1. The AMA recognises that the ever-increasing capacity of the broadband infrastructure, technological improvements including the broadband integration of mobile phones, personal digital assistants (PDAs) and other highly portable devices as well as Instant Messaging, SMS and other now familiar media will impact markedly on the way business and medical encounters will be conducted into the future.

2. Increasing numbers of GPs and medical providers are incorporating on-line e-mail and other forms of broadband connected consultations into their patient care. As technology becomes integrated into routine medical practice, providers must also incorporate measures that enhance benefits and reduce risks.

3. The AMA acknowledges that a range of telecommunication systems do have a place in the delivery of health care into the future, particularly for less complex services where the doctor considers a face-to-face consultation is not necessary. This type of consultation does not, however, replace care where the doctor considers a face-to-face consultation is necessary in order to provide the best care for the patient and in compliance with quality and safety standards for patient care.

4. Anecdotal evidence suggests that for patients and doctors, convenience associated with on-line consultation represents a significant benefit where a patient can efficiently engage in a secure on-line consultation that does not necessitate a face-to-face encounter. For example, patients have demonstrated an acceptance of unrebated fees in exchange for the convenience and timeliness of being able to request repeat prescriptions, seek advice on their medication or receive information on test results on-line rather than experience the frequent difficulty of organising and attending a face-to-face appointment. Secure on-line communications will enable a practice to efficiently disseminate recalls or reminders. Anecdotal evidence indicates that doctors consider the ability to respond to patient requests on-line at their convenience, delivers benefits in the management of their time and their face-to-face patient load.

5. Non face-to-face health services provided through either on-line or other telecommunication systems offer an alternative to the traditional mode of consultation, where they:

• are used as an adjunct to normal medical practice;
• replace services which do not compromise the quality and safety of patient care, or the type of care that necessitates face-to-face consultations;
• are employed to access medical care services in areas where such services are otherwise unavailable.
  
  Regardless of the mode of consultation, the duty of care to the patient does not alter.

6. It is mandatory for all medical practices integrating electronic communications to ensure they are compliant with appropriate standards around hardware and software, and secure transmission of data, including authentication.

7. For practices considering the development of an on-line or other telecommunication consultation system where the practitioner is not in the vicinity of the patient, a number of key principles should be applied. The system should only be available to patients that have an established relationship with the doctor or the practice. The AMA does not support the provision of on-line consultations between medical practitioners and patients where no established relationship exists. The only exceptions should be where there is no practical alternative available, for example, remote emergency treatment of a previously healthy individual or where it provides access to medical services in areas where such services would otherwise be unavailable.

8. In circumstances where a doctor wishes to incorporate on-line consultations as part of the practice's services, patients wishing to avail themselves of such a service should be required to agree to strict written terms and conditions in order to be eligible to use the system. Such terms and conditions must clearly outline the manner in which the system will operate and the limitations on the type of care that will be provided through a non face-to-face consultation using such systems. Importantly it must be made clear to patients that in all cases the doctor retains the right to determine that providing advice or a specific service on-line is inappropriate.

9. Any system will require the establishment of practice protocols around the types of issues that might be dealt with on-line or by other telecommunication modes. In that context the AMA policy position seeks to develop some key principles around the establishment of non face-to-face consultation using on-line or other telecommunication systems.

10. These principles are those the AMA believes are applicable across the medical profession. The AMA acknowledges that issues unique to the variety of medical specialities will require the development of additional specific principals by each craft group. The principles contained in this position statement represent the foundation principles on which it is recommended each specialist craft group should build to meet the needs and practices of their members.

11. The AMA, recognising that increasing numbers of medical providers are incorporating on-line and other forms of telecommunications consultations into their patient care, agrees that the following principles, in conjunction with principles that may be developed by specific craft groups to meet the needs and practices of their members, must guide the provision of such consultations systems and that such services must:

• only be used as an adjunct to normal medical practice;
• only replace services where the quality and safety of patient care is not compromised including where they provide access to medical care services in areas where such services are otherwise unavailable;
• not replace face-to-face consultations where the provision of quality care requires a face-to-face consultation;
• incorporate the ultimate right of the doctor to determine whether consultation or provision of specific advice or care on-line is appropriate in any circumstance;
• incorporate the ultimate right of the doctor to determine whether or not he/she will provide any medical care to any patient on-line;
• ensure that medical records reflect the content of on-line consultations as with any other medical record;
• normally only be available to patients that have an established relationship with the doctor or the practice. The AMA does not support the provision of on-line consultations between medical practitioners and patients where no established relationship exists unless there is no practical alternative or where they are employed to access medical care services in areas where such services may otherwise be unavailable;
• reflect, in associated protocols or guidelines, that the duty of care remains unchanged;
• where offered to patients with an established relationship with the doctor or practice be underpinned by signed patient agreement to strict written terms and conditions for eligibility to use that also outline the limitations on the type of care that will be provided through the system and the right of the doctor to determine whether the provision of any advice or care through such a system is inappropriate;
• provide for the registration of all patients who wish to use the system with access based on a minimum of user name and password. The AMA encourages the use of stronger authentication mechanisms;
• be compliant with appropriate standards around hardware and software, secure transmission of data and communications, including appropriate encryption.