ she added.