Ever since coronavirus became a household name and it was realised that no country has sufficient healthcare resources, the world has woken up from its slumber and accepted that providing virtual teleconsults is the only way to significantly reduce unnecessary footfalls to hospitals and clinics.
Interestingly, it was 20 years ago, on March 24, 2000, that the world’s first VSAT-enabled village hospital was commissioned in Aragonda, Andhra Pradesh. However, the growth of telemedicine has been slow. The World Health Organisation (WHO) and the Centers for Disease Control and Prevention (CDC) in Atlanta have endorsed the use of telemedicine for the current pandemic. The U.S. government has earmarked $500 million exclusively for use of telemedicine in the fight against COVID-19. Scores of countries like China, Japan, Australia, Hong Kong are now providing virtual care on a war footing. Health insurance companies in the U.S. have approved reimbursements for COVID-19 teleconsults. In India, the number of institutions and individuals offering free teleconsultation and tele-information is doubling every few hours. It has required a virus to help telehealth emerge from the sidelines to the centrestage. All it needs is a successful take-off.
A contributory factor for the lack of exponential growth of telemedicine in India has been the apprehension in the medical community about the legality of providing remote healthcare. This was compounded by an erroneous extrapolation of a 2018 judgement of the High Court of Bombay questioning whether telephonic advice given by a specialist was legal. On May 14, 2019, the Karnataka Medical Council advised doctors against engaging in online teleconsults and even threatened to have them struck of the State rolls.
For several years, the office-bearers of the Telemedicine Society of India have had multiple brainstorming sessions. After reviewing the regulations in various countries, proposals were submitted to NITI Ayog and other authorities to notify unambiguous regulations. The authorities are to be complemented for understanding the immediate urgency. On March 25, 2020, the Ministry of Health has put up in the public domain, a comprehensive 51-page document , to deal with the current pandemic.
Immediate advantages of virtual remote healthcare in the present situation include:
1. Providing access to services that may not otherwise be available
2. Considerably reducing footfalls to hospitals, clinics and OP services
3. Diagnosing, coronavirus-like illness (CLI) on a clinical basis virtually
4. Treatment monitoring and reviews can be done with the ‘patient’ quarantined at home – even if the doctor is also quarantined. Quarantined healthcare workers can continue to evaluate patients remotely
5. More manpower to provide physical care at hospitals
6. Increases patients’ and health workers safety by providing care at and from home
7. During long periods of national lockdown it will be difficult for the patient and the doctor to even physically go to a hospital for any condition
8. AI-powered self diagnostic questionnaires can even be administered by a chatbot
9. Today it is possible to remotely evaluate pulse rate, BP, oxygen saturation, fever, cough, shortness of breath, transmit heart and lung sounds through the internet using a digital stethoscope and even look at the throat, nose and ear from anywhere.
Digital health is a critical enabler for exponentially transforming the healthcare system. The urban rural health divide can be addressed. At the grassroots level a mid-level provider/health worker can connect patients to doctors through technology platforms in providing timely and best possible care. In India, there was no legislation or guidelines on the practice of telemedicine, through video, phone, Internet-based platforms (web/chat/apps, chatbot etc). The existing provisions under the Indian Medical Council Act, 1956, Clinical Establishment (Registration and Regulation) Act, 2010, Information Technology Act, 2000 and the Information Technology (Reasonable Security Practices and Procedures and Sensitive Personal Data or Information) Rules 2011 primarily govern the practice of medicine and Information Technology independently.
Gaps in legislation and uncertainty of rules posed a risk for both doctors and patients. The guidelines now notified integrates clinical standards, protocols, policies and procedures for provision of care with various technologies. All currently registered medical practitioners need to complete a mandatory online course within three years of notification of these guidelines to be authorised to provide consultation via telemedicine.
A Registered Medical Practitioner (RMP) may now use any telemedicine tool suitable for carrying out technology-based patient teleconsultation e.g. 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 also have safeguards in place. They provide 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, prescribing and reimbursement and health education. Medicines that may be deemed necessary during public health emergencies can be e-prescribed. The RMP shall provide photo, scan, digital copy of a signed prescription or e-Prescription to the patient via email or any messaging platform. As per the guidelines practise of telemedicine is envisaged in five scenarios: a) patient to a RMP b) Caregiver to RMP c) Health Worker to RMP d) RMP to specialist e) Emergency Situations. It is expected that the RMP will exercise professional discretion for the mode of communication depending on the specific medical condition.
Prof. K. Ganapathy is former president of Telemedicine Society of India & Neurological Society of India, and Director, Apollo Telemedicine Foundation
