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Accréditation Sans Frontières · ASF Health Standards 9.0

Standard 23 · Telemedicine

22 criteria · optional module (declare to apply)

Optional module (declare to apply). 22 criteria, of which 0 non-negotiable. Each criterion is numbered 23.Y, with its classification and verification questions.

Criteria

23.1 The Service Never Disadvantages a Patient Who Cannot Access It Digitally

CORE

A process exists so that a patient who cannot access the telemedicine platform — no reliable internet, no suitable device, limited digital literacy — is never simply left without care, but is referred or redirected to an appropriate alternative, not told the service is unavailable to them with no next step.

VERIFICATION QUESTIONS

  1. Is there a defined pathway for a patient who cannot access the platform digitally?
    Without a defined pathway, a patient who cannot use the platform has nowhere to go.
  2. Are staff trained to recognise and respond to digital access difficulty?
    Staff who cannot recognise the difficulty will not respond to it.
  3. Can the facility show a recorded example of a patient redirected to an appropriate alternative?
    Evidence that the pathway works in practice, not only on paper.

23.2 AI Systems Are Introduced in Line With Law and Best-Practice Guidance

STANDARD

Any artificial intelligence tool used to support triage, diagnosis, or clinical documentation is introduced in accordance with applicable law, or where none exists, with available best-practice guidance such as WHO's Ethics and governance of artificial intelligence for health: WHO guidance (2021) — not adopted with no reference to any external standard of responsible use.

VERIFICATION QUESTIONS

  1. Is any AI system introduced in line with applicable law?
    Verified compliance, not an assumption that general policy covers AI.
  2. Where no law exists, is introduction informed by recognised guidance?
    A referenced guidance source, not an ad hoc decision.
  3. Has the governance basis been checked against each relevant jurisdiction?
    Governance is checked against the law where patients are, not assumed to be the same everywhere.

23.3 AI Systems Are Monitored for Unintended Consequences

STANDARD

The provider monitors any AI-assisted triage or diagnostic tool for over-diagnosis, missed diagnosis, and other unintended consequences — a heightened concern in a remote setting where an AI tool may be compensating for the absence of physical examination — not deploying a tool and assuming it works as intended with no ongoing scrutiny.

VERIFICATION QUESTIONS

  1. Is AI-assisted output audited?
    Audit output on a schedule, not assumed reliable.
  2. Does monitoring reflect remote assessment's specific limitations?
    A tool that works well in person can mislead when used remotely.
  3. Can the facility show a recorded example of monitoring identifying an issue?
    Evidence that monitoring works in practice, not only that it exists.

23.4 Clinicians Are Consulted Before an AI System Is Introduced

STANDARD

Clinicians who will use a new AI tool are consulted before its introduction, with training needs identified and addressed — not a tool rolled out to a distributed, often remote clinical workforce with no engagement beyond a brief notification.

VERIFICATION QUESTIONS

  1. Are clinicians consulted before introduction?
    A tool introduced without the people who use it is harder to use safely.
  2. Does consultation reach remote clinicians across time zones?
    Consultation that reaches clinicians in other time zones, not only those at a head office.
  3. Can clinicians describe having been consulted?
    A consultation that no one remembers did not change anything.

23.5 Accountability for AI-Assisted Care Is Explicitly Defined

CORE

The provider has considered and documented accountability for care decisions made with AI support — who is responsible when an AI-assisted decision is wrong — not leaving this as an unexamined question until it matters, a harder question when the clinician, the platform and the AI vendor may all sit in different jurisdictions.

VERIFICATION QUESTIONS

  1. Is clinical accountability explicitly documented?
    Accountability that is not written down is contested after an incident.
  2. Do clinicians understand accountability across jurisdictional lines?
    Responsibility can differ between the place the clinician works and the place the patient is.
  3. Is there a defined process for reviewing accountability in a safety incident?
    A defined review route, not an unresolved question after an incident.

23.6 Patients Are Informed When Their Care Involves AI

STANDARD

A patient whose care involves an aspect delivered with AI system support is informed of this — not left to assume every decision was made by the remote clinician alone, with disclosure treated as optional rather than a standard part of informed telemedicine care.

VERIFICATION QUESTIONS

  1. Is a patient informed when AI is involved in their care?
    Disclosure at the start of care, not left to be discovered later.
  2. Is this disclosure understandable, not buried in platform terms?
    Plain-language disclosure a patient can act on.
  3. Can a patient asked directly confirm they were told?
    A confirmation the patient can give, not disclosure that exists only in policy.

23.7 Ongoing Competency Is Regularly Evaluated

CORE

The continued clinical competency of every provider is regularly evaluated, including competency specific to remote assessment technique — not assumed to remain adequate indefinitely once initial credentialing under criterion 4.2 is complete.

