JCPSLP Vol 17 Supplement 1 2015_lores

Ethics and technology

Digital possibilities and ethical considerations Speech-language pathologists and the web Grant Meredith, Sally Firmin and Lindy McAllister

The world wide web offers the promise and means of continual development and improved access to speech-language pathology services for people with communi­ cation disorders. In this paper we describe practices and possibilities for service provision for this population, using telehealth and emergent virtual worlds. We illustrate these technologies with a particular focus on research and developments for people with communication disorders. We then highlight some of the ethical risks associated with the web in terms of the promotion of non- evidence based practices, client–patient relationships and the storage and access of client data. These concerns are discussed with reference to Speech Pathology Australia’s Code of Ethics, and provide guidance to speech-language pathologists regarding the potential dangers associated with service provision over digital platforms. L ast year the world wide web (the web) turned 21, and now over 72% of Australian households are connected to it (Australian Bureau of Statistics, 2011). The web is a collection of web pages which function as a resource of the Internet (the world’s largest network consisting of millions of linked computers) (Morley, 2011). Today, the Internet and the web enable people around the world to communicate, interact, and share information on a large scale for activities such as commerce, health care, education, socialising, and gaming. However, global inequality of access and knowledge of information and communication technologies (ICT), known as the digital divide (Wei, Teo, Chan, & Tan, 2011) does exist. Consequently, the Australian federal government has recently begun rolling out its highly publicised National Broadband Network (NBN) which aims to connect all Australians to a high-speed web by 2020, enabling a digitally supported economy (Department of Broadband, Communications & the Digital Economy, 2011). As an ICT infrastructure develops, it is the role of all public sectors, including health, to utilise and plan for its inclusion into a digital future. The first purpose of this paper is to outline developments within telehealth, and work

associated with the emergent virtual world platforms, with regard to the provision of speech-language pathology (SLP) services. The second aim of this paper is to outline for SLPs some major ethical concerns associated with embracing these emergent and evolving technologies; that is, serving a digital community while abiding by the profession’s Code of Ethics. We commence our discussion of these applications of the web in regards to people with communication disorders (PWCD) through a short review of the more established area of telehealth. Telehealth Telehealth is not a new digital phenomenon. Modern telehealth started in the 1960s largely driven by the needs of the military and of space exploration. Early technologies included the use of television and the telephone (World Health Organisation [WHO], 2010). Contemporary telehealth includes: The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities. (WHO, 2010, p. 38) The provision of health services to remote sites is supported by a wide range of technologies (see Table 1 for a list of resources commonly used by SLPs to support their service delivery). Technologies such as videoconferencing suites, email, tele-imaging, and more recently, rich multimedia approaches such as video-streaming are commonly used (WHO, 2010). The use of fixed, high-tech videoconferencing suites to provide telehealth services through public health departments is well established. One example of the use of this technology occurs within the Southern Inland Health Initiative which delivers telehealth services including videoconferencing and remote diagnosis to outpatients in rural and remote areas in Western Australian (Department of Health, 2011). A second tool is the portable e-hab system, developed by Theodoros and colleagues, for telehealth service delivery to people with a range of communication and swallowing impairments (see for example, Sharma, Ward, Burns, Theodoros & Russell, 2011). Another technology being investigated for service provision is desktop videoconferencing applications such as Skype, which is envisaged to play an important role in future delivery of low-risk clinical functions (Armfield, Gray & Smith, 2012; Carey et al., 2010).

KEYWORDS ACCESS ETHICS INFORMATION PRIVACY STUTTERING TELEHEALTH

Grant Meredith (top), Sally Firmin (centre) and Lindy McAllister

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JCPSLP Volume 17, Supplement 1, 2015 – Ethical practice in speech pathology

Journal of Clinical Practice in Speech-Language Pathology