What are the Telemedicine guidelines and why are they important?

Mohit Matta
Jun 18, 2020
8 min read

The healthcare market functions through several segments which are the hospitals, diagnostic facilities, medical and surgical equipment supplies, pharmaceuticals, medical insurance, and finally, telemedicine.

Quality health care infrastructure is the need of the hour and not everyone has access to the quality medical facilities!

The inadequate infrastructures consisting of roads and transport make it even more difficult to provide the needed health care in remote and rural areas and for the transport of patients properly.

Due to inaedequate medical infrastructure, people from rural areas and small cities come to developed cities or metro cities.

For instance, people residing in the surrounding cities near Indore had to rush to Indore for COVID-19 treatment which created a lot of problems not only for many people.

Telemedicine services have the potential to improve both the quality of and access to health care regardless of the geography of a particular place.

What is Telemedicine?

Believe it or not, guidance given by the doctors through phone calls has been prevalent for quite some time. But it took twenty years and a pandemic for these guidelines to get past the regulation and as a result these guidelines were issued on 25th March 2020.

The World Health Organization defines telemedicine as: “The delivery of health-care services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for the purposes of diagnosis, treatment, prevention of disease, and injuries, research and evaluation, and the continuing education of health-care workers, with the aim of advancing the health of individuals and communities.”

Telemedicine can also be understood as the distant delivery of health care and remote sharing of medical knowledge using telecommunication means by the Registered Medical Practitioners.

The aim of telemedicine is to improve the quality of healthcare and reduce its cost by faster communication of medical information between physicians and patients.

The principal advantage of Telemedicine is that the doctor and the patient need not be at the same place. Medical services can now be delivered to any location.

Telemedicine has basically changed the complete healthcare delivery dynamics in the interest of extending health services to all individuals and eliminating time and distance barriers.

There are a number of benefits of telemedicine. It increases timely access to appropriate interventions including faster access and access to services that may not otherwise be available.

Background:

In India, till now there was no legislation or guidelines on the practice of telemedicine, through video, phone, Internet-based platforms.

The earliest published record of the usage of telemedicine was in the first half of the 20th century when the ECG (Electrocardiogram) was transmitted over telephone lines.

Inventions such as the telephone and the electrical telegraph played an important role in fostering the telemedicine that as we know it.

Telemedicine started in India in the year 2000, with Apollo's Aragonda project in Andhra Pradesh.

There are around 400 telemedicine centers across India and approximately 50 specialty hospitals are linked to these.

Apart from this, there are around 100 tele-ECG centers supported by various specialty hospitals.

An estimated 0.15 million patients have been provided online consultation by various Government and private telemedicine centers.

A CPOE application substitutes physical medical records with an electronic template where the physicians can issue orders for therapy and procedures electronically, saving time in patient care.

These advanced technologies are helping in extending fast and to-the-point healthcare services and also enhancing the productivity and efficiency of healthcare practitioners.

What is the importance of Telemedicine?

In India, providing In-person healthcare is challenging especially during the COVID-19 outbreak, particularly given the large geographical distances and limited resources at our disposal.

One of the major advantages of telemedicine can be for the saving of cost and effort especially for the patients or people in rural areas, as they need not travel long distances for obtaining consultation and treatment.

Amidst this pandemic, telemedicine can provide an optimal solution for not just providing timely and faster access to health care facilities, but It would also reduce the travel costs, especially for the people belonging in rural areas.

Telemedicine can play a particularly important role in cases where there is no need for the patient to physically see the RMP (or other medical professional), e.g. for regular, routine check-ups or continuous monitoring. Telemedicine can reduce the burden on secondary hospitals.

Purpose:

The purpose of these guidelines is to give practical advice to the medical practitioners so that all services and models of care used by the health workers.

So that more and more medical practitioners are encouraged to consider the use of telemedicine as a part of normal practice.

These guidelines will assist the medical practitioners in pursuing a sound course of action to provide effective and safe medical care founded on current information, available resources, and patient needs to ensure patient and provider safety.

The key drivers for telemedicine can be:

Huge rural population - With almost 70 percent of India's population living in rural areas and 90-95 percent tertiary health centers located in metros / mini-metros, there is an enormous need for telemedicine projects, to reach out to the remotest of areas with healthcare services.
The Time-lag factor - The time-lag between the occurrence of medical need and delivery of the medical services, makes the requirement of telemedicine facilities even more imperative.
Cost-Effectiveness - With the increasing cost of healthcare services, telemedicine is an effective way of providing cost-effective care services by saving on travel and time.
Technological Innovations - new technological innovations are providing easy-to-use devices and applications thus reducing the call-for-expertise to operate and manage these devices.
Breaking Geographical Boundaries - telemedicine set-ups have broken distance barriers and have helped healthcare services to extend outreach to remote locations.
Knowledge enhancement - telemedicine will give an opportunity to the remote doctors to enhance their clinical knowledge over a period of time by having an expert opinion for patients.

