Health ministry issues telemedicine practice guidelines to tackle COVID-19

In order to enable registered medical practitioners provide healthcare using telemedicine effectively, Union health ministry has issued telemedicine practice guidelines. These guidelines have been prepared in consultation with NITI Aayog.

In India, till now there was no legislation or guidelines on the practice of telemedicine, through video, phone and internet based platforms like web, chat, apps, etc.

The purpose of these guidelines is to give practical advice to doctors so that all services and models of care used by doctors and health workers are encouraged to consider the use of telemedicine as a part of normal practice. These guidelines will assist the medical practitioner in pursuing a sound course of action to provide effective and safe medical care founded on current information, available resources, and patient needs to ensure patient and provider safety.

These telemedicine guidelines will help realize the full potential of these advancements in technology for health care delivery. It provides 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 the patient records and exchange of information, prescribing and reimbursement, health education and counseling.

These guidelines will provide information on various aspects of telemedicine including information on technology platforms and tools available to medical practitioners and how to integrate these technologies to provide health care delivery. It also spells out how technology and transmission of voice, data, images and information should be used in conjunction with other clinical standards, protocols, policies and procedures for the provision of care. Where clinically appropriate, telemedicine is a safe, effective and a valuable modality to support patient care.

These guidelines should be used in conjunction with the other national clinical standards, protocols, policies and procedures.

The existing provisions under the Indian Medical Council Act, 1956, the Indian Medical Council (Professional Conduct, Etiquette and Ethics Regulation 2002), Drugs and Cosmetics (D&C) Act, 1940 and Rules 1945, 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.

Gaps in legislation and the uncertainty of rules have posed a risk for both the doctors and their patients.

Telemedicine offers 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 diagnosis, treatment and prevention of disease and injuries, research and evaluation in the interests of advancing the health of individuals and their communities.

There are some countries that have put in legislative measures and some countries, which follow non- legislative measures such as guidelines to practice telemedicine. In some countries guidelines are treated as professional norms that need to be followed by medical practitioners. We reviewed these other guidelines and consulted to put together these guidelines to enable medical practitioners to practice telemedicine.

India’s digital health policy advocates use of digital tools for improving the efficiency and outcome of the healthcare system and lays significant focus on the use of telemedicine services, especially in the health and wellness centers at the grassroots level wherein a mid-level provider or health worker can connect the patients to the doctors through technology platforms in providing timely and best possible care.

However, there has been concern on the practice of telemedicine. Lack of clear guidelines has created significant ambiguity for registered medical professionals raising doubts on the practice of telemedicine. The 2018 judgement of the Bombay High Court (HC) had created uncertainty about the place and legitimacy of telemedicine because an appropriate framework did not exist.