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Telemedicine/Teleconsultation: Complete Guide [2020]

  • 07 Jul, 2020
  • By UHAPO
  • 2369

Up until 2019, Telemedicine was a form of consultation that was used by a small number of people in India. But after the COVID-19 struck and forced us to stay put in our homes, the field of telemedicine has grown manifold.

 

There has been an unprecedented rise of users in teleconsultation platforms like


Uhapo, Practo, Docprime


all due to the unavailability of safe zones to consult doctors for health problems and ailments. (because hospitals have become hot zones of COVID-19)

 

Moreover, this has led the government to work on a set of new telemedicine guidelines for RMP’s in 2020 and beyond. This has proven that telemedicine is going to change the way we consult with doctors and vice versa. 

 

This guide will help you understand all about teleconsultation and how it is shaping up the healthcare industry. 

 

Let's try to understand teleconsultation and telemedicine in detail,

 

 Teleconsultation is the process of delivering medical services with the help of information and communication technologies. This

service is provided to patients by doctors and medical professionals when distance may be a constraint.

 

Teleconsultation can also be used in Instances where patients and caregivers cannot reach medical professionals due to external reasons.

 

 

For example:

 

COVID-19 has proved to be extremely challenging for patients to consult doctors in the hour of need. Especially under strict lockdown restrictions and when


hospitals are hot zones for the virus spread
Or, in case the mobility of the patient is restricted due to the disease. 

 

This is where medical professionals can leverage communication and information services to provide consultation over audio, video, or text-based services.

 

 

This has proved beneficial for millions of patients as they schedule a teleconsultation appointment and schedule their challenges from the comfort of their home.

 

Here’s why there will be a massive surge in teleconsultation in India

 

After the massive spread of the COVID-19 Pandemic, plenty of doctors and medical institutions have taken to teleconsultation appointments to provide for the needs of their patients.

 

In a time where doctors are losing their lives to the deadly virus, telemedicine and teleconsultation come in pretty handy, to conduct appointments without the risk of virus spread. Medical institutions are pushing doctors to take up Teleconsultation and telemedicine as a viable source forcing the Medical Council of India to finally update telemedicine in India.

 

 

Types of Telemedicine:

 

Three types of Teleconsultation help doctors consult their patients. RMP uses three basic types of teleconsultation which are Text, Audio, Video.

 

Let us take a look at these three types of telemedicine in detail.

 

VIDEO for Teleconsultation:

 

A video is a great tool that will help doctors and RMP's finish their consultation without much of a hassle. With a Visual tool for consultation, doctors can efficiently read the body language of the patient to identify their concerns.

 

A dedicated Video Teleconsultation application like UHAPO makes it possible for patients to discover doctors and connect with them quite efficiently.

 

Video Teleconsultation platforms for doctors make life easier to screen patients with the ultimate need to visit the hospital.

 

 Let’s take a look at the strengths and Drawbacks of Video for telemedicine

 

Strength:

 

·      Easy to identify Visual Clues

·      The consultation process is much efficient with the support of Video

·      RMPs can discuss with the caregiver and the patient at once with video teleconsultation

 

 

Drawbacks:

 

·      A high-Speed network connection is necessary to carry out teleconsultation through Video.

 

 

AUDIO for teleconsultation:

 

Audio works well for teleconsultation by doctors. It can be done with a normal phone call, VOIP, and dedicated applications like UHAPO.

 

 Let’s take a look at the strengths and drawbacks for audio-based teleconsultation

 

Strengths:

·      Audio is Convenient, fast and helpful for emergency cases

·      It helps with a real-time interaction without the danger of data privacy

·      Audio is simple and does not require any additional infrastructure for scaling

 

Drawbacks:

 

There is a high danger of imposters in the Consultation process

There is a risk of doctors and patients missing verbal cues

Moreover, it is not suitable for medical conditions that would require a visual inspection

 

TEXT for teleconsultation:

 

Text can also be used for teleconsultation and telemedicine procedures. Text-based communication can be used in most cases. 

 


Here are the basic principles of teleconsultation in India

 

The Medical council of India released a page of Telemedicine guidelines for RMP's on March 25, 2020. This has been a major directional pointer for RMP's, teleconsultation platforms, and patients in India.

 

Before we get into the rules of teleconsultation, some essential principles must be followed by every RMP before performing a teleconsultation appointment.

 

 Essential Principles for Teleconsultation in India

 

·      The RMP is responsible for deciding between a teleconsultation appointment or an In-person meeting for your medical condition. 

