Union Health Minister Harsh Vardhan inaugurated a 24x7 National COVID-19 Teleconsultation Centre at AIIMS in New Delhi through which experts will share information and redress the queries of doctors from across the country.

“Through this facility launched at AIIMS, doctors in other hospitals and medical colleges will be provided clinical guidance on managing COVID-19 patients by experts through video conference, Skype, WhatsApp and other modes of communication,” a senior health ministry official said.

What is CoNTeC?

The CoNTeC, an acronym for the COVID-19 Teleconsultation Centre, is a telemedicine hub established by AIIMS, New Delhi, wherein expert doctors from various clinical domains will be available 24x7 to answer the  questions from specialists from all over the country. 

It is a multi-modal telecommunications hub through which two-way audio-video and text communications can be undertaken from any part of the country. 

The modes of communication will include simple mobile telephony as well as two way video communications, using WhatsApp, Skype and Google Duo.

The CoNTeC is also fully integrated with the National Medical College Network (NMCN) to conduct a full fledged video conference between the 50 medical colleges connected through the NMCN with its national resource centre located at SGPGI, Lucknow.

Harsh Vardhan informed that the telemedicine guidelines have also been notified by the government of India and with the help of digital platform and technology, the public will get the benefit for treatment of other diseases also. 

What is telemedicine?

Telemedicine literally means “healing at a distance”. It signifies the use of  information and communication technologies (ICTs) — such as computers, Internet, and cellphones — to improve patient outcomes by increasing access to care and medical information.

WHO has defined telemedicine 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 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”.

There are a number of benefits of telemedicine. It increases timely access to appropriate interventions including faster access and access to services that may not otherwise be available.

Telemedicine in India

For universal outreach of health care services in an affordable manner, the ministry of health and family welfare (MoHFW) has aligned its initiatives along with the Sustainable Development Goals (SDGs) to ensure healthy life and well-being of the citizens. 

MoHFW has proactively taken a leap to utilise the effective fusion of ICTs with existing health infrastructure in meeting the challenges of health care delivery to rural and remote areas to ensure continuum of care.

The key initiatives of the MoHFW in this direction include National Medical College Network, National Telemedicine Network, use of space technology for telemedicine, etc.

Under the National Medical College Network (NMCN) scheme, 50 government medical colleges are being inter-linked with the purpose of tele-education, e-learning and online medical consultation by utilising the connectivity provided by National Knowledge Network (NKN). Under this initiative a virtual layer of specialty/super speciality doctors from these medical colleges is created for providing online medical consultation facility to citizens similar to outpatient department (OPD) facility through a web/ portal.

The states/UTs have been supported under National Health Mission (NHM) under Program Implementation Plan (PIP) for strengthening state telemedicine initiatives to create reliable, ubiquitous and high speed network backbone, all available and future network. 

MoHFW in collaboration with the department of space has set up telemedicine nodes for health awareness, screening of non-communicable disease (NCD) and for providing specialty consultation to the devotees at some pilgrimage centers. 

Indian Space Research Organisation (ISRO) through its department of space (DoS) initiated a nationwide telemedicine (TM) programme in 2001 and provided TM systems hardware, software, communication equipment as well as satellite bandwidth for 384 hospitals, including 60 specialty hospitals, connected to 306 remote/rural/district/medical college hospitals. 

As many as 18 mobile telemedicine units were also enabled for satellite connectivity. These units cover diverse areas of ophthalmology, cardiology, radiology, diabetology, mammography, general medicine, women and child health care.

Significance of telemedicine in India

In India, providing in-person healthcare is challenging, particularly given the large geographical distances and limited resources. 

One of the major advantages of telemedicine is that rural patients need not travel long distances for obtaining consultation and treatment.

In this scenario, telemedicine can provide an optimal solution for not just providing timely and faster access. It would also reduce financial costs associated with travel.

Telemedicine can play a particularly important role in cases where there is no need for the patient to physically see the medical practitioner (or other medical professional) for check-ups or continuous monitoring. 

Telemedicine can reduce the burden on the secondary hospitals. 

With telemedicine, there is higher likelihood of maintenance of records and documentation hence minimises the likelihood of missing out advice from the doctor and other health care staff. Conversely, the doctor has an exact document of the advice provided via tele-consultation. Written documentation increases the legal protection of both parties. 

Telemedicine provides patient’s safety, as well as health workers safety especially in situations where there is risk of contagious infections. 

There are a number of technologies that can be used in telemedicine, which can help patients adhere better to their medication regimens and manage their diseases better. 

Telemedicine can also enable the availability of vital parameters of the patient available to the physician with the help of medical devices such as blood pressure, blood glucose, etc management.

Hence, mainstreaming telemedicine in health systems will minimise inequity and barriers to access. 

India’s digital health policy advocates use of digital tools for improving the efficiency and outcome of the health care system and lays significant focus on the use of telemedicine services.

Telemedicine during an outbreak

Disasters and pandemics pose unique challenges to providing health care. Though telemedicine will not solve them all, it is well suited for scenarios in which medical practitioners can evaluate and manage patients. 

A telemedicine visit can be conducted without exposing staff to viruses/infections in the times of such outbreaks. Telemedicine practice can prevent the transmission of infectious diseases reducing the risks to both health care workers and patients. 

Unnecessary and avoidable exposure of the people involved in delivery of health care can be avoided using telemedicine and patients can be screened remotely. 

It can provide rapid access to medical practitioners who may not be immediately available in person. 

In addition, it makes available extra working hands to provide physical care at the respective health institutions. 

Need for guidelines

In India, till now there was no legislation or guidelines on the practice of telemedicine, through video, phone, Internet based platforms (web/chat/apps etc).

The existing provisions under the Indian Medical Council Act, 1956, the Indian Medical Council (Professional Conduct, Etiquette and Ethics Regulation 2002), Drugs & Cosmetics Act, 1940 and Rules 1945, Clinical Establishment (Registration and Regulation) Act, 2010, Information Technology Act, 2000 and the Information Technology (Reasonable Security Practices and Procedures and Sensitive Personal Data or Information) Rules 2011 primarily govern the practice of medicine and information technology.

Lack of clear guidelines has created significant ambiguity for registered medical professionals, raising doubts on the practice of telemedicine. 

The 2018 judgment of the Bombay High Court had created uncertainty about the place and legitimacy of telemedicine because an appropriate framework does not exist. 

There are some countries that have put in legislative measures and some countries, which follow non-legislative measures such as guidelines to practice telemedicine. 

In some countries guidelines are treated as professional norms that need to be followed by medical practitioners. The health ministry reviewed these and consulted to put together these guidelines to enable medical practitioners to practise telemedicine.

Telemedicine will continue to grow and be adopted by more healthcare practitioners and patients in a wide variety of forms, and these practice guidelines will be a key enabler in fostering its growth.

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