Coronavirus prompts Ministry of Health and Family Welfare to notify Telemedicine Guidelines – By Swati Agrawal

Swati Agrawal is a diversity and inclusion activist. She lives with her two cats, and Fibromyalgia and Bipolar Disorder! She tries to spread awareness about invisible illnesses and mental health conditions and advocate for the rights of the patients. She has also started a support group for Fibromyalgia patients in India.

Telemedicine involves provision of e-prescriptions, e-consultations and other health services using information and communications technology such as emails, voice calls and video calls. On 25 March 2020, the Ministry of Health and Family Welfare notified the first Telemedicine Guidelines of India to guide Registered Medical Practitioners in providing telemedicine services. This announcement came in wake of COVID 19 due to which physical distancing is being mandated. In-person face-to-face consultations are riskier for doctors and patients. Although the guidelines had been in the process for nearly a decade, they were notified recently.

Through these guidelines, people would be able to avail many health services from the ease of their homes. Hopefully, these guidelines would continue even after the COVID-19 situation is resolved. In a country like India where areas outside major cities have very less doctor-patient ratio, the Telemedicine Guidelines are a boon. They are also very useful for patients with chronic illnesses and disabilities who may have limited mobility.

Introduction to Telemedicine under the Guidelines

The Telemedicine Guidelines describe Telemedicine as delivery of health care services from a distance using information and communication technologies. It has adopted the definition from World Health Organisation.

Only a Registered Medical Practitioner (RMP) can provide telemedicine services. RMP is a person who is enrolled in the State Medical Register or the Indian Medical Register under the Indian Medical Council Act 1956.

Telemedicine would not include evaluation and continuing education of health-care workers, consultations outside the jurisdiction of India and digital technology to conduct surgical or invasive procedures remotely. Moreover, for emergency, telemedicine should be avoided. If not avoidable, then the patient should be advised to consult in-patient with an RMP at the earliest.

RMP will decide if Telemedicine is sufficient or in-person consultation is needed.

E-Consultations

The patients can use the telemedicine for first consultation for diagnosis and treatment of her condition or for health education and counseling. They can also used telemedicine for follow-up consultations with the same RMP.

Consultations can be between the patients or the caregiver and RMP. They can also be between an RMP and another RMP such as when a general doctor seeks advice of a specialist. Also, a health worker such as nurses can facilitate a consultation between a patient and an RMP.

First consult means that the patient is consulting with that RMP for the first time. If 6 months have passed since the previous consultation or consultation is for another disease, then it is again considered as first consultation. Follow-up consultation is when the patient is consulting with the same RMP for the same disease without any new symptoms within six months of last consultation.

Caregiver is a family member or any other person authorised by the patient to represent the patient. Consult between caregiver and RMP is possible without the patient being present in two cases:

• When the patient is a minor or incapacitated.
• Caregiver has a formal authorisation or verified document and/or has been verified by patient in a previous in-person consult. The patient should have given explicit consent in that case.

Guidelines also give rules for teleconsultation facilitated by a health worker with a RMP or by a RMP with another RMP.

E-Prescriptions

Prescription is only allowed after proper diagnosis/provisional diagnosis. The guidelines clearly prescribe which medicines can be prescribed and when.

List O contain medicines that are often available over the counter such as paracetamol, ORS etc. and those deemed necessary during public health emergencies. They can be prescribed through any mode of teleconsultation

List A are safe medicines with low possibility of abuse. They can be prescribed through first consultation that is a video consultation or during a follow-up consultation.

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

Medicines listed in Schedule X of Drugs and Cosmetics Act and Rules or any Narcotic and Psychotropic substance listed in the Narcotic Drugs and Psychotropic Substances, Act, 1985 cannot be prescribed through telemedicine.

RMP shall provide photo, scan, digital copy of the e-Prescription to the patient via email or any messaging platform. Sample format has been provided in the guidelines for it.

Rules Applicable to Telemedicines

Telemedicine will be governed by laws and same professional and ethical norms and standards as in-patient treatments. Misconduct will be as per prevailing laws.

• Patient and the RMP need to know each other’s identity. RMP should ascertain patient’s name, age, address etc. and may ask for age proof/registered ID/any other identification. RMP needs to explicitly ask the age of the patient. RMP would begin the consultation with his name and qualifications. His registration number should be displayed.
• If the patient initiates telemedicine consultation then consent is implied. If initiated by caregiver, health worker or RMP then explicit consent is needed. It can be recoded in any form such as email, text, voice etc. The patient may discontinue the teleconsultation at any time.
• RMP is required to maintain confidentiality. The Guidelines are very strict about not revealing any sensitive information about the patient.
• Records: RMP shall maintain all patient records including case history, investigation reports, images, etc. as appropriate. RMP should provide a receipt for the telemedicine.
• Minors: Minors are people below 17 years of age. Telemedicine would be allowed only if they are along with an adult. Adult’s identity needs to be ascertained.
• Techonology Platforms: Technology platforms shall ensure that the consumers are consulting with duly registered RMPs. They will provide the name, qualification and registration number, contact details of every RMP listed on the platform. They cannot rely on AI and machine learning based responses or consultation. They should have proper mechanism for clearing doubts and for grievances.

These Guidelines will go a long way in making medical services more accessibly, affordable and equitable.

PLEASE NOTE THAT THIS DOCUMENT IS JUST FOR EASE OF REFERENCE AND DOES NOT PROVIDE ANY MEDICAL OR LEGAL ADVICE.
For more details please refer to the official guidelines here: https://www.mohfw.gov.in/pdf/Telemedicine.pdf