JCPSLP Vol 17 Supplement 1 2015_lores

Evidence based treatments have been ethically researched, scrutinised by peers and have proof of their general effectiveness. The opposite can be said for some web- based treatments and therapies already in existence. Second, non-research based information on a website may be used by PWCD to self-diagnose and perhaps self-treat their communication disorder. The risk for these people can be significant in terms of financial commitments and wasted effort learning techniques taught by unqualified people. Another risk for PWCD could be loss of faith in the associated SLP profession due to the technique not providing them with a promised “cure” or “elimination” of their communication disorders. SLPs have ethical duties to educate clients, their families and carers, and the community at large, about evidence based approaches that are known to be effective and provide accurate and timely information about those practices which are not evidence based (SPA, 2010, Practice 3.1). Professional associations may play a role in monitoring these sites. The SLP profession itself has a responsibility to actively educate members and clients about trusted websites and supported techniques. At the very least, individual SLPs need to be able to make informed and ethical comments about web-based information if asked by clients (SPA, 2010, Practice 3.1). Clinician–patient relationships The interpersonal aspects of therapeutic interventions delivered via the web need careful consideration and management by SLPs to fulfil their ethical duties to their clients (SPA, 2010, Practice 3.1). A growing area of ethical concern in the use and expansion of virtual worlds, telehealth and other web- based services is the impact that they may have on the “traditional clinician–patient relationships” (Stanberry, 2000, p. 615). Cornford and Klecun-Dabrowska (2001) caution against the “substitution of care with treatment” (p. 161). Very little research has been conducted to examine patient satisfaction with the quality of interactions in telehealth relationships (Ellis, 2004), although recent work and understanding has suggested that client satisfaction and acceptance of telehealth is on the rise (Theodoros, 2012). It is possible that the impersonal nature of some telehealth practices and virtual worlds hosted by automated avatars, or even completely unmoderated, may increase a sense of alienation commonly experienced by some clients (Bauer, 2010). Developers of on-line practices must be careful to supply information to clients and potential clients in easily understood language. Checking the comprehension of information provided to clients is easier to do in face-to- face clinical settings. In on-line and largely unmoderated environments information needs to be provided with attention to the complexity and language used (Worrall, Rose, Howe, McKenna & Hickson, 2007). Privacy and data storage The Code of Ethics requires SLPs to protect client confidentially and ensure the safety and welfare of their clients (SPA, 2010, Standards 3.1.4 and 3.1.7). The use of web based speech-language pathology services and digital records create additional complexities and ethical concerns for both clients and SLPs to manage. Telehealth and virtual worlds, as well as older technologies like email, require the storage, retrieval and transmission of various forms and levels of personal data concerning users at both client and practitioner levels. Privacy of data Informational privacy (control over the flow of our personal information) is threatened through the use of the web

(Tavani, 2011). In a telehealth context, personal information can be transmitted using a variety of technologies including the traditional approaches such as email, videoconferencing and the web or in new and emerging technologies such as cloud computing (applications and services which are offered over the Internet, collectively termed the cloud [Creeger, 2009]), and virtual worlds. SLPs need to adopt standards, data policies and procedures in order to minimise the impact of the above technologies (Darkins, 2012). This could include a range of privacy protection approaches such as phish detection filters, the use of strong passwords and sign-out, the use of anti-virus and anti-spyware protection, maximising browser privacy enhancing capabilities, and the adoption of authentication and encryption protocols particularly when cloud computing and mobile technologies are utilised (Tavani, 2011; Zhang & Zhang, 2011). In addition, Darkins (2012) suggests organisations adopt a systems approach (a holistic and analytical approach) as an overall model for thinking about data privacy issues in the implementation of telehealth programs. This suggests organisations think about their telehealth as part of their overall health delivery and not in isolation. SLPs need to be aware of the Privacy Act 1988 (Cth) which regulates the way personal information is collected, stored, used and disclosed (McDermid, 2008), and the Privacy Amendment (Private Sector) Act 2000 (Cth). This legislation extended the protection of information privacy to include many private sector organisations, and organisations that provide health services or store health-related information (McDermid, 2008). The legislation includes a list of ten national privacy principles which set the minimum standard for information privacy. The intent of this legislation is governance for organisations in the information economy, and is of particular relevance to SLPs ensuring protection of client confidentiality, safety and welfare. Storage of data Another issue of concern is the enormous volume of data (e.g., practitioner notes, lab test results, scans) digitally generated and the storage of that data. Telehealth practitioners need to consider what type of data should be stored, how much should be stored, for how long, and in what format. Currently, legislation requires health practitioners to store files for seven years after a client finishes treatment, or until the child reaches 25 years of age. This requires enormous data storage capacity. Telehealth providers are considering the use of cloud computing as an option to overcome their data storage dilemmas; however, storage in the cloud provides its own set of privacy and security concerns. Some suggest the use of private clouds , where data is restricted to servers in specific locations, and the development of standards and metrics to measure performance and regulations compliance by cloud computing vendors (Herold, 2012) will be important. This emerging landscape may provide SLPs adopting telehealth services or using other digital services with an alternative solution, but will require preservation of ethical standards required by SPA. In conclusion The web offers new frontiers like media rich telehealth and virtual worlds for SLPs to venture into, explore and appraise. These digital platforms offer new avenues for treatment and education provision to clients. They also aid SLPs to deliver services across large geographical areas in cost-efficient and ethically considered ways, through implementation of processes and organisational philosophies which protect the privacy and storage of data. Both telehealth and virtual

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

Journal of Clinical Practice in Speech-Language Pathology