·      The RMP must also apply the same principles of consultation even though the process is carried out with the help of Audio, Video, Text, or a combination of all. In simple words, it is the responsibility of the RMP’s to maintain quality with their consultation services.

·      At any stage, the RMP has the right to cancel the teleconsultation and call for an in-person consultation

·       Likewise, the Patient or Caregiver can also cancel the teleconsultation at any point and go with a choice of In-person consultation

 

 

Rules to be Followed with a Teleconsultation appointment in India

 

Just like a common set of principles, the teleconsultation guidelines of March 2020 must also make sure that RMPs and Patients must always follow a set of rules. These rules must be followed very strictly for the safety of the patient/caregiver and the RMP alike.

 

Identification of Context:

 

The RMP should identify when and where teleconsultation comes into play. As a certified professional they should take note of the complexity of the medical situation and make a judgment that would be beneficial for both parties alike.

 

The Registered Medical Practitioner should take in mind the 

 

·      The complexity of the patient’s condition

·      Mode/ technologies available for teleconsultation

·      The Comfort levels of the patient for taking a teleconsultation

 

Mutual identification of patient and the RMP:

 

Both parties must mutually disclose their identities before they start with the process of teleconsultation.

 

For the Patient:

 

·      They should submit their Name, Age, Address, E-Mail Id, Phone Number

·      If required they must also submit proof for verification of their identity

·      If the patient is a minor, the presence of an adult is required during the process of teleconsultation.

 

The RMP must have a sound mechanism to get all these details with ease.

 

For the RMP:

·      The medical practitioner must identify themselves with their name and their professional qualification to the patient.

·      They must also disclose their professional registration number on Websites, prescriptions, and receipts given to the patients

 

Choosing the Mode of Teleconsultation:

 

There are three modes for legally carrying out consultation through the process of teleconsultation. The RMP must assess the patient and their condition before choosing a valid form of teleconsultation.

 

They must choose Audio, Video, and text based on the complexity of the patient and the necessity to treat the patient. Some conditions would require the use of Video to get Non-Verbal cues from the patient.

 

 Finally, the model is decided on the Judgement of the RMP.

 

Consent of the patient:

 

This is of utmost importance before carrying on with teleconsultation. 

 

When the patient approaches a medical professional for teleconsultation, then the consent is considered to be Implied.

 

If the RMP or a healthcare worker initiates teleconsultation, then there exists a need for Explicit consent.

 

For proof of explicit consent, the RMP must obtain a recorded form of consent from the patient. This includes Email, Audio, Video, and text form which is placed in the patient’s record before going forward with the procedure.

 

 This recording can include something like “Yes, I (Your name) accept to go forward and give my consent to teleconsultation with my doctor (The doctor’s name).

 

 

The telemedicine guidelines also state that RMP must take his utmost effort to gather the details and files about his patient before making a professional judgment.

 

 

 Identifying the Type of teleconsultation:

 

In a professional teleconsultation procedure, there are two types of consultation. 

 

1. First Consult

2. Follow - up Consult

 

Here’s the difference between the first consult and follow-up consult

 

Whenever a Registered Medical Practitioner (RMP) provides teleconsultation to a patient or a caregiver, the process is usually divided into one of two types,

 

First Consult:

 

Certain criteria define if whether your teleconsultation appointment is for the first consult.

·      When a patient is approaching an RMP through teleconsultation for the first time

·       When a patient is approaching the RMP for a second time, but it has been longer than 6 months since the last consultation

·       When a patient approaches the same RMP within six months, but for a different medical condition.

 

When a teleconsultation appointment falls under any of these categories, it is described as a First Consult.

 

Follow-up Consult:

 

Now that you have understood the criteria of a First consult, let’s take a look into what makes your teleconsultation appointment a follow-up consult.

 

·      If a patient or a caregiver consults the same RMP within 6 months, for the same medical condition.

 

This puts the teleconsultation appointment as a Follow - up a consult.

 

However, there are a few conditions here. If the below-mentioned conditions do qualify, then your teleconsultation appointment is not considered as a follow-up consult

 

·       RMP does not recall the context or if the RMP does not remember the previous teleconsultation appointment

·       There are new health symptoms that are not aligned with the medical condition for which you consulted with the RMP

 


When these conditions are qualified, your teleconsultation appointment is considered as a First Consult.

 


Understand the patient management guidelines for offering Health Education, Counselling and medication

 

 In a Teleconsultation appointment, the RMP can offer health education, counseling, and medication for a patient or caretaker if they

satisfy the previously mentioned rules and regulations.

