Clarifying responsibility: professional digital health in the doctor-patient relationship, recommendations for physicians based on a multi-stakeholder dialogue in the Netherlands

Abstract

Background: Implementation of digital health (eHealth) generally involves adapting pre-established and carefully considered processes or routines, and still raises multiple ethical and legal dilemmas. This study aimed to identify challenges regarding responsibility and liability when prescribing digital health in clinical practice. This was part of an overarching project aiming to explore the most pressing ethical and legal obstacles regarding the implementation and adoption of digital health in the Netherlands, and to propose actionable solutions.

Methods: A series of multidisciplinary focus groups with stakeholders who have relevant digital health expertise were analysed through thematic analysis.

Results: The emerging general theme was 'uncertainty regarding responsibilities' when adopting digital health. Key dilemmas take place in clinical settings and within the doctor-patient relationship ('professional digital health'). This context is particularly challenging because different stakeholders interact. In the absence of appropriate legal frameworks and codes of conduct tailored to digital health, physicians' responsibility is to be found in their general duty of care. In other words: to do what is best for patients (not causing harm and doing good). Professional organisations could take a leading role to provide more clarity with respect to physicians' responsibility, by developing guidance describing physicians' duty of care in the context of digital health, and to address the resulting responsibilities.

Conclusions: Although legal frameworks governing medical practice describe core ethical principles, rights and obligations of physicians, they do not suffice to clarify their responsibilities in the setting of professional digital health. Here we present a series of recommendations to provide more clarity in this respect, offering the opportunity to improve quality of care and patients' health. The recommendations can be used as a starting point to develop professional guidance and have the potential to be adapted to other healthcare professionals and systems.

Keywords: Digital health; Health policy; Liability; Professional digital health; Responsibility; eHealth.

Fig. 1

Interacting stakeholders within ‘professional digital health’. Here the roles of patient, physician, the healthcare institution and the manufacturer (including those hosting and processing data) converge. The doctor-patient interaction is key because the decision-making process regarding the adoption of digital health generally occurs in this context. Professional digital health is influenced by the roles of the health institution and the manufacturer, which serve to ensure the quality of the digital health technology and offer technical and organisational support for its application when necessary. In the background, external factors outside of the physician’s control may influence the performance of a digital health technology, such as the quality of the internet connection.