VERIFICATION QUESTIONS

  1. Is ongoing competency evaluated on a schedule?
    Competency assessed once at credentialing is not evidence of current competency.
  2. Does this include remote-specific assessment competency?
    Remote assessment is a distinct skill from in-person assessment.
  3. When a gap is identified, is there a defined response?
    A defined response, not a gap noted with no follow-through.

23.8 Providers Have Access to Ongoing Education and Peer Connection

STANDARD

Every provider has access to ongoing education and, specifically, opportunities for peer connection and consultation — which a geographically distributed, remote workforce can easily lack compared to colleagues who work alongside each other daily in a shared physical space.

VERIFICATION QUESTIONS

  1. Does every provider have ongoing access to education?
    Ongoing access to education, not training limited to induction.
  2. Are peer consultation opportunities offered?
    Isolated providers need a route to colleagues for complex cases.
  3. Can a provider describe an opportunity taken in the past year?
    A specific, recent example, not a theoretical entitlement.

23.9 Clinician Wellbeing and Isolation Risk Are Monitored

STANDARD

The provider monitors for the wellbeing and professional isolation risk distinct to remote clinical practice — a provider working alone from a home office, without colleagues physically present, faces different wellbeing risks than one in a shared clinical setting, not treated identically to in-person workforce wellbeing.

VERIFICATION QUESTIONS

  1. Does the provider consider isolation risk specific to remote practice?
    Remote work carries isolation risks that in-person work does not.
  2. Are regular check-ins conducted beyond clinical or administrative matters?
    Check-ins that cover wellbeing, not only tasks.
  3. Can a clinician describe an instance where this made a difference?
    A specific, recent example, not a general statement.

23.10 Workplace Issues Raised by Staff Are Investigated and Resolved

STANDARD

A process exists for investigating and resolving workplace issues raised by staff — including whistleblowing concerns — with protection from adverse treatment, not a grievance process that exists on paper with no follow-through, a gap that is harder to see when staff work remotely.

VERIFICATION QUESTIONS

  1. Is there an accessible process reaching remote staff?
    A process that remote staff can reach and use, not only office-based staff.
  2. Is there evidence of resolution?
    A documented outcome for each workplace issue raised.
  3. Are staff protected from adverse treatment?
    Protection that exists only in policy does not encourage people to speak up.

23.11 Workforce Feedback Is Gathered and Acted On

STANDARD

The provider has a systematic approach to gathering feedback from its remote workforce, with analysis and an implemented response — not feedback collected occasionally with no pattern of actual improvement. A remote workforce lacks the informal, in-person feedback moments that office-based staff have, so structured feedback matters more.

VERIFICATION QUESTIONS

  1. Is feedback gathered on a systematic, recurring basis?
    Feedback gathered on a schedule, not only when a concern arises.
  2. Is collected feedback analysed?
    Feedback that is collected and not analysed cannot show what to change.
  3. Can the facility show a recorded example of feedback leading to a change?
    A concrete change that followed from feedback.

23.12 Equality, Diversity and Inclusion Across the Workforce Are Monitored

STANDARD

The provider monitors and responds to patterns of equity across recruitment, work allocation, scheduling, and promotion — including across a distributed, remote clinical workforce — not an assumption that fair treatment exists simply because no formal complaint has been raised.

VERIFICATION QUESTIONS

  1. Is workforce data monitored for patterns of inequity?
    Equity is checked with data, not assumed.
  2. Where a pattern is identified, is there a defined response?
    A defined response to any pattern found.
  3. Can the facility show a recorded example of this informing a change?
    A concrete example, not a statement that data exists.

23.13 Digital Infrastructure Impact Is Assessed, Not Assumed Negligible

STANDARD

The provider assesses the environmental impact of its own digital infrastructure — server hosting, data storage, device energy use — not assumed negligible simply because the service has no physical patient-facing facility.

VERIFICATION QUESTIONS

  1. Has the provider assessed its hosting and data infrastructure footprint?
    A measured footprint, not an assumption that digital services have none.
  2. Where cloud or hosting services are used, has their provider's own environmental practice been reviewed?
    Hosting practice matters, so it should be checked, not assumed.
  3. Is this assessment revisited periodically?
    An assessment done once does not reflect the current infrastructure.

23.14 Hosting and Technology Procurement Considers Environmental Impact

STANDARD

Decisions about cloud hosting providers, servers, and core technology infrastructure factor in environmental impact alongside cost and performance — not sustainability treated as irrelevant to a purely digital service.

VERIFICATION QUESTIONS

  1. Does hosting provider selection weigh environmental impact?
    Environmental impact is part of the choice, not an afterthought.
  2. Can the facility show a recorded example of this influencing a choice?
    A recorded example of environmental impact changing a decision.
  3. Is data storage reviewed for efficiency?
    Retained data that is not needed adds cost, energy use and exposure.