 

 

Offering Health Education:

 

An RMP is approved to give proper Health Education to his patients in a teleconsultation appointment. They can offer advice regarding


·      Diet

·      Exercise

·      Contagious infection prevention

·      Hygiene practices

·      Steps to curb excessive smoking

·      Immunization practices Etc

 

 

As long as this advice is provided professionally with the help of a professional teleconsultation app like Uhapo, it is legal and safe.

 

 

Offering Health and Wellness counseling:

 

An RMP can also offer health counseling for patients who require the service for their comfort. This can include


·      Dosage of drugs like Anti-cancer drugs

·      Home physiotherapy exercises

·      Proper usage of additional support hearing aids

 

And most importantly

 

Advice and instructions that need to be carried out before the next investigation. This also includes support for additional counseling for the upcoming teleconsultation appointments.

 

For Prescribing medicines

 

The Telemedicine guidelines state that RMP’s must maintain the same level of integrity as an in-person consult when they are prescribing medicine. In short, this rule states that the quality of consultation remains the same as when a person would consult a doctor in their clinic or a hospital.

 

 

Limitations for prescribing medicines:

 

As far as it concerns the fact of prescribing medicine through a teleconsultation appointment, RMP's are required to follow many criteria.

 

The Medicines are categorized into four categories, depending upon their potency and the reason for which they are used.


·      List O

·      List A

·      List B

·      Prohibited List

 

 

To better understand them, let’s take a look at the four categories in detail.

 

List O:

 

This includes a list of over the counter medications that are used to cure common health issues.

 

 

Restriction:


They have no restrictions and can be prescribed through any mode of teleconsultation appointment (this includes Audio, Video, and Text).

 

Example of List O Medicines: Paracetamol, cough syrups, and lozenges.

 

 

 List A:

 

These medications can only be prescribed to patients on the first consult and again on the follow-up consult for a refill (If Needed)

 

Restriction

Can be Consulted in the First and Follow up consult, but only through a Video consultation appointment.

 

List B:

 

This includes a list of medications that can be prescribed to the patient in a follow up consult to the RMP.

 

Restriction:

This can only be prescribed by the RMP in a Follow up to consult and not in a First consult.

 

Prohibited List:

 

By all means, no RMP can prescribe the medicine in a prohibited list. Medicines in this list have a very high potential for abuse and should not be prescribed to the patient under any condition.

 

 

Here are the Frameworks for a teleconsultation appointment you should be aware of

 

The telemedicine Guideline states 5 frameworks for five different scenarios that might occur in a teleconsultation appointment.

 


·      RMP to patient

·      RMP to the caregiver

·      RMP to a health care worker

·      RMP to another RMP (for a professional opinion)

·      Emergency Situations

 

 

Let’s take a look at the framework of each of these types

 

RMP to patient

 

1.   First Consult

 

·      Start of teleconsultation with a suitable mode of communication

·       Patient Identification and Consent

·      Quick Assessment

·      Exchange of Information for Patient evaluation

·      Patient management

 

1.    Follow-Up Consult

 

·      Start of a teleconsultation appointment for follow-up

·      Patient Re-identification (If Required)

·      Re-approval of patient consent (If Required 

·      Quick Assessment for Emergency Condition (guidance will be provided by RMP

·      Routine Follow Up

·      Patient Management

 

RMP to Caregiver of patient

 

The caregiver in these terms could be anyone from a relative of the patient to any person authorized to take care of the patient.

 

In this form of Teleconsultation, there could be one of two possibilities.

 

1. The patient is present with the caregiver during the teleconsultation appointment

2. The patient is not present with the caregiver during the appointment

 

In the second condition where the patient is not present, we can divide it further down into 

 

·      The Patient is less than 16 years of age or has been incapacitated with a physical disability or dementia.

·       The caregiver has a registered and verified document that authorizes him to take the teleconsultation appointment for the patient

·       The Caregiver has been explicitly identified by the patient as their caregiver

 

NOTE: Whatever the case, the framework remains the same as the one between RMP and patient.

 

 

RMP to Healthcare Worker

 

This is the situation where a healthcare worker in a Mid-level or district level hospital seeks medical advice from an RMP in a higher level of qualification. In this case, the Healthcare worker is in the role of caretaker for the patient or a representative of the patient.

 

In essence, a Healthcare worker might be anyone from Nurse, Allied Health Professional, or a Mid-level health practitioner. 

