Telemedicine Guidelines in India: What you need to know? [Updated May 2020]

telemedicine guidelines

In this article:

  • Permitted formats for telemedicine
  • Latest guidelines for telemedicine in India, updated on 25th March 2020
  • Prescription limitations for audio, video & chat consultations
  • Doctors’ rights in telemedicine (medico-legal)
  • Tips for successful delivery of online consultations

Telemedicine has been around for years but is receiving a lot of attention recently. It allows health care professionals to evaluate, diagnose and treat patients remotely using technology, exactly what the healthcare fraternity requires during the ongoing pandemic crisis. The Medical Council of India along with The NITI Aayog released updated guidelines for telemedicine in India on 25th March 2020. It is a welcome move as the legislation and guidelines around online consultation were not very clear earlier. This article simplifies the intricacies of these highly dynamic and well-timed guidelines that are bound to revolutionize healthcare delivery in India.

In order to follow the most sought-after precaution of this global pandemic, social distancing, you can now start practicing telemedicine for the patients through four basic modes of communication

  1. Text-based or chat: It is asynchronous since there is a time lag between the responses from both ends i.e. doctor & patients. It includes SMS, WhatsApp chat, e-mail, and other messaging platforms.
  2. Audio-based: such as phone call or WhatsApp audio call. This is synchronous and provides more cues to the doctor as compared to the passive messaging or chat mode.
  3. Video-based: such as WhatsApp video call and Skype call. This is way more advantageous as compared to audio-only as a doctor can carry out visual inspection of the patient’s condition and gets stronger cues.
  4. Many platforms provide an amalgamation of two or more of the above-mentioned consultation modes. Typically, these are included in specialized Android/ iOS apps on smartphones and some browser-based apps too.

Now that you are well versed in the modes of telemedicine, let us look at some key guidelines that you must keep in mind while providing online consultations.

 

Step 1: When a patient approaches you

The first and foremost point that you should keep in mind when a patient approaches you for online consultation is to evaluate the overall well-being of the patient. If the patient seems under the influence of alcohol or drugs, is not in the right mental state, or requires emergency attention then do not begin telemedicine and ask the patient to seek in-person consultation.

Another important step is taking explicit consent for telemedicine using a simple text such as “I consent and understand the limitations of telemedicine”. Further, it is advisable that you record the demographic details and/or an ID number such as Aadhar or PAN. This becomes important if you must identify the patient for follow-up consultations or any medico-legal issue. Do not forget to take the details of the accompanying parents and/or guardians in the case of minor patients.

Also, make sure that the patient is in proper surroundings such as no background noise and adequate lighting so that you can listen and see the patient properly and do optimum diagnosis and treatment. If necessary, you can ask the caregiver to join the discussion (only if the patient is comfortable). Similarly, you can ask the caregiver to leave the consultation at any time, on any of the telemedicine platforms, if you need to consult the patient in private.

 

Step 2: Understanding medical history and performing diagnosis in Telemedicine

It is advisable to record the entire medical history in telemedicine to avoid any medical liabilities in the future. It is advisable to write the medical history in Rx itself, as it will be easier for you to store and it can be easily shared with the patient too. Otherwise, write it in your medical notes and make sure to keep it safe with you for future reference.

Note: You can discontinue the consultation if the patient does not give proper medical history. Politely ask them for more information and if they do not comply or are not able to answer then ask them to visit you or any other medical practitioner in-person.

During the diagnosis, it is preferred that you make use of other cues (beyond what the patient is saying), focus on their tone, expressions or any other uneasiness. As mentioned earlier, make sure that the patient is in proper surroundings such as no background noise, adequate lighting, so you can listen and see, and deliver successful diagnosis and treatment.

 

Step 3: Writing Prescription in Telemedicine

While writing a prescription in Telemedicine write the word “Telemedicine” or “Teleconsultation” at the top of prescription. This will set the right expectations for all the stakeholders including patient, referred physician (if any), radiologists, etc. while safeguarding you on the legal front.

Considering the ongoing crisis, the authorities have put some limitations on the kind of medicines that can be prescribed to the patients via telemedicine. This list is expected to be updated over the next few months and years. It is important to know what can and cannot be prescribed using telemedicine:

  • List O: Medicines that are used for common conditions and are often available ‘over the counter’ or OTC. You can prescribe drugs from this list via any mode of telemedicine i.e. phone, video or chat. The list includes medicines that could be deemed necessary during public health emergencies.
  • List A: The scope of prescription for drugs under List A is limited to only video calls for the first consultation, but they can be re-prescribed or re-filled over any mode (audio, video or chat) for follow-up consultations.
  • List B: The doctor can prescribe medicines from List B only in case of follow-up consultations and not during the patient’s first online visit.
  • Prohibited List: You cannot prescribe drugs that have a high potential for abuse via telemedicine. This includes drugs under List X and narcotic drugs.

Related article: Frequently Asked Questions (FAQs) about OPDlift: For Doctors who wish to practice telemedicine on a compliant platform.

