In March 2020, the Board of Governors at the Medical Council of India officially authorized Registered Medical Practitioners in India to provide healthcare using telemedicine.

A set of guidelines was put in place, and applies to Registered Medical Practitioners under the Indian Medical Council Act, 1956.

ELIGIBILITY

• An online course/programme will be developed and made available by the Board of Governors in supersession of the Medical Council of India.
• All registered medical practitioners intending to practice telemedicine must complete this mandatory online course within three years of notification.
• A registered medical practitioner is entitled to practice telemedicine only after completing the online course training and qualifying them for the same.

TOOLS FOR TELEMEDICINE

A registered medical practitioner can use any telemedicine tool suitable for carrying out technology-based patient consultation.Telemedicine includes all channels of communication with a patient that leverage Information Technology platforms, such as voice, audio, video, text, and digital data exchange.

The practice of telemedicine consists of four main components:

1. Mode of communication: Video, audio, and/or text. This can include a mobile or landline telephone, email and/or fax, devices connected over Local Area Network or Wide Area Network, chat platforms such as WhatsApp, Facebook Messenger, Google Chat and Google Hangouts, mobile applications for tele-consultations, audio-visual data transmission systems such as Skype, or Internet-based digital platforms for telemedicine.
2. Timing of information transmitted: Real-time audio/video and asynchronous transmission of information
3. Purpose of consultation: New consultation , follow-up, emergency consult for immediate assistance, first-aid, etc.
4. Individuals involved: Patient–Registered medical practitioner, Caregiver–Registered medical practitioner, Registered medical practitioner–Registered medical practitioner or Health worker–Registered medical practitioner.

GUIDELINES FOR TELEMEDICINE IN INDIA

As per designated guidelines for the practice of telemedicine in India, seven points are to be considered before any telemedicine consultation:

1. Context: It should be verifiably determined and clearly communicated that telemedicine is in the patient’s interest, taking into account a holistic assessment of a given situation.
2. Identification:
   1. The patient should have access to a mechanism that verifies the credentials and contact details of the registered medical practitioner being consulted.
   2. The registered medical practitioner should display the registration number accorded to them by the State Medical Council/Medical Council of India, on the platform being used for teleconsultation, prescriptions, electronic communications and receipts given to the patient.
3. Mode of communication: Video, audio and/or text
4. Consent:
   1. Patient consent is implied when the patient initiates a telemedicine consultation.
   2. Explicit patient consent is required if a health worker, registered medical practitioner, or caregiver initiates a telemedicine consultation.
   3. The registered medical practitioner must document explicit patient consent in the patient records.
   4. Explicit patient consent can be recorded in the following forms: An email, text, audio/video message, intent stated clearly to the registered medical practitioner on an audio or video call (“Yes, I consent to avail consultation via telemedicine” or a similar communication).
5. Type of consultation: New consultation, follow-up, emergency, or first-aid
6. Patient evaluation: The medical records of the patient must be thoroughly evaluated by the consulting registered medical practitioner prior to the teleconsultation.
7. Patient management: Health education, counseling, and medication.

PRESCRIBING MEDICATION

Prescribing medicines without an appropriate or provisional diagnosis will amount to a professional misconduct on the part of the registered medical practitioner.

• The categories of medicines that can be prescribed are as follows:
  • List O: Can be prescribed through any mode of teleconsultation. These include paracetamol, ORS solutions, cough lozenges etc.
  • List A: Can be prescribed during the first (video) consultation and re-prescribed for refill in case of a follow-up consultation.
  • List B: Can be prescribedduring a follow-up consultation in addition to the medicines that have been prescribed during an in-person consultation for the same medical condition.
  • Prohibited list: Medicines listed in Schedule X of the Drugs and Cosmetics Act and Rules, or any narcotic and/orpsychotropic substance listed in the Narcotic Drugs and Psychotropic Substances Act, 1985.
• When prescribing medicines, the registered medical practitioner should issue a prescription as per the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, and shall not contravene the provisions of the Drugs and Cosmetics Act and Rules.

FRAMEWORK FOR TELEMEDICINE

1. Start of a telemedicine consultation for the first consult
2. Patient identification and consent
3. Quick assessment
4. Exchange of information for patient evaluation
5. Patient management
   
   

GUIDELINES FOR TECHNOLOGY PLATFORMS ENABLING TELEMEDICINE

• It must be ensured that patients are consulting registered medical practitioners qualified for telemedicine consultation.
• The platform must provide the name, qualifications, contact details and registration number of every registered medical practitioner listed on it.
• Platforms based on Artificial Intelligence/Machine Learning are not permitted to counsel a patient or prescribe any medication.