|
 
 |
| LETTER TO EDITOR |
|
| Year : 2021 | Volume
: 11
| Issue : 1 | Page : 62-64 |
|
Telemedicine: An evolving practice in India
Udit Kakar1, Shikhar Tripathi2, Atul Gogia2, Atul Kakar2
1 Student, School of Business, Amity University, Noida, Uttar Pradesh, India
2 Department of Medicine, Sir Ganga Ram Hospital, New Delhi, India
| Date of Submission | 18-Dec-2020 |
| Date of Acceptance | 06-Jan-2021 |
| Date of Web Publication | 19-Feb-2021 |
Correspondence Address:
Dr. Shikhar Tripathi
Department of Medicine, Sir Ganga Ram Hospital, New Delhi
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/cmrp.cmrp_79_20
How to cite this article:
Kakar U, Tripathi S, Gogia A, Kakar A. Telemedicine: An evolving practice in India. Curr Med Res Pract 2021;11:62-4 |
Dear Editor,
Telemedicine has become a very important source of two-way communication between the healthcare worker and the patient. It reduces the travel time of patients and is economical. Tele-consultation is not a new technology, however, this field has improved severalfold and became more popular with patients and hospital authorities due to the ongoing COVID-19 pandemic, which is an expeditiously disseminating outbreak that has proven to have compelling effects on global health and medical groundwork.[1] Telemedicine is defined as ‘The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for the diagnosis, treatment and prevention of disease and injuries, research and evaluation and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities.'[2] It is a brilliant mechanism to provide equitable and equivocal service to everyone while ensuring safety in times of pandemics.
There are several advantages of telemedicine. It is a well-paced approach that leads to early diagnosis as well as prompt treatment of patients, especially for those who cannot access medical services. There is a disparity between the health care services in villages and in major cities. It is a harsh reality that even today many villagers have to travel great distances just to get an opinion about a simple condition. With the recent digitalisation drive, telemedicine can be used to extend optimum and timely healthcare service in rural as well as in urban India. India, as a growing and developing economy has a great scope in the future of healthcare services and should tap this technology to its maximum capacity because of its diffuse and diverse geographical locations. Telemedicine also reduces the cost of consultation and is more economical compared to a conventional consultation.
Telemedicine can decrease the number of hospital admissions by early intervention. It also reduces the footfalls in outpatient departments (OPDs) and the burden on the physicians. Record maintenance is an important aspect of patient care and any patient who has had a teleconsultation should carry a document about what has been prescribed. Written records help to protect maintain data as well as the doctor from any legal consequences.[3] It is also very beneficial to health care workers as they can practice in a safe environment, which is particularly important when there is an outbreak of a highly infectious disease such as the present COVID pandemic. Due to easy access to technology the patient's symptoms can be monitored regularly. This, particularly now, carries high importance as the mortality from COVID-19 is much greater in patients who have comorbidities such as diabetes mellitus, coronary artery disease, kidney problems, cancers or are on immunosuppressive drugs, thus regular monitoring can act as a solid mechanism of precaution.
It is usually provided by a registered medical practitioner (RMP). In conventional situations when a patient comes to a doctor, he records the history, does a physical examination and then suggests some tests and medications. In telemedicine no physical examination can be done as it is across an electronic media divide, still history taking and inspection can provide an overall aid as an alternative for regular in-physical OPD check-ups. Thus, telemedicine goes well with the patients who require a routine check-up. In case of any medical emergency, post a telemedical consultation, the physician can refer the patient to an appropriate centre promptly. This will also involve judicious time management, as the time that the patient shall take to reach the centre post reference by the telemedical physician can be utilised to fulfil all the healthcare centre's formalities and preparations for the patient's examination as well as primary treatment.
The tools required for a tele consult are as follows:
- A telephone connection which can be a landline or mobile service
- Video devices
- Local area network, wide area network connection
- Broadband Internet
- Chat platforms such as ‘WhatsApp', ‘Facebook', messenger.
This only shows how tele-consultation is a very simplified practice which can be professed via multiple media and still require only minimal logistics, with the comfort of home environment for the patient and consultant alike.
