Telemedicine meaning: India's 2020 guidelines, defined Who may practise it, what tools count, what the guidelines exclude, and what they say about prescribing.

Telemedicine, in India's Telemedicine Practice Guidelines of 25 March 2020, takes the World Health Organization's definition: "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." The guidelines were issued by the Board of Governors in supersession of the Medical Council of India, prepared with NITI Aayog, and the document states that it "constitutes Appendix 5 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulation, 2002". That makes them part of the professional conduct rules every allopathic doctor is registered under.

Is telemedicine the same as telehealth?

No. The guidelines separate the two: "telemedicine is used to denote clinical service delivered by a Registered medical practitioner while telehealth is a broader term of use of technology for health and health related services including telemedicine". A health-education video is telehealth; a doctor advising a patient over video is telemedicine.

Who may practise telemedicine in India?

A Registered Medical Practitioner. The guidelines define an RMP as "a person who is enrolled in the State Medical Register or the Indian Medical Register under the IMC Act 1956", and section 1.3.1 says an RMP "is entitled to provide telemedicine consultation to patients from any part of India". Section 1.3.2 holds them to "the same professional and ethical norms and standards as applicable to traditional in-person care". Section 1.3.3 says all RMPs intending to provide online consultation "need to complete a mandatory online course within 3 years of its notification". The guidelines are written for RMPs under the IMC Act; AYUSH practitioners are under their own councils and should check their own council's rules.

What counts as a telemedicine tool?

Almost any channel. Section 1.4.1 says an RMP "may use any telemedicine tool suitable for carrying out technology-based patient consultation e.g. telephone, video, devices connected over LAN, WAN, Internet, mobile or landline phones, Chat Platforms like WhatsApp, Facebook Messenger etc., or Mobile App or internet based digital platforms for telemedicine or data transmission systems like Skype/ email/ fax etc." The scope section says telemedicine "includes all channels of communication with the patient that leverage Information Technology platforms, including Voice, Audio, Text & Digital Data exchange". So a doctor answering a patient's WhatsApp message with advice is practising telemedicine, and the guidelines apply.

What do the guidelines not cover?

The scope section lists the exclusions: "Specifications for hardware or software, infrastructure building & maintenance"; "Data management systems involved; standards and interoperability"; "Use of digital technology to conduct surgical or invasive procedures remotely"; "Other aspects of telehealth such as research and evaluation and continuing education"; and the guidelines do "not provide for consultations outside the jurisdiction of India".

What do the guidelines say about prescribing by telemedicine?

They limit it by list and by mode. Section 3.7.4 says "There are certain limitations on prescribing medicines on consult via telemedicine depending upon the type of consultation and mode of consultation" and sets out List O (medicines "safe to be prescribed through any mode of tele-consultation"), List A (prescribed "during the first consult which is a video consultation" and re-prescribed on follow-up), List B (follow-up additions to an in-person prescription) and a Prohibited List, which includes "Medicines listed in Schedule X of Drug and Cosmetic Act and Rules or any Narcotic and Psychotropic substance". Which medicine sits in which list is a clinical matter: read Annexure 1 of the guidelines and ask your council. Our longer post walks through the guidelines for a clinic: telemedicine guidelines India, a clinic summary.

What does telemedicine look like for a small OPD?

A one-doctor clinic's regular patient, seen in person last month, calls to say the blood pressure tablets are finishing. That call is a follow-up telemedicine consult. The doctor confirms identity, decides whether a phone call is enough or the patient should come in, prescribes within the lists the guidelines allow for that mode, and records the consultation like any other visit. The record-keeping duty is the same as for in-person care; see medical record.