 

The process of Teleconsultation appointment between an RMP and a Healthcare worker is as follows

 

1) Start of the teleconsultation by the healthcare worker

 

In this step, the healthcare worker is primarily responsible for taking the consent of the patient as well as educating them about the teleconsultation procedure.  The healthcare worker is also responsible for collecting all the details of the patient like the Patient's age, Name, Address, phone number, etc.

 

 

2) Patient Identification by RMP

 

After the healthcare worker has started the teleconsultation procedure, the doctor has to check with the identification of the patient. This is done to ensure that there is no duplicity of data or proxy at the pace of the patient.

 

 

3) Patient Consent recognition by RMP

 

The RMP must also reconfirm with the consent of the patient before starting the teleconsultation appointment.

 

Now there are two conditions here


·      In Case of Emergency

·      Not an Emergency

 

In case of an emergency, the healthcare worker would immediately contact the RMP and let him know about the emergency. The RMP would then suggest the first-aid procedure along with the next steps, like moving the patient to the hospital or getting them a session with Another experienced RMP for immediate measures.

 

If it is not the case of an Emergency, then the following steps are to be followed

 

4) Exchange for Information of Patient Evaluation

 

The patient would be required to share information about his illness along with medical reports, prescriptions, and previous check-ups (If Any ). The RMP will then make an informed decision with the data available at hand.

 

5) Appropriate Patient management by RMP

 

The RMP will provide appropriate health education and frequent checkups to manage the condition of the patient.

 

What is the role of the healthcare worker in all of this?


The healthcare worker helps the patient follow the advice and the procedures that have been suggested by the RMP. In times of emergency, they are responsible for contacting the RMP or applying the medical advice and the knowledge the RMP has imparted them.

 

RMP to another RMP:

 

There are cases in which an RMP might consult with another RMP for expert advice or a different opinion on a patient's health condition.  In this approach, the RMP seeking an external opinion will be held liable and responsible for the patient. Any advice he takes and implements with his patient from the external RMP will still be the responsibility of the RMP.

 

 

The Guidelines support some forms of technology for the management and prevention of diseases. This includes 


·      Tele-Radiology

·      Tele-Pathology

·      Tele-Ophthalmology

 

Emergency Situations;

 

This is considered to be the most important part of the telemedicine guidelines in India. Under an emergency Condition, the responsibility of the RMP is to

 

·      Advice Proper First-Aid Measures

·      Start a Counsel to identify the seriousness of the Injury/Illness

·       Facilitate Referral for the patient

 

However, in all emergency conditions, the RMP is required to advise the person for an In-Person interaction with a Doctor or Health Professional as soon as possible.

 

 

 

What are the Teleconsultation applications that will rule in the future of the Indian Health Industry?

 

 

As we have stated before the COVID-19 pandemic has transformed hospitals into virus hotspots thereby preventing patients from accessing these hospitals quite easily. Stuck up in their homes and unable to go to these hospitals, patients are now looking at telemedicine as a suitable alternative.

 

Moreover, the shortage of RMP’s and hospital beds has paved the way for teleconsultation apps to rule the future of the Industry. Some of them are

 

·      Practo

·      Docprime

·      Uhapo

·      mFine

·      CallHealth

 

These apps are helping patients with regular (and sometimes advance medical issues) to meet a doctor from the comfort of their home. They can seek professional guidance from RMP's with the Help of Audio, Video, text, or a hybrid of all to solve their health problems.

 

 

Teleconsultation in India is a sure-fire way to reduce the time and cost of medical consultations. Moreover, this can be beneficial for the rural areas, where distance stands as the main challenge for acquiring quality medical services from RMP's.

 

 

With a CAGR (Compound Annual Growth Rate) of 31% and an estimated growth of $5.4bn by 2025, teleconsultation is here to stay in India for a long time.

 

The Sooner we adapt ourselves to telemedicine, the better it is for our nation.

 

Jai Hind

 

 

References:

 

https://www.thehindu.com/sci-tech/science/why-hospitals-are-hotbeds-of-coronavirus-transmission/article31318113.ece

 

https://www.mohfw.gov.in/pdf/Telemedicine.pdf

 

https://arogyalegal.com/2020/article/indias-new-telemedicine-practice-guidelines-analysis-and-dos-and-donts-for-doctors-offering-teleconsultation/

 

https://mciindia.org/MCIRest/open/getDocument?path=/Documents/Public/Portal/LatestNews/Final_FAQ-TELEMEDICINE%20%206-4-2020..pdf

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6618173/