Telemedicine In India - A Guide For Families

Telemedicine or e-medicine guidelines were finally passed in India last month. What does this mean for Indian patients and families? Swati Agrawal, a diversity and inclusion advocate has created this primer for us to understand the guidelines. 

With the onslaught of COVID19, the Ministry of Health and Family Welfare finally passed the Telemedicine Guidelines that were proposed nearly a decade ago. Due to social distancing and COVID19, reaching out to medical professionals and availing health services had started becoming a challenge. To ease out the situation, the MoHFW notified these guidelines on 25th March 2020.

Telemedicine is a great policy initiative as it will help reach out people with low mobility and people in remote places. Also, in these testing times, it will protect the patients and the doctors from exposure to the much-dreaded virus. It will also foster more collaboration between medical health professionals.

Here are some of the important features of the guidelines that have been summarized for the benefit of the patients and caregivers.

Related Reading: What Patients and Doctors Expect From Telemedicine

PLEASE NOTE THAT THIS ARTICLE 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

What is Telemedicine under the Guidelines?

Telemedicine involves remote access to health services through telecommunication technologies. Through telemedicine, patients can get consultations, prescriptions and other health related services. through communication and information technologies such as emails, phone calls etc.

Telemedicine would include health-related services such as consultations, providing prescriptions, health information services and self-care within jurisdiction of India. It does NOT cover use of digital technology to conduct surgical or invasive procedures remotely. It also does not include other aspects of telehealth such as research and evaluation and continuing education of health-care workers.

Telemedicine includes all channels of communication including Voice, Audio, Text & Digital Data exchange (such as emails). It can be done through Skype, Whatsapp, Facebook messenger, mobile apps, fax etc.

Telemedicine should be avoided for emergency consult and if telemedicine is provided for emergency cases then the patient should be advised to visit a RMP (Registered Medical Practitioner) in person as soon as possible.

Who can provide Telemedicine services?

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

What are the rules applicable to Telemedicine?

• RMP will exercise their professional judgment to decide if telemedicine is suitable.
• Telemedicine will be governed by same ethical and professional norms as in-patient consultation including maintaining privacy and confidentiality.The doctors have the same liabilities as in-patient consults.
• Patient consent is necessary. It is implied if telemedicine is initiated by the patient. If caregiver, health worker or RMP initiates then explicit consent recorded in any form (email, text, audio/video message etc.) is needed.
• Telemedicine consultation cannot be anonymous. Both RMP and the patient should know each other’s identities.In particular:
  • RMP will confirm your details including name, age, address, email ID, phone number, registered ID or any other identification as may be deemed to be appropriate. If there is any doubt, RMP may ask for age proof.
  • There should be a mechanism for you to verify the credentials and contact details of the RMP.
  • RMP will begin the consultation with his name and credentials. RMP shall display his registration number on prescriptions, receipts, e-communications, website etc.

• RMP shall provide a receipt for the fees charged.
• RMP is required to maintain all records of the patients.
• Penalties for not meeting the general laws and guidelines apply on RMPs.
• Technology platforms (website, mobile apps etc) providing telemedicine services to consumers shall be obligated to ensurethat the consumers are consulting with duly registered RMPs. They shall do their due diligence, provide mechanism for queries or grievances and provide details including qualification and registration number of every RMP listed on the platforms.

Can minors access Telemedicine?

Where the patient is a minor, tele consultation would be allowed only if the minor is consulting along-with an adult. Adult’s identity needs to be ascertained. Minor is anyone who is 16 years or lesser.

Can caregivers speak to the RMPs directly?

Caregiver is a family member or any other person authorized 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 authorization 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.

Which medicines can be prescribed through telemedicine?

• Medicines 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 cannot prescribed via telemedicine. For instance, Anti-Cancer drugs; Narcotics such as Morphine, Codeine etc.
• Here is the list of medicines that could be prescribed along with the mode and nature of consultation.

*If there is a gap of more than 6 months from previous consultation, it will be treated as first consultation.

What is a follow up consultation?

Follow up consultation includes the following cases:

• The patient is consulting with the same RMP within 6 months of his/her previous in-person consultation, and
• This is for continuation of care of the same health condition.

It will not be considered as follow up if:

• There are new symptoms that are not in the spectrum of the same health condition; and/or
• RMP does not recall the context

How can a prescription be obtained?

RMP shall provide a prescription according to existing laws if he deems that medicine is necessary only after proper diagnosis (provisional or otherwise). RMP shall provide photo, scan, digital copy of a signed prescription or e-Prescription to the patient via email or any messaging platform. A sample format has been given in the guidelines. If sending directly to pharmacy, it should be with approval of the patient. The prescription should have their registration number. Prescription will only be given after a proper diagnosis/provisional diagnosis.

Please note that consultations can also be between RMPs to RMPs and Healthworkers to RMPs. Please refer to the guidelines for the procedures to be followed in such telemedicine cases.

Swati Agrawal, a diversity and inclusion advocate in New Delhi and can be reached here. Illustration is by Saumya Maheshwari, a Delhi-based lawyer.