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The legal, ethical and regulatory issues common to telemedicine are many: licensure, jurisdiction, credentialing/privileging, informed consent specific to the distinctive features of telemedicine, confidentiality, privacy, data security, the healthcare provider‐patient relationship, continuity of care, quality of care, responsibility of care, scope of practice, and documentation [25–28]. State laws regarding telemedicine vary significantly and impact care that is provided within each state and across state lines. To stay abreast of individual US‐state laws and impending changes, American Telemedicine Association’s Policy web page is a helpful resource [27]. Healthcare providers who practice telemedicine in the US need to ensure their license covers the level of care they are providing in both the location they practice and where the patient resides [26,27].

Telehealth also requires maintaining data security during acquisition, transfer and storage for all digitally transmitted medical data and photographs [25,29,30]. Table 4.2 displays a compilation of recommendations for safeguarding medical information and clinical images for telehealth. As with any medical provider‐patient encounter, telehealth should be approached with the same ethical principles. It is also very important to recognize the limitations of telehealth which is not a substitute for in‐person evaluation. Providers need to recognize when clinical need is outside the scope of safe delivery of telemedicine and recommend in‐person evaluation [28].

Table 4.2 Safeguarding medical information and photos in telehealth

Medical information

Photographs

Obtain consent prior to accepting patient data via electronic means, ensuring patient understands how the information will be used, stored and shared Use password‐protected, encrypted email when exchanging information with patients about their clinical queries Set a standard for turnaround times for messages and communicate this with patients; email should not be used for urgent matter Include email communications from patient in their medical record Request that patient include their full name and date of birth in the body of the email

Obtain consent prior to accepting patient photographs via electronic means, ensuring patient understands how the photo will be used, stored and shared Receive photographs to an encrypted, password protected email address, photos should not be received via text message to a clinician’s personal phone Send photographs to other clinicians for consultation using password‐protected, encrypted email or via the medical record Delete photographs from any mobile devices after upload Upload all patient photographs to their permanent medical record If consent has been obtained for teaching or research purposes (not just clinical purposes), use photographs in a way that de‐identifies the patient