GROWTH OF TELEMEDICINE IN THE ERA OF COVID-19 PANDEMIC AND ACTS GOVERNING IT.

Author :- Eshika Singla

GROWTH OF TELEMEDICINE

The days are passing but there has not been even a slightest reduction in spread of coronavirus in India. Cases rise by approximately 14000 to 15000 in every 24 hours and the number of deaths is increasing in India. It’s no longer a temporary disaster that would stop in a day or two instead it has become a huge pandemic putting humans’ life to end. It is way too scary and devastating than a disaster can be. Cure is yet to be found until the only option left with people is to stop socialising and take precautions to prevent its spread. Now the question arises that since hospitals are contaminated with coronavirus patients how are people with normal flies, headache, somebody with pain in bones or let’s say a person suffering from any kind of medical issue apart from coronavirus is supposed to get treatment for the same. Is it safe for him or her to visit the hospital and get the cure in which chances are severe that person might get infected from this disease named coronavirus? So, in order to fulfil their oath and provide the needy with necessary treatment, medical faculty have come up with this very trending idea of telemedicine.

Now a layman might wonder what exactly does this term means and even if people understand it quite well questions might arise in their minds like  is it safe to go for it , are doctors capable enough to handle things that way or what happens if any patient suffers any sort of mishaps after making use of this facility named telemedicine are there any strict laws regulating telemedicine. Not only this but patients are also suffering from this fear that what if their record is being shared with other people, they have any right to privacy in following this telemedicine technique. Although one can say that coronavirus is the reason that telemedicine practise is increasing day by day but one should not forget that the reason behind evolution of telemedicine is geographical distance.

In order to protect the interest of patient’s various laws have been passed for telemedicine practitioners and also certain guidelines have been issued for the patients. This article is an attempt to study how coronavirus emergence led to extensive use of telemedicine and provisions of law binding telemedicine technique.

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MEANING OF TELEMEDICINE (TM)

The term ‘Telemedicine’ means use of electronic communication, information technology or other means between a physician in one location and patient in another location, with or without an intervening health care provider. Term telemedicine is also known as e-health or tele-health. It basically means providing health care services via electronic medium but only by registered medical practitioners.

Telemedicine consultations can be held between-

1. Patient-Doctor
2. Doctor-Doctor
3. Caregiver-Doctor
4. Health worker-Doctor

TELEMEDICINE GUIDELINES 2020

The Health Ministry of India issued these guidelines and hence it is the doctor’s responsibility to decide whether tele-communication is enough based upon a patient’s situation. These guidelines are particularly issued for RMPs under IMC Act 1956.

BASIC GUIDELINES OR RESTRICTIONS

1. It is very important for the parties to know each other’s identity well to verify in case needed. Patients should have a means to identify and verify a doctor’s credential to know whether he or she is capable enough to provide patient with treatment. Similarly, doctors are supposed to collect a patient’s personal data.
2. Consent of patients is very important while treatment. In cases where a doctor approaches a patient there is a need to get explicit consent of the patient via mail, message etc however consent is assumed to be implicit in case the patient approaches the doctor.
3. Age of the patient also plays an important role in telemedicine as in case of minors he or she needs to be accompanied by an adult member of the family. It is the doctor’s responsibility to explicitly ask the patient’s age as well as proof for the same in case needed.
4. As far as fees are concerned it will be similar to that charged from an in-person patient there is no change in fees.

MODE OF COMMUNICATION

Telemedicine consultations can be delivered through various modes of technology depending upon the situation of the patient. Different means available are video call, voice call or chat. Each method carries its own benefits, weakness and it depends upon the nature of the means used to determine whether it will be suitable enough to treat the patient.

For example-

1. Consider a situation where an RMP requires to hear a patient’s voice in such a case voice call would be considered as most appropriate rather than an email or text.
2. Similarly, RMP may recommend video consultation in cases where visual diagnosis of the patient is necessary.

KINDS OD CONSULTATION

There are basically two types of telemedicine consultations-

1. First consult
2. Follow-up consult

Now in cases where RMP never had an in-person consultation with a patient he may prefer the first consultation to be a video call in order to understand the patient’s need better. However, in case of prior in-person consultations with a patient it is easier for an RMP to make a better judgement regarding a patient’s illness.

1. First Consult- The term implies when a patient consults for the first time to RMP or when the patient has consulted before but for a different health problem or when the patient had consulted the RMP before but there has been a time lapse for then 6 months since the last consultation.
2. Follow up Consult- When a patient consults an RMP for the same health condition within 6 months of previous consultation. However, in case a patient develops new symptoms not being part of a persistent health condition and when RMP does not remember any past advice given in such a case it will not be considered as follow up consult.

PRESCRIPTION OF MEDICINES

Prescribing of medicines via telemedicine consultations totally depends upon the professional discretion of RMP, if RMP is satisfied that he or she has collected all the necessary information regarding the patient’s health condition and that medicines prescribed are in the best interest of the patient. In cases where deeper diagnosis is required prescribing medicines through telemedicine consultation may not be considered appropriate and will be termed as professional misconduct. Depending upon the type of consultation and mode of consultation certain limitations are placed on prescribing medicines.

Certain categories of medicines that can be prescribed are listed below-

1. List O- Medicines which are considered to be safe to provide any mode of tele-consultation are included in this category. Medicine easily available off the counter are included in this. They can be used to treat all types of conditions and are considered to be a necessity in times of public health emergencies.

For example- Paracetamols, ORS solutions etc.

2. List A- Medicines prescribed in first consultation via video call or are being re-prescribes to re-fill in follow up consult are included in this category.
3. List B- This list includes those medicines which are prescribed in addition to medicines prescribed during in person consultation. Such medicines are prescribed in follow up consultation.
4. Prohibited list- Medicines mentioned in this list cannot be prescribed by an RMP via telemedicine. If used improperly these medicines have the ability to harm patients or society at large also they are considered to be abusive by nature.

DATA PRIVACY AND CONFIDENTIALITY

RMPs are expected to abide by the guidelines issued by IMC Act 1956 and with provisions of IT Act for maintaining data protection and confidentiality of a patient’s information. Reasonable care should be taken by an RMP regarding a patient’s personal information. In case it is found out that a patient’s information has been leaked and it is due to negligence of an RMP then he or she may be held responsible for the same. Misuse of a patient’s image or data obtained via telemedicine is strictly not allowed. Adding patients to virtual support groups without the prior permission of the patient will be considered against a patient’s will.

TELEMEDICINE CONSULTATION FEES

Fees charged for a telemedicine consultation is meant to be the same as that charged for in-person consultation. Further RMP must issue a receipt or invoice to the patient for the fees charged.

LIMITATIONS TO TELEMEDICINE

The decision that telemedicine is no longer suitable for a specific person totally lies in the hands of an RMP based on his professional discretion. The condition of a patient may act as a major barrier to telemedicine.

Secondly, for some people it may not be possible to arrange necessary medium for telemedicine due to high maintenance cost.

Thirdly, people may not completely trust this telemedicine technique due to many factors and hence end up preferring in-person consultation.

Fourthly, even some health care facilitators find it difficult to arrange set up for telemedicine technique.

CONCLUSION

It is hard to believe that an enforced lifestyle for today will become new normal and that is why telemedicine will continue to grow rapidly. Even it is in the interest of patients to avoid the hassles of travelling and visiting hospitals. Shift to virtual care was started 18 years ago and there is no doubt in saying that telemedicine is not a today’s thing it’s just that COVID-19 has accelerated the process of growth of telemedicine.