Telemedicine In India and it’s Legal Aspects
Definitions
Telemedicine basically means healing at a distance. The W.H.O. has given an overview of telemedicine as the delivery of health care services, where distance is a critical factor by all healthcare 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.
Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education and training, public health and health administration.
Telehealth, Telemedicine and Telecare
- Telehealth is defined as encompassing a wide variety of technologies. This is utilized by health care professionals to enhance and exacerbate the entire health care delivery system. This definition is not limited to only healthcare but includes non-clinical services, such as training, administrative meetings, continuing medical education, etc.
- Telemedicine on the other hand is a subset of telehealth that refers specifically to clinical services. Health care professionals provide services using the electronic platform and software rather than an interface physical visit to the patient.
- Telemedicine is utilized for follow-up visits, management of chronic conditions, medication management, specialist consultation etc. that is a bridge and labyrinth of technological communication.
- Telecare is the utilization of communication technology to provide infrastructural support remotely. Unlike telehealth and telemedicine, it is continuous, consistent and automatic. Telecare practices monitor patients and mitigate risks while allowing the patients to continue living in their own homes.
- Such risks might include a fall which may need immediate medical attention. Telecare is of paramount importance for senior citizens.
- 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.
Telelmedicine in India
In Utopia, every citizen may have immediate access to the appropriate specialist for medical consultation. In the real world however, this cannot even be a dream. It is a fact of life that “All Men are equal, but some are more equal than others.” We in India are at present, unable to provide even total primary medical care in the rural areas. Secondary and tertiary medical care is not uniformly available even in suburban and urban areas. Incentives to entice specialists to practice even in suburban areas have failed.
In contrast to the bleak scenario in healthcare, computer literacy is developing quickly in India. Healthcare providers are now looking at Telemedicine as their newly found Avatar. Theoretically, it is far easier to set up an excellent telecommunication infrastructure in suburban and rural India than to place hundreds of medical specialists in these places. We have realized that the future of telecommunications lies in satellite-based technology and fiber optic cables.
The Beginning
The Apollo group of hospitals was a pioneer in starting a pilot project at a secondary level hospital in a village called Aragonda 16 km from Chitoor (population 5000, Aragonda project) in Andhra Pradesh. Starting from simple web cameras and ISDN telephone lines today, the village hospital has a state-of-the-art videoconferencing system and a VSAT (Very Small Aperture Terminal) satellite installed by ISRO (Indian Space Research Organization). Coupled with this was the Sriharikota Space Center project (130 km from Chennai) which formed an important launch pad of the Indian Space Research Organization in this field.
Laws applicable to medical practitioners in India
The Registered Medical Practitioner and Telemedicine are required to comply with various laws applicable to medical practitioners in India such as –
- Drugs & Cosmetics Act, 1940
- Drugs & Cosmetics Rules, 1945
- Narcotic Drugs and Psychotropic Substances Act, 1985.
- Indian Medical Council Act, 1956
- National Medical Commission Act, 2019
- Indian Medical Council Professional Conduct, Etiquette and Ethics Amended Regulations, 2002.
- Clinical Establishment Registration and Regulations Act, 2010.
- Information Technology Act, 2000.
- Information technology Intermediary guidelines Rules, 2011.
- Personal Data Protection Bill, 2019
Challenges Being Faced
- Perspective of medical practitioners:Doctors are not fully convinced and familiar with e-medicine.
- Patients’ fear and unfamiliarity:There is a lack of confidence in patients about the outcome of e-Medicine.
- Financial unavailability:The technology and communication costs being too high sometimes make Telemedicine financially unfeasible.
- Lack of basic amenities:In India, nearly 40% of population lives below the poverty level. Basic amenities like transportation, electricity, telecommunication, safe drinking water, primary health services, etc. are missing. No technological advancement can change anything when a person has nothing to change.
- Literacy rate and diversity in languages:Only 65.38% of India’s population is literate with only 2% being well-versed in English.
- Technical constraints:e-medicine supported by various types of software and hardware still needs to mature. For correct diagnosis and pacing of data, we require advanced biological sensors and more bandwidth support.
- Quality aspect:“Quality is the essence” and every one wants it but this can sometimes create problems. In case of healthcare, there is no proper governing body to form guidelines in this respect and motivate the organizations to follow-it is solely left to organizations on how they take it.
- Government Support:The government has limitations and so do private enterprises. Any technology in its primary stage needs care and support. Only the government has the resources and the power to help it survive and grow. There is no such initiative taken by the government to develop it.
Conclusion
It does not require too much of a stretch of imagination to realize that telemedicine will soon be just another way to see a health professional. Remote monitoring has the potential to make every minute count by gathering clinical data from many patients simultaneously. However, information may be lost due to a software glitch or hardware meltdown. Therefore, relying too heavily on a computer system to prevent errors in healthcare data may be problematic. There has to be a smart balance between total dependence on computer solutions and the use of human intelligence. Striking that balance may make all the difference in saving someone’s life. In 2008, the potential of telemedicine, tele-health and e-health is still left to our imaginations. Time alone will tell that Telemedicine is a “forward step in a backward direction” or to paraphrase Neil Armstrong “one small step for IT but one giant leap for Healthcare”.