Reference: List of Schedule H drugs by the ministry of Health & family welfare, GoI

Apart from which class of medicine you can prescribe, it is important to pay attention to the mode of prescription. Refrain from typing the medicines’ names over an SMS or WhatsApp chat in any case. The simple and wise idea would be to write the prescription on your letter pad or a piece of blank paper (in which case, you are required to mention your medical registration number) along with the necessary details of the patient’s medical history, diagnosis, and the drugs or tests prescribed. Do not forget to self-attest the prescription document, either by physical or electronic means to avoid any kind of potential misconduct in the future.

It is important to act wisely to avoid future medico-legal complications, so please ensure that you preserve all records including conversations with the patients in a confidential, secure and technologically convenient manner. Remember to retain the history of the entire information exchange during telemedicine, for as long as necessary.

To start with the basics, if you are consulting patients over WhatsApp then start saving these prescriptions by creating a WhatsApp group with yourself so you can refer to those prescriptions in the future.

A quick tip: Follow these steps to create a WhatsApp group with yourself!

  1. Open WhatsApp
  2. Go to the menu (the menu from where you change your WhatsApp status)
  3. Select New group
  4. Give your group a name, for example, My Prescriptions
  5. Add one of your close friends or family member to the group
  6. Tap on Create group button to finish the group creation.

Alright, now you have a WhatsApp group that has only two members – you (as admin) and your friend or relative.

Now, it is time to remove your connection from this newly created WhatsApp group, because you don’t want anyone else to access your patient records. Exit them from your group and this will leave you as the only member of the group. The messages that you send to this group and now truly yours!

Step 4: Follow-ups & Referrals

It is important to refer the patient and immediately discontinue telemedicine if you feel that patient does not fall under the purview of your expertise. You can always refer the patient for an in-person consultation if you think that he/she will require detailed inspection that cannot be done over a phone or video call. It is your right to discontinue the consultation, by politely asking the patient to come for an in-person consultation to you or any other medical practitioner (Read more about Doctor’s Rights in Telemedicine in the next section).

The guidelines are designed to make it easier for doctors and patients to use telemedicine for follow-up consultations. This saves them considerable time and effort for commute and reduces their risk of infection considering the ongoing pandemic. The guidelines further encourage you to use telemedicine for follow-up consultations by relaxing the type of medicines that can be prescribed in case of a repeat patient visit, as compared to the first visit.

Doctor’s Rights, Duties and How to Stay Clear from Medico-Legal Issues:

If we have to say it in one sentence: Exercise your professional judgment and work in the best interest of the patients with no bad malice, at all times.

According to The Epidemic Diseases Act, 1897 “no suit or other legal proceeding shall lie against any person for anything done or in good faith intended to be done under this Act.”  This is particularly relevant given the COVID-19 situation which was declared a global pandemic by WHO on 11th March 2020. The Disaster Management Act of 2005 also states a similar wording. Therefore, you make sure that you continue to work in good faith for the betterment of the patients, and the laws will support you

  • A teleconsultation must ensure that the doctor sought the best available medical information from and about the patient. This is critical since in telemedicine you receive limited cues to confirm your diagnoses, as compared to in-person consultations. It is important to spend even more time than usual to properly understand patients’ medical history and symptoms and ask them as many follow-up queries as required. In the process, do not forget to document every minor and major detail while you practice telemedicine.
  • You can anytime switch the mode of communication and even disconnect if it goes beyond the normal therapeutic relationship. For instance, if the patient is under the influence of alcohol, drug, not in the right mental state, or adamant on getting a specific Rx drug then you have the right to discontinue the consultation. Depending on the situation, you can politely recommend the patients for an in-person or video consultation, but you will not be liable for any deficiency of service in this case.
  • Please note that surgical or invasive surgeries conducted remotely are not included in the preview of these guidelines currently. Also, telemedicine is not allowed if the doctor is located outside India. The primary goal of telemedicine is to improve treatment access to patients, so if your primary purpose is medical research then refrain from telemedicine.
  • There is also a mandatory online course that the doctor shall complete within 3 years of beginning to practice telemedicine. You can find more details about it here: https://tsi.org.in/
Telemedicine Guidlines in India - latest 25th March 2020 - OPDlift
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It becomes your duty to ensure your patients’ and your own safety by following the above-mentioned guidelines while practicing telemedicine and safeguard yourself from any medico-legal mishappenings. Telemedicine is a powerful tool and if used in the right manner, it can transform your reach, rapport, and relationship with your patients. Therefore, act responsibly and make the best use of technology to help the society during this time of crisis and beyond. OPDlift is an online consultation platform that is compliant with the latest telemedicine guidelines and we help you activate your online OPD within 4 hours. Please click here to know how we can help you can run online OPD during the Covid-19 pandemic. For any queries, please fill the form below and we will get in touch with you.


Further reading: Frequently Asked Questions (FAQs) about OPDlift: For Doctors who wish to practice telemedicine on a compliant platform.

 

Note: This document has been prepared to help doctors get a basic understanding of telemedicine guidelines and is not a comprehensive document. It has not been legally vetted and cannot be held as a legal document in any legal proceedings.

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