The Hearing Professional Conduct and Complaints Body (HPCCB) has warned against live streaming and/or audiovisual recording of patient appointments for training purposes, claiming these actions raise significant ethical and legal concerns.
The body said it was “unethical, and illegal in most cases” to record or view a client appointment without the client’s informed consent. It was also a potential breach of the Code of Conduct for audiologists and audiometrists.
HPCCB is an independent organisation to promote ethical hearing service practice and handle complaints against audiologists and audiometrists. It began operating in October 2024 and replaces the previous AudA and ACAud Inc. HAASA Ethics Review Committees (ERCs).
The new body said that during 2024-2025, it had received anonymous contacts from audiologists and audiometrists who were concerned about the ethics of live streaming and/or audiovisual recording of client appointments by their employer.
Following the reports, the HCPPB released a document on the ethics of live streaming and recording of appointments for training purposes.
“The audiologists and audiometrists describe that these live streaming and/or recordings are to review the hearing aid device recommendations and subsequent sales the hearing practitioner makes by their manager, training, sales and/or marketing teams,” the body stated.
“In some cases, we have heard that the audiologist or audiometrist is asked by the employer to mislead the patient and say that those observing the appointment via the live stream, or viewing the recording later, are also practitioners so that the client ‘feels more comfortable’.
“We have also heard that the hearing practitioners were not aware in some cases that the appointments were being recorded and/or live streamed by their employer, only finding out inadvertently or being told by their employer later.”
The HPCCB said this activity raised several significant ethical and legal concerns, including:
- Clients not being aware of who has access to their personal and health information.
- Recording of clients without their informed consent.
- The intentional deceit of clients as to the role and purpose of others who can view their appointment recording or livestream.
- A potential lack of understanding that appointments with audiologists and audiometrists are health consultations and the information shared in these is therefore highly regulated.
Illegal ‘in most cases’
“It is unethical, and illegal in most cases, to record or view a client appointment without the client’s informed consent,” the HPCCB said.
“This means that before the client consents to an appointment being viewed or recorded, the client must understand:
- how the software used to livestream/record is secure, where the data is stored, and who retains ownership of the data,
- who will be able to view the recording and/or live stream and for what purpose(s),
- how any recording will be securely stored as part of their clinical/health record, and
- how they can receive a copy of the recording.”
Potential breach of code of conduct
The body said if it received a complaint about an audiologist or audiometrist recording or allowing others to view an appointment without the client’s informed consent, it would likely consider it a potential breach of the following requirements under the Code of Conduct for audiologists and audiometrists:
- Requirement 3.1 Prior to delivering a hearing service, members must ensure that consent appropriate to the hearing service has been obtained and that the nature of the consent complies with the laws of the jurisdiction.
- 16.1. Members must comply with all relevant federal and state or territory laws and regulations. This includes complying with any contracts with, and related policies of, government funding agencies including, but not limited to, Medicare, the Hearing Services Program, the National Disability Insurance Agency, and the Department of Veterans’ Affairs.
- 16.2. Without limiting subclause 16.1, members must comply with the relevant state, territory and federal criminal laws, laws regarding consumer protections, and privacy laws that apply to clients’ health information, including the Privacy Act 1988 (Cth) and the relevant state or territory legislation.
- 17.1. Members must maintain accurate, legible and up-to-date clinical records for each client consultation and ensure that these are held securely and not subject to unauthorised access.
- 17.2. Members must retain clinical records for a period of time as determined by relevant legal and legislative requirements.
Guidance on recording
The body said guidance had been developed on the recording of appointments/consultations by health professionals, health services and/or clients.
“This has largely focussed on the recording of appointments for the purposes of improving the client’s understanding and/or recall of the information provided during the appointment, to increase health professional safety, and for medico-legal reasons in the hope it will resolve disputes more easily,” it said.
The guidance is a 2022 briefing document1 by University of Melbourne law school researchers Dr Megan Prictor and Ms Nikka Milani. It said consultation recording exists in a complex regulatory environment in Australia.
The paper referred to audio recording of a health appointment, which the HPCCB said applied to client appointments with audiologists or audiometrists.
The HPCCB said it was unable to find any legal guidance on the recording of health appointments for the purposes of sales or marketing strategy development or sales-based performance reviews.
It said key messages from legal and ethical guidance to health professionals on recording appointments included that:
- In general, under the law, and ethically, you must get your client’s consent before recording their appointment (2)(3)(4).
- The recording forms part of the client’s clinical/health record. This means you must follow the relevant legislation and guidelines about storing the recording securely and allowing others to access/view the recording (2)(3)(4).
- The client should preferably be given a copy of the recording and a request to access the recording by the client cannot be denied in most cases as it forms part of their clinical/health record (2)(3).
- You must consider how the software used to record the appointment stores/transfers the information securely, and whether the software developers have any rights in the recording (2).
Informed consent document
The HPCCB has further unpacked the topic of informed consent in delivering service in guidance on its website entitled, ‘Informed consent: More than just a signature on a piece of paper.
“In this guidance we address the belief held by some audiologists and audiometrists that they have obtained consent if the client has signed a document agreeing to the service to be provided,” the body states.
“However, the signature itself is not the “consent”. Consent is the point in shared decision-making where the client and audiologist reach a mutual understanding and agreement about the services to be provided.”
Practising without clinical certification a potential breach of conduct code
The body also released a document on Practising without clinical certification following some confusion about the issue.
It said it had heard some audiologists and audiometrists say they do do not need to be clinically certified if they are only providing services to clients who are privately funded (i.e. clients with no Hearing Services Program, Medicare, WorkCover, TAC or private insurance funding).
“This is not the case. Clinical certification is about protecting the public from harm,” the body said. “Clinical certification also supports audiologists and audiometrists to meet the requirements of the Code of Conduct.
“Practising (i.e. providing services to clients) without clinical certification is a potential breach of the Code of Conduct for audiologists and audiometrists.”
The HCPPB said practitioners concerned about employers’ recording of patients could call or email Dr Sandra South, the HPCCB ethics officer, on ethicsofficer@hpccb.org.au or phone 1300 048 828 for a confidential, discussion which can be anonymous.
References:
(1) Prictor, M. and N. Milani, 2022. Consultation recording in healthcare settings: an overview. Melbourne Law School, The University of Melbourne.
(2) The University of Melbourne and the Peter MacCallum Cancer Centre, 2022. Audio Recording Healthcare Appointments: Information for Healthcare Professionals about the Law.
(3) Medical Indemnity Protection Society, 2020. Managing Patient Recordings: A Guide.
(4) Prictor, M., C. Johnston, and A. Hyatt, 2021. Overt and covert recordings of health care consultations in Australia: some legal considerations. Medical Journal of Australia , 214(3): 119-123.
