With an aim to provide quick medical services amid the Coronavirus lockdown in India, the Indian Government has issued a set of practice guidelines for the functioning of telemedicine or remote medical services. The Ministry of Health and Family Welfare (MoHFW) has issued the Telemedicine Practice Guidelines1 (hereinafter referred to as the Telemedicine Guidelines or the Guidelines) in collaboration with Niti Aayog and Board of Governors, Medical Council of India (MCI). These guidelines 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.
Thus, the Telemedicine Guidelines, which have been recognized 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. Thereby, allowing the patients to consult the certified medical professionals without stepping out of the house. The issue of guidelines amidst the Coronavirus outbreak in the country will also decrease the risk of infectious transmission as telemedicine visit in such situations can be conducted without exposing staff to viruses/infections.
The Telemedicine Guidelines:
The guidelines read, "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,"
The provisions as outlined under the Telemedicine guidelines are as follows:
- 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 compliances 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 practiced.
- 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.
Telemedicine Start-ups in India:
The Guidelines define telemedicine as "The delivery of health-care services, where distance is a critical factor, by all health-care professionals using information and communications technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and the continuing education of health-care workers, with the aim of advancing the health of individuals and communities."
Telemedicine only refers to a small part of the bigger sphere of health tech start-ups. Telemedicine encompasses consultation which is not provided physically by doctors whereas health tech startups also include online stores for medicines and medical equipments.
The Indian healthcare market is estimated to be valued at $372 Billion by 2022.3 As of 2018, there were a total of 4,892 start-ups in the Indian health tech space.4 Overall, the health tech start-ups in India raised a total of $504 Million between 2014-2018.5 The guidelines will further boost the healthcare market as whole as internet based health care start-ups are on rise.
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. As the guidelines legalise the telemedicine process, the start-ups can now function successfully in the healthcare sphere by adhering to these guidelines. Further, now 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. This will also add to the revenue of the healthcare industry. 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.
3 Indian Tech Start-up Funding Annual Report, 2018 (https://inc42.com/startupreports/indian-tech-startup-funding-report-2018/)
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