ETHICAL ISSUES IN USING A SOCIAL MEDIA BASED REMOTE PATIENT MANAGEMENT PLATFORM: A FOCUS GROUP DISCUSSION

D.C. Rajakulathunga¹, M.D.A.I. Karunaratne², J.S.S. Jayalath³, S.N. Silva⁴

Background: The physical distancing and social isolation related challenges posed by the Covid-19 global pandemic forced many healthcare delivery institutes to use telehealth solutions. The Impulse Rehabilitation Centre, based in Welisara, Sri Lanka, also planned to use an innovative telehealth solution based on the popular social media platform Facebook™. This was to ensure a quickly-deployable, low-cost solution that ensured continuous delivery of care via a platform that is already familiar to the common public. However, the researchers as well as the management of the institute were concerned whether such an approach would create any ethical issues or dilemmas.

Purpose: The main purpose of this study was to determine the likely ethical issues that may arise when using a social media platform based remote patient management scheme. Also it included finding likely solutions to mitigate such issues.

Methods: Two focus group discussions were held via video conferencing software. One group comprised six physiotherapists; four, directly connected to the clinic and two living abroad. The other group was composed of 10 patients, including both males and females, reasonably representing the age groups of the clinic’s patient base. The interview questions were mainly around what ethical aspects they thought are challenged and what measures can be taken to minimize them. The results were thematically analyzed.

Results: Four main themes were identified. The first was the expected “threat of breaching privacy and confidentiality”. The points under this were ‘inability to un-tag the private information of a social media profile when using it as a patient profile and the threat of health-related information being leaked into the social media space.The therapists were concerned about the group therapy sessions and patients being able to access each other's profiles.  “Using social media will be more ethical” was the second. It will uphold justice as a majority can use it and it will be beneficial for most patients as it is the quickest and most low-cost solution that can fill the gap in service delivery in a pandemic time. “Thorough explanation would improve informed participation”, was the third. With adequate explanation of risks, the majority are likely to still consent because the majority require care only for non-stigmatized, common conditions. “The likely harms of alternative systems” was the fourth theme. Several points were grouped under this theme, such as; a delay in deploying a system, likely reduced acceptance due to introduction of a complex system or one with sophisticated security features and unavailability of suitable hardware and software from patients’ end.

Conclusion(s): Using a common social media platform to deliver telehealth services does generate multiple ethical issues. However a certain level of compromising can be made in order to deliver rehabilitation services to a larger patient group more efficiently during a crisis situation.

Implications: This project implies that social media can be used to a great extent to supplement delivery of health services if the ethical challenges are identified and mitigated adequately.

Funding, acknowledgements: The study was funded by Impulse Rehabilitation Centre, which is affiliated under the International Institute of Health Sciences, Sri Lanka.

Keywords: Remote patient monitoring, Ethics in Telehealth, Social media

Topic: Professionalism & ethics

Did this work require ethics approval? Yes

Institution: International Institute of Health Sciences, Sri Lanka

Committee: BioInquirer Ethics Review Committee

Ethics number: ECR/2020/089