Chapter 7: Practicing Ethically in a Digital World

INTRODUCTION

In the first edition of this book telehealth was addressed in the “future” chapter. While many of the important components of telehealth were in place at the time very little telehealth was being done and it was anticipated that at least another decade would pass before telehealth became a potential mainstream way in which to deliver physical therapy services. A global pandemic changed the practice landscape bringing telehealth into mainstream practice with the accompanying ethical considerations.

Telehealth is defined as care at a distance: Telehealth is about access; Access to providers and providers’ access to patients. In a “hands-on” profession such as physical therapy, there is understandable concern about this care delivery model (American Telehealth Association, 2023). The basic ethical principles prevail regardless of setting, and telehealth is just that, another physical therapy practice setting. A remote expert is a wonderful adjunct but does not completely replace the provider who is on site. Practice must still maintain the centrality of the patient as a whole when determining the optimal location for the delivery of health care through telehealth (Cheshire, 2017).

Physical therapy can be delivered through telehealth in several different formats.

Pure Telerehabilitation consists of services provided completely remotely. There is also a hybrid model in which the initial evaluation is done in person and subsequent sessions remotely. Another model of care delivery is either synchronous where communication is occurring in real time or asynchronous where sensors are utilized to deliver data which is responded to by the therapist at a later time. The least effective type of telerehab is telecommunication only, voice and no video, while there may be times this is adequate most of the time it is not an effective methodology for the delivery of physical therapy services.

When considering telehealth as a viable setting there are seven things to consider.

1. Clinician competence.

2. Right person, right place, right time.

3. Patient safety.

4. Legality.

5. Privacy.

6. Confidentiality.

7. Evidence-based support.

Clinician competence: Though not restricted to clinicians with experience only individual clinicians must carefully assess their skill set and comfort level with delivering care remotely and managing the treatment venue including the effective use of technology. (Principle 3C, 6A)

Right person, right place, right time: Telehealth is not a replacement for the delivery of optimal care, it should never be considered “better than nothing.” Not all patients are right for telehealth delivery, or they are not in the place for the care they need or not in the right time considering their recovery. (Principle 3A)

Patient safety: is critically important, Is the home environment safe for the patient and care givers. Can the therapist adequately assess that patient or develop interventions that are appropriate and ensure the patient’s safety as they participate. Consider not just the obvious risks but the hidden risks as well. (Principle ...