Note On telemedicine Practice Guidelines 2020

1. Background 

In the present situation where stress on health care system is at peak, Telemedicine becomes key to reduce the stress on health care systems. In layman terms, it promotes timely access and enhances services which may not be otherwise available (say logistics or transportation issue). Telemedicine has been defined by World Health Organization as, delivery of health-care services by health care professionals using technology for information and communication purposes. Such information may be communicated for diagnosis, treatment and prevention of disease and injuries, research and evaluation etc. 

In India, where due to large geographical distances and limited resources, particularly for rural patients, telemedicine can be an optimal solution. The advantages of telemedicine are viz., (i) saving of cost and efforts, (ii) likelihood of maintenance of record and information, (iii) legal protection, (iv) eliminating transmission of contagious disease particularly during outbreaks such as COVID-19 and (v) providing extra hands to other patients which demand physical care.   

The Guidelines have been issued in absence of any legislation or guidelines on the practise of Telemedicine. In addition, the 2018 judgment by the Hon’ble Bombay High Court created ambiguity and uncertainty about the place and legitimacy of Telemedicine in absence of framework. In this backdrop, the Ministry of Health and Family welfare issued the aforesaid Guidelines in partnership with NITI Ayog. 

The Guidelines note that certain countries have specific legislation, whereas some countries follow non-legislative measures such as guidelines. 

Object 

The Guidelines have been issued to provide practical advice to doctors so that doctors and health workers are encouraged to promote the use of Telemedicine. The important objects of the Guidelines are as mentioned below:  

• providing norms and protocols relating to physician-patient relationship; 
• issues of liability and negligence; 
• evaluation, management and treatment; 
• informed consent; 
• continuity of care; 
• referrals for emergency services, 
• medical records; 
• privacy and security of patient records and exchange of information; 
• health education and counselling.  

Another object of Guidelines is ensure that Telemedicine cannot be misused. It acknowledges that it has some risks, drawbacks and limitations, which can be mitigated through appropriate training, enforcement of standards, protocols and guidelines. These guidelines shall be used in conjunction with the other national clinical standards, protocols, policies and procedures. 

1. Telemedicine: Definitions, Scope and Telemedicine Applications 

Definition 

Scope 

The Guidelines shall cover the norms and standards for RMP to consult patients via Telemedicine, RMPs registered under IMC Act, Telemedicine including all the channel of communication with the patient that leverage Information Technology platforms, including Voice, Audio, Text & Digital Data exchange. 

The Guidelines are specifically excluded for: 

• 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; 
• consultations provided outside the jurisdiction of India. 

Online course of practice on Telemedicine 

It recommends the RMPs who intend to practice Telemedicine, to get well versed and familiar with new Guidelines, limitations and process of Telemedicine practice. Further, an online program will be developed and made available by the Board of Governors in supersession of Medical Council of India. 

All RMPs shall be obligated to complete the mandatory online course within 3 years of notification of these guidelines if they intend to provide consultation via Telemedicine. Thereafter, undergoing and qualifying such a course, as prescribed, will be essential prior to registration of a medical practitioner. 

Applications for Telemedicine 

The Guidelines provide that RMPs may use any tool suitable for carrying out technology-based patient consultation. It could be connected through a telephone, video, devices connected over LAN, WAN, Internet, mobile or landline phones, Chat Platforms like WhatsApp, Facebook Messenger etc., or Mobile App or internet based digital platforms for telemedicine or data transmission systems like Skype/ email/ fax etc. The Guidelines provide that irrespective of the tool of communication used, the core principles of telemedicine practice remain the same. 

The Guidelines classify Telemedicine into four basic types, as per mode of communication, timing of the information transmitted, the purpose of the consultation and the interaction between the individuals involved such as RMP-to-patient / caregiver, or RMP to RMP. 

Mode of Communication 

• Video (Telemedicine facility, Apps, Video on chat platforms, Skype/Facetime etc.) 
• Audio (Phone, VOIP, Apps etc.) 
• Text Based: 

• chat based applications (specialized telemedicine smartphone Apps, Websites, other internet-based systems etc.) 
• General messaging/ text/ chat platforms (WhatsApp, Google Hangouts, Facebook 
• Messenger etc.) 
• Email/ Fax 

Strengths and Limitations on various modes of communication 

This part of Guidelines deals with the advantages and disadvantages classified into 3 primary modes i.e. Audio, Video or Text. 

The information contained in this article is not legal advice or legal opinion. The contents recorded in the said document are for informational purposes only and should not be used for commercial purposes. Acuity Law LLP disclaims all liability to any person for any loss or damage caused by errors or omissions, whether arising from negligence, accident, or any other cause.