23.15 The Provider Considers Its Reduction of Patient Travel Impact

STANDARD

The provider recognises and, where meaningful, documents the environmental benefit telemedicine delivers by reducing patient travel — not an unexamined assumption of benefit with no attention to whether this is communicated or substantiated.

VERIFICATION QUESTIONS

  1. Does the provider recognise telemedicine's travel-reduction benefit?
    A benefit that is not measured cannot be reported or improved.
  2. Is this benefit communicated to patients where appropriate?
    Patients should be told where it is relevant to their choice.
  3. Does this recognition inform scope decisions?
    A recorded benefit should shape the service, not sit in a report.

23.16 Staff Are Engaged in Sustainability Practice

STANDARD

Staff understand and participate in the provider's sustainability practices — not a policy known only to leadership with no staff awareness or input.

VERIFICATION QUESTIONS

  1. Can staff describe a sustainability practice?
    Staff can describe at least one practice in their own words.
  2. Is staff input sought?
    Practice that staff have not been asked about is hard to sustain.
  3. Does communication reach remote or distributed staff?
    Staff who work away from a central office are easily missed.

23.17 Sustainability Commitments Are Reviewed, Not Static

STANDARD

The provider's sustainability goals and practices are reviewed and updated as circumstances change — not a document written once and never examined for whether it still reflects actual practice.

VERIFICATION QUESTIONS

  1. Are goals reviewed?
    Goals not reviewed do not reflect current practice.
  2. Can the facility show a recorded example of a goal being revised?
    A review that never changes a goal is not testing it.
  3. Is responsibility assigned?
    Goals with no owner are not delivered.

23.18 Patient Identity Is Confirmed at Every Remote Consultation

CORE

The identity of the patient is confirmed at the start of every remote consultation, and the clinician confirms who else is present and whether the consultation is private.

VERIFICATION QUESTIONS

  1. Is the patient's identity confirmed at the start of each remote consultation by a documented method?
    A consultation with the wrong person is a serious breach.
  2. Does the clinician confirm who else is present, and that the patient consents to them being there?
    A third party in the room can change what the patient says.
  3. Is the consultation private, and is the clinician able to confirm that privacy at the start?
    Privacy is required for safe and honest disclosure.

23.19 Informed Consent for Remote Care Is Recorded

CORE

The patient receives information about the limits of remote care, including when an in-person examination is needed, and gives consent to remote care, recorded before the consultation.

VERIFICATION QUESTIONS

  1. Does the patient receive information on what remote care can and cannot do before the first consultation?
    A patient who does not know the limits may rely on care that cannot meet their need.
  2. Is consent to remote care recorded before the consultation, and can the patient withdraw it?
    Consent given without information is not informed.
  3. Is the patient told when an in-person examination is needed, and is the referral recorded?
    A condition that needs examination must not stay remote.

23.20 Prescribing at a Distance Follows a Safe Process

CORE

Medicines prescribed during remote consultation are prescribed only where the clinician has enough information to do so safely, with checks for allergies, interactions and the patient's current medicines, and the prescription is recorded.

VERIFICATION QUESTIONS

  1. Does the clinician check the patient's allergies, current medicines and relevant history before prescribing remotely?
    A prescription without these checks is a known route to harm.
  2. Is each remote prescription recorded with the reason, the dose and the review date?
    A prescription that cannot be reviewed cannot be safely continued.
  3. Are controlled and high-risk medicines excluded from remote prescribing unless the local rules allow them?
    Some medicines require an examination before they are prescribed.

23.21 Clinical Records From Remote Consultations Are Complete

CORE

Each remote consultation produces a clinical record that is complete, accessible to the clinician responsible for the patient, and stored under the facility's record-keeping rules.

VERIFICATION QUESTIONS

  1. Is a clinical record made for each remote consultation, including the advice given and any follow-up?
    A consultation without a record cannot be followed up.
  2. Can the clinician responsible for the patient access the record in time for their next contact?
    A record that cannot be found is no record.
  3. Are remote consultation records stored under the same retention rules as other clinical records?
    Consistent retention prevents records being lost or kept too long.

23.22 Technical Failure During a Consultation Has a Safe Route

CORE

When a remote consultation fails because of a technical problem, a clear route exists for the patient to be contacted, reviewed or redirected, so that the patient's care is not left incomplete.

VERIFICATION QUESTIONS

  1. Is there a defined route for completing or continuing a consultation that fails technically?
    A dropped call with an unresolved problem is a patient left without care.
  2. Does the clinician record the outcome of an interrupted consultation, and is the patient contacted where needed?
    An interrupted consultation is an open clinical event.
  3. Are technical failures recorded, so that patterns can be identified and fixed?
    A recurring failure is a safety risk that must be tracked. ————————————————————

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