The Medical Council of India, in partnership with NITI Aayog, recently released guidelines for the practice of telemedicine. Considering the current COVID-19 outbreak, the guidelines could not have been released at a more apt time. Using telemedicine is a safe way of screening and treating patients in times of infectious outbreaks.
It ensures the safety of doctors, as they do not need to be in the physical vicinity of a patient. Besides outbreak situations, telemedicine is also of great help where healthcare facilities are not easily available or accessible. It saves patients the time taken to travel long distances for minor illnesses. While the telemedicine practice guidelines have paved the way for more efficient practices in healthcare, it is imperative to have the infrastructure and the funding in place, for their implementation on ground.
Final Call Taken By Registered Medical Practitioner & NOT Via AI Or Machine Learning
The purpose of the guidelines is to encourage doctors to use telemedicine, not just in times of outbreaks, but also as a part of regular practice. The guidelines are intended to help doctors pursue an appropriate course of action, based on available information and resources. The document specifically mentions the aspects it excludes – specifications for hardware/software, data management systems, use of telemedicine for conducting surgery, research and evaluation.
The guidelines do not cater to consultations outside the jurisdiction of India.
It categorises the modes of telemedicine into three types – audio (internet calls, regular calls), video (WhatsApp, Skype, etc) and text (online messaging apps, network messaging service). It emphasises on proper identification of patients by registered medical practitioners (RMPs) and vice versa. It also addresses the requirement of consent for telemedicine, by the patient. It asks for confidentiality and privacy of data to be observed in accordance with the IT (Amendment) Act, 2008. The guidelines have chalked out the framework for first time consultation and follow up, so that a common protocol can be followed by the RMPs. It does not allow for Artificial Intelligence/Machine Learning to counsel patients or prescribe any medicine. The final call has to be strictly taken by the RMP.
Telemedicine Outreach: A Missed Opportunity?
Prescribing medicines through telemedicine has to be done with great precaution. The guidelines divide the drugs into four categories – List O, List A, List B and Prohibited. List O includes the commonly used over-the-counter drugs such as paracetamol, antacids, ORS etc. List A medications are drugs prescribed during first consult (video consultation) and are relatively safe, with low potential for abuse. List B includes add-on medications which are used to optimise an existing condition. The prohibited list refers to drugs such as narcotics and psychotropic substances which have a greater potential for abuse. The document also provides for the RMP to send the prescription directly to the pharmacy, only on patient’s consent.
While the guidelines address issues such as identification, confidentiality and privacy, prescription, it has missed out on the opportunity to strengthen the outreach of telemedicine. Primarily, the target user base for telemedicine is people who cannot access healthcare facilities, which happens to be the case in most of the rural areas of India.
But the question is: does India have enough infrastructure, especially in remote rural areas, for doctors to practice telemedicine and for rural people to avail of the benefit?
A report published by Internet and Mobile Association of India (2019), states that India has 451 million active Internet users. However, the overall internet penetration in the country is just 36 percent. The number of urban and rural internet users is almost the same, in terms of absolute users. When you look at those numbers in terms of percentage, there is a huge disparity between urban and rural population, with urban India having a considerably high penetration.
Health Data Storage & Privacy Concerns
As mentioned before, the guidelines specifically exclude any technical specifications. This can be complemented by the telemedicine guidelines released in 2019, for Ayushman Bharat – Health and Wellness Centres (HWCs). The 2019 guidelines specify the kind of infrastructure that will be needed, so as to ensure minimum standards and interoperability. The telemedicine practice guidelines make it compulsory for the RMP to maintain a record of all teleconsultations and prescriptions.
However, there is no mention of how to store the healthcare data. With no guidelines for the same, it will be difficult to ensure the privacy and confidentiality.
Telemedicine has a lot of potential in a country like India, where the digital divide is narrowing year by year. Only if the guidelines of 2019 regarding the budget allocation and infrastructure for telemedicine are implemented, will it be possible for the RMPs to efficiently practice telemedicine.
India has a poor doctor-population ratio, and implementing the telemedicine practice guidelines will hopefully help in alleviating the burden of the doctors. According to a McKinsey report (2019), it could free up to 15 percent of the doctors’ time. Along with saving time, it can help in reducing the urban-rural health disparity as well. It can make primary health settings more efficient, in terms of providing referral services for people who are not able to visit higher health facilities. Given its scarce resources and increasing health needs, it is the right time for India to optimise the potential of telemedicine and improve the public health scenario.
(Sunila Dixit is a Research Analyst at The Takshashila Institution. This is an opinion piece and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for them.)
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