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Ethics and telehealth services in the time of Covid-19

Thursday, April 23, 2020   (0 Comments)
Posted by: Daniel Klim
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As a long-time instructor for the NJSBPTE approved ethics course, and a member of the APTANJ Ethics Committee, I am reaching out regarding the provision of physical therapy services during this unprecedented time of self-isolation and social distancing necessitated by the pandemic.  I have been fielding emails from colleagues on telehealth which is why I am writing this article.  Many excellent questions were raised. Most importantly, I would like to highlight sources to guide or support the decisions you need to make when using this new model of clinical practice.

The APTANJ has been a leader in assisting physical therapists in navigating the  provision of telehealth physical therapy services under the NJ Uniform Enforcement Act and also in accordance with the Department of Education directive that mandated physical therapy be provided to children with special needs in NJ schools during the state-wide school closure. While APTANJ has been the paramount source for accurate information for physical therapists, the association cannot provide specific direction on how we should address the potentially complicated decisions that implementation of telehealth creates.

Rather, it is our professional duty as physical therapists to reflect and re-examine the evidence as well as our moral compass when we make clinical decisions with respect to practicing via telehealth.  An APTA position statement (P03-03-12-28), articulated that “autonomous practice is characterized by independent, self-determined professional judgment and action. Physical therapists have the ability and responsibility to exercise professional judgment within their scope of practice, and to professionally act on that judgment.”  The pandemic and telehealth have not changed this extremely important approach to clinical practice.

During these truly challenging times, we as professionals are called upon to follow our Code of Ethics and Professional Core Values as we strive to utilize the best evidence to serve our patients/clients and practice autonomously. Recent questions have been posed that indicate we are reflecting and working hard to determine the best course of care for those we serve.   At the core of these questions is to determine whether to practice telehealth at all, or to do so in a more selective, case by case basis.  Colleagues are clearly exploring that because we can treat our patients via telehealth does not mean we should in all circumstances. 

We need to exercise our professional judgment with respect to all of the individuals we serve and determine what is truly in their best interest as we always have. We cannot base our practice decisions on direction from practice owners, supervisors or the like. Rather, we need to reflect and use our independent professional judgment. We need to ask ourselves whether a particular patient will decline without our services?  Can or should an individual wait to be appropriately or optimally managed when the pandemic ends, and we return to face to face practice? Can the patient be managed during the pandemic with a home exercise program? Also, how do we appropriately bill for our services via telehealth? Is it only the time we are delivering physical therapy services, or can we bill for setting up the services?  How do we ensure patient confidentiality and be HIPAA-compliant using a variety of virtual platforms?  And perhaps the most important clinical decision: given the patient’s or client’s situation, can we effectively and safely provide skilled physical therapy services via telehealth? 

All of these questions cause us to reflect and explore options for each individual patient/client. They may be of varying difficulty for physical therapists depending upon the personal and practice situations in which you find yourself.  Where do you practice?  What stressors on practice viability and your own productivity or even employment status are there?  Are these factors working to inform or perhaps even dictate your clinical decisions during this pandemic?  Some physical therapists are fortunate in that by virtue of an employment situation and/or experience, they are able to continue to practice and support themselves and their families.  Others may be challenged by their practice on a daily basis to remain productive and meet their personal needs while exploring the delivery of telehealth services.

Despite the unforeseen dynamics that Covid-19 has brought to us, I truly believe physical therapy professionals in New Jersey can effectively navigate this situation with skill by maintaining the high level of autonomous practice we standardly deliver and that consumers of our services have come to expect. 

In these trying times, rely on your professional association, your colleagues, the best evidence and key professional documents beyond the NJ Practice Act, like the Code of Ethics and Core Professional Values, to assist in your clinical decision making with respect to telehealth. Explore the appropriateness and effectives of the services you are able to provide for each individual you treat. Covid-19 and telehealth have challenged how we practice currently and may change the landscape of our practice when we return to on-site delivery of care. Now and moving forward, we are in this together, and we will be better as a profession as we face these challenges/questions together.

I wish you well. Be safe. Be strong.  I hope to see you at an APTANJ conference in the (near) future.

Lee Ann Guenther

Lee Ann Guenther PT, DPT, MS

Associate Professor of Physical Therapy Stockton University

NJ School Certified PT

 

Lee Ann is a member of the APTANJ Ethics Committee and has presented Ethics courses  in New Jersey approved by the New Jersey State Board of Physical Therapy Examiners 


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