Telemedicine is classified into four types, based on the mode of communication used:[4]
- Video - Apps, Video on chat platforms, Skype/Face time, Zoom
- Audio - Phone, VOIP, Apps
- Text based:
- Smartphone apps, websites, other Internet-based systems, etc.,
- General messaging/text/chat platforms (WhatsApp, Google Hangouts, Facebook messenger, etc.).
- Asynchronous (email/Fax etc.).
The old concept of telemedicine was through a satellite connection where a district hospital was connected to a speciality hospital to improve patient care.[5] In this, the communication was from physician to physician. The new concept of telemedicine is simple and the communication can be between patient and physician or between two physicians.
There have been series of events, post-COVID-19, which have led to the development of laws related to telemedicine, in India. The first was that of a law which was one hundred and twenty years old called ‘The Epidemic Diseases Act of 1897’ being revoked. This lead to the Medical Council of India to make a new law, pertaining to telemedicine, for doctors to practice social distancing while consulting, on 25th March 2020. It included advice on who should give telemedicine and which medicines should be prescribed. On 11th April 2020 the list of drugs which could be prescribed over tele-consultation was updated and new drugs were added to the list. With the ever-increasing need as well as demand for telemedicine and tele-consultation, it was exemplary to bring out the new law, which could address the need of the hour, that was social distancing and soon adapted to the contemporary scenario so as to dwell into the everyday practice of medicine and increase accessibility to medicine for everyone around the country, at the comfort of their homes.
The salient features and advantages of the telemedicine law, 2020 are as follows:[6]
- Telemedicine is now available for use by any consultant for prescription and for health education. It helps both the community and individual professionals, in diagnosis, treatment and presentation
- The minimum requirement to profess telemedicine is to be a RMP
- Telemedicine is important in resource-constrained countries, and especially in rural areas where the patient would be required to travel to a health care facility to obtain an opinion. This reduces the travel time and is also cheaper than a normal consultation
- Telemedicine has a distinct place in certain physical conditions and also in natural disasters, epidemics or pandemics- as it has proven to be during COVID-19
- Emergency telemedicine should be limited to giving first aid measures and advising the attendants about which hospital the patient should be referred
- What is considered to be a first consultation? Any person who consults a physician for the first time. Any person who has consulted earlier, but there has been a gap of >6 months from the last consultation, any person who has consulted earlier but this time has a new problem, is referred to as a first consultation
- What is considered to be a follow-up? Any patient who consults the same doctor within six months of the previous encounter is considered to be a follow-up. However, in case any new symptoms have arisen or the details of the previous consultation are not available to that doctor, it should be considered a new one
- There is also a restriction on which medicines can be prescribed in telemedicine, and the list contains list O (the medicines that can be safety given, the medicines that can be prescribed during the first consultation, or on follow-up). List A- can only be prescribed via video, and list B (which consists of medicine that the doctor can prescribe on follow-up) and finally there is a list called the prohibited list (this list cannot be prescribed as it contains potent drugs which can be abused by or harm the patient.
All of these features of the new law exhibit the visionary approach towards the acclimatisation of our profession to the modern needs and demands of a patient, and we can conclude that these laws shall help a patient and consultant alike.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Tripathi S, Gogia A, Kakar A. COVID-19 in pregnancy: A review. J Family Med Prim Care 2020;9:4536-40.  [Full text] |
| 2. | Mahajan V, Singh T, Azad C. Using telemedicine during the COVID-19 pandemic. Indian Pediatr 2020;57:652-7. |
| 3. | Combi C, Pozzani G, Pozzi G. Telemedicine for developing countries. A survey and some design issues. Appl Clin Inform 2016;7:1025-50. |
| 4. | Maia MR, Castela E, Pires A, Lapão LV. How to develop a sustainable telemedicine service? A pediatric telecardiology service 20 years on – An exploratory study. BMC Health Serv Res 2019;19:681. |
| 5. | Mishra SK, Kapoor L, Singh IP. Telemedicine in India: Current scenario and the future. Telemed J E Health 2009;15:568-75. |
| 6. | |
|
Search Pubmed for