In a significant development last week, the Board of Governors (BoG) of the Medical Council of India (MCI) in partnership with NITI Aayog, issued clear guidelines approving the use of telemedicine to prevent the transmission of Coronavirus (COVID-19) and mitigate the risks to both patients and more importantly, healthcare workers.
How do you define telemedicine?
According to the World Health Organization (WHO), telemedicine includes, “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.”
Speaking to The Better India, Dr Alexander Kuruvilla, the Chief Strategy Officer at Practo, a digital healthcare platform with over 2 crore users, explains how these guidelines can help and why telemedicine is a necessity.
“It’s a great step by the authorities to issue these guidelines. If you are asking for social distancing, you can’t have hospitals flooded with people carrying all sorts of symptoms—this raises the possibility of mass transmission. In these circumstances, unnecessary and avoidable exposure of the people involved in the delivery of healthcare can be avoided using telemedicine and patients can be screened remotely. At this juncture, what we needed the most were definitive guidelines clearing the air about the legality of teleconsult and putting everything together as a matter of policy,” says Dr Kuruvilla.
As per the WHO, the recommended doctor to population ratio is 1:1000, whereas, in India, we currently stand at 1:1700. Hospitals are crowded, and routine check-up visits and preliminary investigation must be avoided while we gear up to address COVID-19.
Telemedicine can address outpatient queries, allowing hospitals to address those that are symptomatic and are critical.
“Teleconsulting is something doctors can use to remotely screen patients and based on the protocol issued by local authorities identify which patients need to get further tested. The other massive advantage of telescreening is that at any given point in time, we have a limited amount of test kits. So, if everybody runs in to get themselves tested then, there may not be enough testing kits to test who may need it the most,” adds Dr Kuruvilla.
As per the guidelines, doctors may use any telemedicine tool suitable for carrying out technology-based patient consultation. For example, telephone, video, devices connected over LAN, WAN, Internet, mobile or landline phones, Chat Platforms like WhatsApp, Facebook Messenger or Mobile App or internet-based digital platforms for telemedicine or data transmission systems like Skype/ email/ fax etc.
“Telemedicine services should, however, be avoided for emergency care when alternative in-person care is available, and telemedicine consultation should be limited to first aid, life-saving measure, counselling and advice on referral,” state the guidelines.
“A reasonable clinical examination can be done remotely. All that is required is a dependable bandwidth and good inexpensive video software. Fever, cough, shortness of breath can all be evaluated from a distance. A good torch at the remote end can be used to illuminate the throat and nose of a suspected contact. This can clearly be seen by the healthcare provider wherever he/she is. Digital stethoscopes can transmit lung and heart sounds to arrive at an efficient diagnosis. The audio file can have a description of the sounds with a provisional diagnosis which the clinician at the other end can confirm. Blood pressure, pulse rate, respiratory rate, oxygen saturation and temperature can be monitored remotely,” writes Professor A Ganapathy, director of Apollo Telemedicine Foundation, for Times of India.
Whether you should get tested or not is based on proper history taking of the patient and a clear understanding of the symptoms.
For example, if a patient’s throat has worsened from Day 1 to Day 3, and they have body pain, dry coughs, headaches, etc. the said patient is asked to go for a test. If it comes back positive, the treatment shifts into the hands of a hospital, which goes much beyond the gamut of teleconsulting.
Who can perform a teleconsult?
Only a Registered Medical Practitioner (RMP) enrolled in the State Medical Register or the Indian Medical Register under the Indian Medical Council Act 1956. However, there is an additional caveat stated in the guidelines.
“All RMPs intending to provide online consultation need to complete a mandatory online course within three years of its notification. In the interim period, the principles mentioned in these guidelines need to be followed. Thereafter, undergoing and qualifying such a course, as prescribed, will be essential prior to the practice of telemedicine,” it states.
A fundamental point stated in the guidelines is that neither the patient nor doctor can remain anonymous to each other. An RMP 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, RMPs should begin the consultation by informing the patient about his/her name and qualifications, besides displaying the registration number accorded to him/her by the State Medical Council/MCI, on prescriptions, electronic communications and receipts given to his/her patients
On the subject of medical prescriptions, RMPs can issue them for specific drugs.
These drugs have been set into four categories:
1) List O (for common conditions and over the counter like paracetamol, ORS solutions, cough lozenges, etc. or medicines deemed necessary during public health emergencies
2) List A (prescribed during the first consult including relatively safe medicines with low potential for abuse);
3) List B (for a patient undergoing a consult for the same medical condition)
4) Prohibited List (RMPs cannot prescribe medicines listed in Schedule X of Drug and Cosmetic Act and Rules or any Narcotic and Psychotropic substances listed in the NDPS Act, 1985)
“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, teleconsultation would be allowed only if the minor is consulting along-with an adult whose identity needs to be ascertained,” the guidelines state.
Beyond all the above-stated advantages of telemedicine, there is a higher likelihood of maintenance of records and documentation. This minimises the likelihood of missing out advice from the doctor.
It is incumbent on the RMPs to maintain all necessary documents, and safeguard patient privacy. RMPs will have to fully abide by the Indian Medical Council Regulations, 2002. They can be held liable if regulations aren’t followed.
To conclude, telemedicine is one of the best ways to ensure maximum coverage and attention to those facing symptoms similar to that of COVID-19 while guaranteeing the minimum spread of the virus. There are multiple service providers you can approach.
It is the first line of defence before people feel it is required for them to visit hospitals. Moreover, teleconsultation will prevent people from self-medication, which leads to other complications and can also lead to ignoring symptoms related to the virus.
(Edited by Gayatri Mishra)