As healthcare institutions expand and vertically integrate, healthcare delivery is less constrained by geography, nationality, or even by institutional boundaries. As part of this trend, some aspects of the healthcare process are shifted from medical centers back into the home and communities. Telehealth applications intended for health promotion, social services, and other activitiesprovide services outside clinical settings in homes, schools, libraries, and other governmental and community sites. Such developments include health information web sites, on-line support groups, automated telephone counseling, interactive (...) health promotion programs, and electronic mail exchanges. Concomitant with these developments is the growth of consumer health informatics, in which individuals seeking medical care or information are able to find various health information resources that take advantage of new information technologies. (shrink)

The coronavirus crisis is causing considerable disruption and anguish. However, the COVID-19 pandemic and consequent explosion of telehealth services also provide an unparalleled opportunity to consider ethical, legal, and social issues beyond immediate needs. Ethicists, informaticians, and others can learn from experience, and evaluate information technology practices and evidence on which to base policy and standards, identify significant values and issues, and revise ethical guidelines. This paper builds on professional organizations’ guidelines and ELSI scholarship to develop emerging concerns illuminated by (...) current experience. Four ethical themes characterized previous literature: quality of care and the doctor–patient relationship, access, consent, and privacy. More attention is needed to these and to expanding the scope of ethical analysis to include health information technologies. An applied ethics approach to ELSI would addresses context-specific issues and the relationships between people and technologies, and facilitate effective and ethical institutionalization of telehealth and other health information technologies. (shrink)

This article traces past trends and current developments in medical computing in the United States. It suggests a link between shifts in emphases in medical computing and in federal government policy toward health care delivery. The development of medical computing was not driven solely by the internal imperatives of science and technology, but by dreams and visions of how computers could revolutionize medicine. Such dreams and visions constitute a mythical charter similar to ideologies and rhetoric used to mobilize support by (...) other computerization movements. This mythical charter influenced development of medical computing by tying computing in medicine to policy goals. This charter also affected historical accounts in medical computing, which are characterized by technological determinism and evidence of cognitive dissonance due to failure to achieve policy goals. (shrink)