TELEMEDICENE - GROWING INTEREST & OPPORTUNITY:
The Indian healthcare market is estimated to be valued at $372 Billion by 2022. As of 2018, there were a total of 4,892 start-ups in the Indian health tech space. Overall, the health tech start-ups in India raised a total of $504 Million between 2014-2018.
The Indian Government has issued a set of practice guidelines for the functioning of telemedicine or remote medical services with an aim to provide quick medical services amid the Coronavirus lockdown in India.
The guidelines will further boost the healthcare market as whole as internet-based health care start-ups are on rise.The Telemedicine Guidelines recognised by the Ministry as an enabler of healthcare access and affordability will now enable usage of electronic means like telephonic or video conversations diagnosis for treatment and prevention of disease and injuries by Doctors in India.
The patients can consult the certified medical professionals without stepping out of the house & will also decrease the risk of infectious transmission as telemedicine visit in such situations can be conducted without exposing staff to viruses/infections.
Telemedicine Practice Guidelines in collaboration with Niti Aayog and Board of Governors, Medical Council of India (MCI) have been released as a part of the Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002 and shall constitute the Appendix 5 of the regulations.
The Ministry of Health and Family Welfare (MoHFW) has issued the guidelines amidst the Coronavirus outbreak in the country.
The Telemedicine Guidelines:
"Disasters and pandemics pose unique challenges to providing healthcare. Though telemedicine will not solve them all, it is well suited for scenarios in which medical practitioners can evaluate and manage patients. A telemedicine visit can be conducted without exposing staff to viruses/infections in the times of such outbreaks,"
Telemedicine is one of the successful fields in India in which private sector has taken initiatives and has acted actively in for the public health management. Narayana Hrudayalaya, Apollo Telemedicine Enterprises, Asia Heart Foundation, Escorts Heart Institute, Amrita Institute of Medical Sciences and Aravind Eye Care are some of the Indian private sector players in telemedicine.
In India, the telemedicine service comes under the jurisdiction of the Ministry of Health and Family Welfare and the Department of Information Technology. Telemedicine has also been extended to traditional medicines in India, such as the National Rural AYUSH Telemedicine Network which aims to promote the benefit of traditional methods of healing to the public at large using the medium of telecommunications.
UNDERSTANDING TELEMEDICINE /TELEHEALTH / REGISTERED MEDICAL PRACTITIONER
TELEMEDICINE:
‘The 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, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities
TELEHEALTH
‘The delivery and facilitation of health and health-related services including medical care, provider and patient education, health information services, and self-care via telecommunications and digital communication technologies.’
REGISTERED MEDICAL PRACTITIONER
‘A Registered Medical Practitioner [RMP] is a person who is enrolled in the State Medical Register or the Indian Medical Register under the Indian Medical Council Act 1956.’ [IMC Act, 1956]
PURPOSE:
These guidelines should be used in conjunction with the other national clinical standards, protocols, policies and procedures. 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 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. Like any other technology, the technology used for telemedicine services can be abused. It has some risks, drawbacks and limitations, which can be mitigated through appropriate training, enforcement of standards, protocols and guidelines,
These telemedicine guidelines will help realise 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 counselling.
Telemedicine encompasses consultation which is not provided physically by doctors whereas health tech start-ups also include online stores for medicines and medical equipment ,the start-ups can now function successfully in the healthcare sphere by adhering to these guidelines. The telemedicine consultations have gained more credibility and this opens a room for more qualified doctors to be associated with them. With adherence to the guidelines, these start-ups can now attract new customers with ease and gain their trust.
The Guidelines introduce certain mandatory steps that are to be followed by the health tech start-ups and the guidelines also expand their scope of functioning under the Indian regulatory regime The release of telemedicine guidelines amid the viral outbreak in India is a welcome step and a great boon for enabling remote consultation with medical practitioners.
This will also add to the revenue of the healthcare industry.
The provisions as outlined under the Telemedicine guidelines are :
- Only such medical practitioners who are registered under the Indian Medical Council Act 1956, will be entitled to provide telemedicine consultations.
- Within three years of the publication of the guidelines, all registered medical professionals will be required to complete a mandatory course which can also be done online.
- The Telemedicine consultations cannot be anonymous and records must be maintained about both patient and doctor. They should also be made aware of each other's identity.
- Registered medical practitioners will be required to verify the patient's identity by name, age, address, email ID, phone number, registered ID or any other such identification before sharing any consultations.
- Before prescribing any medicines, the registered medical practitioners need to be sure about the patient's age and they can also use age proof to verify the same.
- The consent of the patient is implied when they initiate the telemedicine consultation.
- Such registered medical practitioners are allowed to use different forms of communication such as text, video or audio-enabled solutions for consultations.
- When a physical examination is a necessary critical information for consultation, the registered medical practitioners will not proceed with the consultation as long as a physical examination cannot be arranged.
The medication that can be prescribed is based on the type of consultation. For example, List A includes safer medicine with lower potential for abuse and some medicines listed in "List B" that can only be prescribed after a follow-up or in-person consultation. Further, no such medicine can be prescribed which is listed under Schedule X of the Drugs and Cosmetics Act and Rules. The Guidelines also restrict the prescription of Narcotics and psychotropic substance listed in the Narcotics Drugs and Psychotropic Substances Act of 1985.
