The government on Wednesday approved medical practitioners to use telemedicine – or being able to consult patients who are not physically present, by video, audio or text, in order to prevent the transmission of the COVID-19 infection and reduce the risks to both healthcare workers and patients.
The guidelines for this were issued by the Board of Governors (BoG) of the Medical Council of India (MCI) in partnership with NITI Aayog. The BoG has taken over the powers and functions of the MCI, pending passage of the National Medical Commission Bill that seeks to replace the council with a freshly constituted regulatory body.
With the entire country on lockdown due to the COVID-19 pandemic, the guidelines state that telemedicine will not solve all the challenges that arise due to it, but can be of help, and help people at home access healthcare services.
The guidelines also explicitly mention that neither party can be anonymous to one another. A medical practitioner should verify and confirm a patient’s identity by name, age, address, email ID, phone number, registered ID or any other identification as may be deemed to be appropriate, according to the guidelines. Similarly, they have to inform the patient about their name and qualifications, and display their registration number on electronic communication and prescriptions they issue.
As part of telemedicine, registered medical practitioners can even issue prescriptions for specific drugs, and the drugs have been demarcated into four categories. Common medicines and relatively safe medicines can be prescribed for the first time in telemedicine.
However, some medication can only be prescribed when the patient and doctor have met in-person before, and this is a follow-up to the same.
There is also a list of drugs prohibited to be issued – anything 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. Schedule X drugs are known to be habit-forming drugs.
“For issuing a prescription, the Registered Medical Practitioner needs to explicitly ask the age of the patient, and if there is any doubt, seek age proof. Where the patient is a minor, after confirming the age, tele consultation would be allowed only if the minor is consulting along-with an adult whose identity needs to be ascertained,” the guidelines state.
There are a number of technologies that can be used in telemedicine, which can help patients adhere better to their medication regimens and manage their diseases better, the BoG said in its telemedicine guidelines.
"It can provide rapid access to medical practitioners who may not be immediately available in person. In addition, it makes available extra working hands to provide physical care at the respective health institutions. Thus, health systems that are invested in telemedicine are well positioned to ensure that patients with COVID-19 kind of issues receive the care they need," it said.
With telemedicine, there is a higher likelihood of maintenance of records and documentation hence minimising the likelihood of missing out advice from the doctor and other health care staff, it said.
Rules governing telemedicine have not been specified in India, something the guidelines acknowledge. “Gaps in legislation and the uncertainty of rules pose a risk for both the doctors and their patients,” it states.
Further, it adds that any technology platform (mobile apps, websites etc.) “providing telemedicine services to consumers shall be obligated to ensure that the consumers are consulting with registered medical practitioners duly registered with national medical councils or respective state medical councils and comply with relevant provisions”.
Practo’s co-founder and CEO Shashank ND called it a monumental step forward for digital health in India. “Clarity in regulations around telemedicine & digital healthcare was the need of the hour, especially, in the light of COVID-19. MoH and Niti Aayog's swift action in this regard is praiseworthy,” he said.
Insurance providers have also acknowledged this. Policybazaar stated that health and term life insurance now can be bought through the platform without a physical check-up. “Medical check-up being an important aspect while buying term and health insurance plans, Policybazaar along with insurance companies have innovated the tele-medical facility. The customer can now get a term or health cover with a medical check on phone, without any physical medical check-up,” Santosh Agarwal, Chief Business Officer of Life Insurance at Policybazaar said.