Table 2

The five key components of an eHealth medical ethics code

Key components of eHealth medical ethics code
Mutual respectThe patient–physician relationship must be based on mutual trust, respect and safety. It is therefore essential that the physician and patient be able to identify each other reliably when using eHealth services.56
Promoting open communication and consentAn eHealth consultation must be treated like any other outpatient consultation, safeguarding sensitive or confidential information at all times.57
Informed care and shared treatment decisionseHealth consultations are ideal in situations where a physician cannot be physically present in a safe and timely manner. eHealth consultations do not allow for the performance of a physical examination; most non-verbal clues usually present in face-to-face meetings will be absent. These might affect the quality of eHealth communication. The principles of shared decision-making are similar in physical or eHealth consultations. However, it might be more challenging in the eHealth setting to confirm the patient’s understanding of the pathology and treatment options. If there is any doubt, a face-to-face consultation should be offered as an alternative. Inform the patient about the nature and limitations of the eHealth consultation and document informed consent. It remains a vital healthcare provider’s responsibility to consider language barriers and to ensure the right to an interpreter or health advocate.
Access to health informationPatients have the right to access all electronic health record information, unless the attending physician specifically restricts access in consultation with a family representative, legal or surrogate guardian. This can be for medical or legal reasons.
Physician autonomy and responsibilitiesThe normal ethical and professional standards apply to all aspects of a physician’s practice. A physician should not participate in eHealth services if it violates the country’s legal or ethical framework. Physicians should only practice eHealth in countries/jurisdictions where they are licensed to practice. This is an essential consideration for team physicians when travelling with a team to competitions and training camps to another country. Physicians should also ensure medical indemnity that covers eHealth.