Some challenges that may be faced by the telemedicine service providers are:

Technology integration, that is, successful interfacing of medical equipment and networking.
Hardware and software, connectivity issues, etc.
The patients or people might not have the instruments needed for diagnosis (checking blood pressure)
Availability of skilled manpower resources (both medical and non-medical) at remote locations
Data protection of patients and security issues
Cost-benefit of the project and of course the adequate patient traffic at the remote centers
Medical Practitioners will now have to be even more careful as the patients will have evidence in case of medical negligence.

Scope:

These guidelines are designed to serve as an aid and tool to enable the Registered Medical Practitioners to effectively leverage Telemedicine to enhance healthcare service.

The guidelines are meant for Registered Medical Practitioners under the Indian Medical Council Act Act, 1956.
The guidelines cover the norms and standards of the Registered Medical Practitioners to consult patients via telemedicine.
Telemedicine includes all channels of communication with the patient that leverage Information technology platforms, including Voice, Audio, Text & Digital Data exchange
The Insurance Regulatory Development Authority of India has also included the telemedicine in the basic claims policy.

Exclusions: The guidelines specifically explicitly exclude the following

Specifications for hardware or software, infrastructure building & maintenance
Data management systems involved; standards and interoperability
Use of digital technology to conduct surgical or invasive procedures remotely
Other aspects of telehealth such as research and evaluation and continuing education of health care workers
Does not provide for consultations outside the jurisdiction of India

As provided by the official guidelines the registered medical practitioners using telemedicine shall uphold the same professional and ethical norms and standards as applicable to traditional in-person care, within the intrinsic limitations of telemedicine.

An online program will be developed and made available by the Board of Governors in the supersession of the Medical Council of India.

All registered medical practitioners intending to provide online consultation need to complete a mandatory online course within 3 years of its notification.

Patient's Consent:

Patient consent is necessary for any telemedicine consultation. The consent can be Implied or explicit depending on the following situations

If the patient initiates the telemedicine consultation, then the consent is implied.
If a Health worker, registered medical practitioner, or a Caregiver initiates a Telemedicine consultation then explicit consent from the patient is required before providing medical assistance.
The registered medical practitioner shall also record the explicit consent given by the patient.
The consent so recorded shall be maintained in the patient's record
The consent can be recorded in any form be it a message, video, audio, email, etc. (e.g. of explicit consent “Yes, I consent to avail consultation via telemedicine” or any such communication in simple words).

Patient's Information:

The Registered Medical Practitioners shall gather sufficient medical information about the patient’s condition before making any professional judgment.

If the Registered Medical Practitioner feels that the information received is inadequate, then he/she can request for additional information from the patient.

If a physical examination is paramount for consultation, then the Registered Medical Practitioner should not proceed until a physical examination can be arranged through an in-person consultation.

The Registered Medical Practitioners shall maintain all patient records including case history, investigation reports, images, etc. as deem fit.

Prescribing Medicine:

Prescribing medications, via telemedicine consultation is at the professional discretion of the Registered Medical Practitioner.

It entails the same professional accountability as in the traditional in-person consult.

The Registered Medical Practitioner may prescribe medicines via telemedicine only when the Registered Medical Practitioner is satisfied that he/she has gathered adequate and relevant information about the patient’s medical condition and prescribed medicines are in the best interest of the patient.

Prescribing Medicines without an appropriate diagnosis/provisional diagnosis will amount to professional misconduct!

There are certain limitations on prescribing medicines on consultation via telemedicine depending upon the type of consultation and mode of consultation.

The categories of medicines that can be prescribed via teleconsultation will be as notified in consultation with the Central Government from time to time.

The categories of medicines that can be prescribed are listed below:

List O:

It will comprise those medicines which are safe to be prescribed through any mode of teleconsultation.

In essence, they would comprise of Medicines which are used for common conditions and are often available ‘over the medical stores.

Medicines that may be deemed necessary during public health emergencies.

List A:

These medications are those which can be prescribed during the first consult which is a video consultation and are being re-prescribed for re-fill, in case of follow-up.

List B:

Is a list of medication which can be prescribed to a patient who is undergoing follow-up consultation in addition to those which have been prescribed during an in-person consult for the same medical condition.

