The constitution of India incorporates provisions guaranteeing everyone’s right to the highest attainable standard of physical and mental health making the right to health an integral part of the right to life. Due to this constitutional duty government of India has issued telemedicine practice guidelines on 25 March 2020. Telemedicine can be defined as the delivery of the health care services, where distance is a critical factor by all health care professionals using Information Technology.
India, whose 31% population resides in the urban area imbibe 75% of the doctors, ranked 184 out of 191 countries in providing health facilities according to the 2012 WHO report. Along with this India has a 1.34:1000 doctor population ratio. In order to curb these unequal distributions of health workers, India has passed the Telemedicine Practice Guidelines. In addition to the unequal distribution of health workers, COVID 19 a contagion virus wreaks havoc with the healthcare system which also forced India to issue guidelines on the 1st day of the lockdown. India has passed the Telemedicine Practice guidelines in March 2020 during the outbreak of the Coronavirus. These guidelines have to be used in conjunction with the other national clinical standards, protocols, policies and procedures.
Purpose of Telemedicine
Telemedicine can be defined as providing health care services by using technology. It enables people across the country to consult specialists irrespective of distance. The main advantage of telemedicine is the saving of the cost and efforts of the patient, especially of rural areas. The main purpose of these telemedicine guidelines is to encourage doctors to use all services and models of care and to make them technology friendly which will enable them to prepare themselves for versatile situations.
Who Can Provide Telemedicine Services?
Any person who is willing to provide medical services to patients, has to registered himself/herself with the State Medical Register or the Indian Medical Register under the Indian Medical Council Act, 1956. In addition to this a Registered Medical Practitioner (RMP) intending to provide health care services need to complete a mandatory online course within 3 years of its notification by the Board of Governors in supersession of Medical Council of India.
Consent-An Essential Element of Telemedicine
An agreement enforceable by law is a contract under which consent plays an important role. Consent also plays an important role for a doctor and patient relationship to exist. Under the Contract Act a person can either explicitly or impliedly give consent for an agreement. Likewise, in telemedicine if a person approaches RMP for consultation then he/she is said to give an implied consent. Along with the consent, the identity of both the patient and doctor have to be revealed, as no telemedicine should be autonomous.
Types of Consultation
1. First-time Consultation
First time consultation can define as the first-time interaction between the patient and the doctor. During the first-time consultation, RMP by applying professional mind has to assimilate the medical information from the patient. During the assimilation of information, the RMP can order some laboratory tests to analyse the situation. After analysing all the information if RMP is of the opinion that in-person consultation is required than RMP may convey the same.
2. Follow-up Consultation
If the patient after the first-time consultation unable to consult the doctor in-person, then the patient can consult through technology, when this consultation take place within the 6 months of in-person consultation then it is known as follow-up consultation. If a time period of 6 months elapsed between the 2 consultations then such consultation will be known as the first-time consultation instead of a follow-up consultation.
Prescription of Medicines
After the first or the follow-up consultation, if the RMP is satisfied then in such case he/she may proceed with a professional judgement of either to provide the telemedicine education or counselling or to prescribe medicines. Professional judgement of prescribing medicines can only be exercised when he/she is satisfied that the prescribed medicines are in the best interest of the patient. After prescribing medicines, RMP can ask patients either to send the signed copy of prescription to them directly or to the pharmacy who will deliver the medicines to them.
Instances of Professional Misconduct
While consulting through technology both patient and medical practitioner has to abide legislations like Indian Medical Council Act, 1956, Drugs and Cosmetics Act, 1940 and rule 1945, Information Technology Rules, 2011 etc. Some of the instances that may leads to professional misconduct are-
- RMP have to ensure the privacy and confidentiality of patients and in case of a breach, he/she will be liable. To ensure the privacy and confidentiality of the patient and to curb the mishappening, the government can create a uniform platform of technology that can be made liable in case of a breach.
- RMP is allowed to prescribe those medicines only which are explicitly mentioned in the guidelines. The prescription has to be digitally signed by an RMP in order to not trigger any misconduct under the Drug and Cosmetic Rules, 1945.
- Telemedicine guidelines have prohibited RMP to force the patient for telemedicine consultation if patient is willing to travel to a facility and he/she can’t solicit patient through any advertisement or inducement.
Telemedicine guidelines will help to integrate technology with health care devices and it will ensure how technology and transmission of data, voice, image and information should be used. But in the era of advancement of technology, the current telemedicine doesn’t help to provide effective, efficient, convenient services to the patients with no limitation. One such instance is the breach of confidentiality and privacy either by RMP or through technology which leads to the creation of another instance of jurisdiction as no specific guidelines are been notified. But one can say that though there are pitfalls but they cannot overflow advantages. Thus, these guidelines should be used in conjunction with the other national clinical standards, protocols, policies and procedures. However, a lot depends upon how telemedicine is regulated and how much liability RMP and online portal incurred in case of any breach of data privacy.
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