Summary of Telemedicine Practice Guidelines in India
Hello All,
We hope you are safe and doing well.
Just three days after PM Narendra Modi asked the country to follow Junta Curfew, the Ministry of health and family welfare released guidelines for telemedicine in India. This document finally clarified the stance of the Indian government on teleconsulting practices. This article helps you understand those guidelines in brief.
Let us start by understanding what exactly is meant by telemedicine. According to the guidelines released telemedicine can be defined as ‘The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for the diagnosis, treatment, and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities.’
What does this mean for doctors?
Doctors can consult all patients over the phone or other digital mediums. Doctors can use teleconsulting for prescribing medicines, providing counseling, and imparting health education.
What does this mean for patients?
The doctor-patient ratio of India is not very high. There were many inhibitions about teleconsulting among Indian patients. Due to the guidelines, patients can cross-check the credentials of doctors. Also, patients need not worry about the data they share with doctors
What does the policy say?
- Doctors could choose the mode of communication as per their convenience
- Both patients and doctors should be able to identify and verify other parties. The doctor’s registration number should be prominent during any communication between patient and doctor
- Doctors should be the judge about whether teleconsulting would be fine or physical examination is required
- The doctor should maintain the same level of care for patients whom they have treated via teleconsulting or for patients who came for physical examination
- Consulting fees for an in-person patient and a teleconsulting patient should be the same. Each doctor should know the limitation and doctor blaming teleconsulting won’t be considered as a defense in case of medical negligence.
- Patient’s consent is implied if they start the consultation. If the health worker starts consultation, then the explicit consent of the patient is required. The doctor needs to maintain that consent. Both patients and doctor have the right to stop teleconsulting at any point in time
- If the patient is a minor or an incapacitated patient, then teleconsulting should happen via a caregiver. The doctor should make sure of the authority and identification of the caregiver
- The guideline recommends a prescription format, but it’s not necessary. It is necessary to give a digital copy or e-prescription to the patient. You can give to a pharmacy only after having explicit consent from the patient
- AI, IoT, data science-based decision support systems, etc. can assist and support a doctor on patient evaluation, diagnosis, or management, but the final prescription or counseling has to be directly delivered by the doctor
- A health worker can help the doctor in facilitating a teleconsultation for patients. They can take a medical history, examine the picture & convey the findings
Some of the Dos and Don’t for doctors
Dos for a doctor
- Patient identification is necessary for the first consultation. It is not mandatory for follow-up visits, although. Doctors need to identify themselves in every consultation
- Doctors should show his/her registration number at every interaction that the doctor has with the patient.
- A doctor must develop, maintain and preserve all the records of patients they have treated via teleconsulting
Don’ts for a doctor
- Doctors shouldn’t continue with teleconsulting if he/she feels that the information provided by them is not enough
- The doctor shouldn’t disclose or transfer any patient’s data without the written consent of the patient
- Doctors can’t deny emergency teleconsulting but could only limit it to immediate assistance or first aid
Rules for prescribing medicine via telemedicine
The guidelines don’t allow the doctors to prescribe any medicine freely over teleconsultation. Now, the doctor needs to make sure that he/she has adequate knowledge of the patient’s medical condition. Prescribing Medicines without an appropriate diagnosis/provisional diagnosis will amount to professional misconduct. Doctors should always ask about age before prescribing anything. Only OTCs are allowed if video consultation didn’t happen. The doctor may, however, prescribe ‘add-on’ medication to such patients to optimize the existing treatment through drugs if such existing treatment was prescribed in an in-person consultation less than six months ago. Also, Please note that there is no bar in prescribing emergency medications. If the patient is examined through video, then the doctor may prescribe medications other than OTC medicines described in List A of Appendix 5 of the Code of Conduct. It is important to note that no doctor is permitted to prescribe habit forming drugs or narcotic or psychotropic drugs through any medium of teleconsultation.
Link to policy guideline: https://www.mohfw.gov.in/pdf/Telemedicine.pdf