Prohibited List:

An RMP providing consultation via telemedicine cannot prescribe medicines that are listed in Schedule X of Drug and Cosmetic Act and Rules or any Narcotic and Psychotropic substance listed in the Narcotic Drugs and Psychotropic Substances, Act, 1985.

As, these medicines have a high potential of abuse and could harm the patient or the society at large if used improperly.

If a doctor has prescribed medicines, then he/she shall issue a prescription as per the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations and shall not contravene the provisions of the Drugs and Cosmetics Act and Rule.

The doctor shall also make sure that he/she provides a photo/scanned/digital copy of the signed prescription to the patient.

Medical Ethics and Data Privacy:

Principles of medical ethics, including professional norms for protecting patient privacy and confidentiality as per The Indian Medical Council Act shall be binding and must be upheld and practiced.

Misconduct:

It is specifically noted that in addition to all general requirements under the MCI Act for professional conduct, ethics, etc while using telemedicine all actions that wilfully compromise patient care or privacy and confidentiality, or violate any prevailing law are explicitly not permissible.

Conclusion:

Telemedicine can not be the answer to all the medical ailments faced by the patients but can be of great use in addressing a vast range of problems.

A doctor can easily consult if needed to patient who is far away from him/her and these guidelines basically provide the dos and dont's for the doctors while providing telemedicine to a patient.

Despite having huge potential the telemedicine has not gained the traction it was supposed to due to lack of awareness and acceptance of the new reforms by both public and private professionals is holding us back!

I hope this post provides a clear idea of what is telemedicine and what is the importance of telemedicine.

The healthcare market functions through several segments which are the hospitals, diagnostic facilities, medical and surgical equipment supplies, pharmaceuticals, medical insurance, and finally, telemedicine.

Quality health care infrastructure is the need of the hour and not everyone has access to the quality medical facilities!

The inadequate infrastructures consisting of roads and transport make it even more difficult to provide the needed health care in remote and rural areas and for the transport of patients properly.

Due to inaedequate medical infrastructure, people from rural areas and small cities come to developed cities or metro cities.

For instance, people residing in the surrounding cities near Indore had to rush to Indore for COVID-19 treatment which created a lot of problems not only for many people.

Telemedicine services have the potential to improve both the quality of and access to health care regardless of the geography of a particular place.

What is Telemedicine?

Believe it or not, guidance given by the doctors through phone calls has been prevalent for quite some time. But it took twenty years and a pandemic for these guidelines to get past the regulation and as a result these guidelines were issued on 25th March 2020.

Telemedicine can also be understood as the distant delivery of health care and remote sharing of medical knowledge using telecommunication means by the Registered Medical Practitioners.

The aim of telemedicine is to improve the quality of healthcare and reduce its cost by faster communication of medical information between physicians and patients.

The principal advantage of Telemedicine is that the doctor and the patient need not be at the same place. Medical services can now be delivered to any location.

Telemedicine has basically changed the complete healthcare delivery dynamics in the interest of extending health services to all individuals and eliminating time and distance barriers.

There are a number of benefits of telemedicine. It increases timely access to appropriate interventions including faster access and access to services that may not otherwise be available.

Background:

In India, till now there was no legislation or guidelines on the practice of telemedicine, through video, phone, Internet-based platforms.

The earliest published record of the usage of telemedicine was in the first half of the 20th century when the ECG (Electrocardiogram) was transmitted over telephone lines.

Inventions such as the telephone and the electrical telegraph played an important role in fostering the telemedicine that as we know it.

Telemedicine started in India in the year 2000, with Apollo's Aragonda project in Andhra Pradesh.

There are around 400 telemedicine centers across India and approximately 50 specialty hospitals are linked to these.

Apart from this, there are around 100 tele-ECG centers supported by various specialty hospitals.

An estimated 0.15 million patients have been provided online consultation by various Government and private telemedicine centers.

A CPOE application substitutes physical medical records with an electronic template where the physicians can issue orders for therapy and procedures electronically, saving time in patient care.

These advanced technologies are helping in extending fast and to-the-point healthcare services and also enhancing the productivity and efficiency of healthcare practitioners.

What is the importance of Telemedicine?

In India, providing In-person healthcare is challenging especially during the COVID-19 outbreak, particularly given the large geographical distances and limited resources at our disposal.

One of the major advantages of telemedicine can be for the saving of cost and effort especially for the patients or people in rural areas, as they need not travel long distances for obtaining consultation and treatment.