Apart from the mandatory rules, the other compliance's include Principles of medical ethics, including professional norms for protecting patient privacy and confidentiality as per IMC that be binding and must be upheld and practised.
The guidelines also state that a Registered Medical Practitioner would be required to fully abide by Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002 and with the relevant provisions of the IT Act, Data protection and privacy laws. This ensures that the information shared by patients is safe and is not shared with third parties.
In India, providing In-person healthcare is challenging, particularly given the large geographical distances and limited resources.
One of the major advantages of telemedicine can be for saving of cost and effort especially of rural patients, as they need not travel long distances for obtaining consultation and treatment. In this type of scenario, telemedicine can provide an optimal solution for not just providing timely and faster access. It would also reduce financial costs associated with travel. It also reduces the inconvenience/impact to family and caregivers and social factors. Telemedicine can play a particularly important role in cases where there is no need for the patient to physically see the RMP (or other medical professional), e.g. for regular, routine check-ups or continuous monitoring. Telemedicine can reduce the burden on the secondary hospitals.
Other Advantages:
- Convenient access to medical care for patients – especially in the present day and time.
- Saves time for the patient & better utilisation of its time
- Less expense incurred on travel to and fro the clinic.
- Beneficial for patients living in rural areas.
- Expands access to quality patient care even to remote areas.
- Also makes it convenient for a patient/ physician to seek consultation and/or expert advice from specialists, from anywhere in the world.
- No exposure to other contagious infections/ diseases.
- Increased revenue for the RMP – fewer missed appointments and cancellations.
- Better quality Patient Care
- Maintains privacy;
- Hospitals can also expand their access to medical specialists, and thus increase their revenue.
Disadvantages:
- Requires Doctors to be tech savvy and undergo tech training along with investment on equipment’s (such as a webcam)/ mobile apps (secure video chat app).
- There is a line of thought in the medical profession which believes that use of such technology will reduce the in-person interactions with doctors (may result in missing of non-verbal cues which a doctor in a in-person consultation can see) and also make consultation a very impersonal affair – it is thus believed that telemedicine can supplement in-person consultation but not replace it.
- Risk of the information exchanged via telecommunication being accessed by hackers and possibility of it being misused.
- Electronic glitches may affect the service – caused by harsh weather leading to power cuts and/or disruption in internet connection, thus affecting transmission of data.
Due to the prevalent Pandemic caused by widespread COVID-19, which has affected countries world over, there appeared challenges to provide health care services to people in need – especially in the wake of social distancing ordered to be maintained by people all over the world coupled with the high risk of catching the COVID-19 infection.
It was the need of the hour to regulate Telemedicine and promote it as a tool available for patients suffering from other ailments to consult and seek timely medical advice, at the same time, also help the RMP's to effectively manage patients and deliver timely consultation as and when desired and required – without requiring the patient to visit the hospital and/or clinic.
The government’s recent notification regulating telemedicine amid the Covid-19 pandemic has given a boost to the business of health tech startups operating in the segment, despite certain restrictions imposed on prescribing medicines to first-time patients.
The government need to do more for first-time consultation remotely as otherwise, the impact would be limited. The rules don’t allow doctors to prescribe most medicines for first consultations.The list for first-time consultation is very restrictive even if the doctor has all the information. It urgently requires updating.
These guidelines were the need of the hour. We’ve always had comprehensive protocols in place to ensure a high quality of care, and there’s a huge overlap between protocols and the guidelines released.Other finer aspects needs to be incorporated.
Scenario in India
WHO recommends a doctor-population ratio of 1:1000 while the current doctor population ratio in India is only 0.62:1000. Training of new physicians is time consuming and expensive, hence the doctor to patient ratio can be expected to remain low for a long time to come. This deficit is partly being made up by the active telemedicine services in various parts of the country.
With regard to COVID-19 epidemic, telemedicine is playing an active role. A lot of hospitals have opened tele consultation services to allow people access to doctors from the safety of their homes.
Telemedicine is helping in two ways. Firstly, it is helping by making medical care available to many people with varying health conditions without them going to clinics and hospitals, mitigating the risk of infection. Secondly, it is helping suspected COVID-19 patients seek medical advice and help in self-quarantine.
CONCLUSION:
- Telemedicine cannot be the answer to all problems, but it can be very important in addressing a vast range of problems.
- Services like tele-health, tele-education and tele-home healthcare are proving to be wonders in the field of healthcare.
- Telemedicine initiatives are bringing the world closer and distance is no longer a barrier in attainment of quality healthcare.
- Lack of awareness and acceptance of new technology both by the public and the professionals are holding it back.
- Governments are now starting to take a keen interest in developing telemedicine practices resulting in a slow but steady rise in its utilisation in public health.
- Hopefully in a few years, telemedicine practices will reach their true potential.
Note:
- https://www.mohfw.gov.in/pdf/Telemedicine.pdf
- Indian Tech Start-up Funding Annual Report, 2018
- https://evisit.com/resources/what-is-telemedicine/
- Secondary Research