Amidst this pandemic, telemedicine can provide an optimal solution for not just providing timely and faster access to health care facilities, but It would also reduce the travel costs, especially for the people belonging in rural areas.

Telemedicine can play a particularly important role in cases where there is no need for the patient to physically see the RMP (or other medical professional), e.g. for regular, routine check-ups or continuous monitoring. Telemedicine can reduce the burden on secondary hospitals.

Purpose:

The purpose of these guidelines is to give practical advice to the medical practitioners so that all services and models of care used by the health workers.

So that more and more medical practitioners are encouraged to consider the use of telemedicine as a part of normal practice.

These guidelines will assist the medical practitioners in pursuing a sound course of action to provide effective and safe medical care founded on current information, available resources, and patient needs to ensure patient and provider safety.

The key drivers for telemedicine can be:

Some challenges that may be faced by the telemedicine service providers are:

Scope:

Exclusions: The guidelines specifically explicitly exclude the following

As provided by the official guidelines the registered medical practitioners using telemedicine shall uphold the same professional and ethical norms and standards as applicable to traditional in-person care, within the intrinsic limitations of telemedicine.

An online program will be developed and made available by the Board of Governors in the supersession of the Medical Council of India.

All registered medical practitioners intending to provide online consultation need to complete a mandatory online course within 3 years of its notification.

Patient's Consent:

Patient consent is necessary for any telemedicine consultation. The consent can be Implied or explicit depending on the following situations

Patient's Information:

The Registered Medical Practitioners shall gather sufficient medical information about the patient’s condition before making any professional judgment.

If the Registered Medical Practitioner feels that the information received is inadequate, then he/she can request for additional information from the patient.

If a physical examination is paramount for consultation, then the Registered Medical Practitioner should not proceed until a physical examination can be arranged through an in-person consultation.

The Registered Medical Practitioners shall maintain all patient records including case history, investigation reports, images, etc. as deem fit.

Prescribing Medicine:

Prescribing medications, via telemedicine consultation is at the professional discretion of the Registered Medical Practitioner.

It entails the same professional accountability as in the traditional in-person consult.

Prescribing Medicines without an appropriate diagnosis/provisional diagnosis will amount to professional misconduct!

There are certain limitations on prescribing medicines on consultation via telemedicine depending upon the type of consultation and mode of consultation.

The categories of medicines that can be prescribed via teleconsultation will be as notified in consultation with the Central Government from time to time.

The categories of medicines that can be prescribed are listed below:

List O:

It will comprise those medicines which are safe to be prescribed through any mode of teleconsultation.

In essence, they would comprise of Medicines which are used for common conditions and are often available ‘over the medical stores.

Medicines that may be deemed necessary during public health emergencies.

List A:

These medications are those which can be prescribed during the first consult which is a video consultation and are being re-prescribed for re-fill, in case of follow-up.

List B:

Is a list of medication which can be prescribed to a patient who is undergoing follow-up consultation in addition to those which have been prescribed during an in-person consult for the same medical condition.

Prohibited List:

An RMP providing consultation via telemedicine cannot prescribe medicines that are listed in Schedule X of Drug and Cosmetic Act and Rules or any Narcotic and Psychotropic substance listed in the Narcotic Drugs and Psychotropic Substances, Act, 1985.

As, these medicines have a high potential of abuse and could harm the patient or the society at large if used improperly.

If a doctor has prescribed medicines, then he/she shall issue a prescription as per the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations and shall not contravene the provisions of the Drugs and Cosmetics Act and Rule.

The doctor shall also make sure that he/she provides a photo/scanned/digital copy of the signed prescription to the patient.

Medical Ethics and Data Privacy:

Principles of medical ethics, including professional norms for protecting patient privacy and confidentiality as per The Indian Medical Council Act shall be binding and must be upheld and practiced.

Misconduct:

It is specifically noted that in addition to all general requirements under the MCI Act for professional conduct, ethics, etc while using telemedicine all actions that wilfully compromise patient care or privacy and confidentiality, or violate any prevailing law are explicitly not permissible.

Conclusion:

Telemedicine can not be the answer to all the medical ailments faced by the patients but can be of great use in addressing a vast range of problems.

A doctor can easily consult if needed to patient who is far away from him/her and these guidelines basically provide the dos and dont's for the doctors while providing telemedicine to a patient.

Despite having huge potential the telemedicine has not gained the traction it was supposed to due to lack of awareness and acceptance of the new reforms by both public and private professionals is holding us back!

I hope this post provides a clear idea of what is telemedicine and what is the importance of telemedicine.

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