Telemedicine Practice Guidelines Research Articles

Assessment of the Practices and Perspectives of Healthcare Providers Towards Utilization of Telemedicine for the Care of Adult Patients With Diabetes Mellitus During the COVID-19 Pandemic in India.

Background and purpose The lockdowns and restrictions enforced periodically during the COVID-19 pandemic posed a serious challenge for non-COVID care, especially in diabetes where telediabetes, the utilization of telemedicine consultations for diabetic care, became more necessary than ever before. Although studies have shed light on the perception of patients, there is a paucity of studies from the perspective of healthcare providers, especially in an Indian context. Moving forward, it is imperative to understand the perspectives of telediabetes providers in this domain. Hence, a nationwide survey was carried out to assess providers' practices and perspectives towards using telemedicine for providing diabetes care in India during the COVID-19 pandemic and beyond. Methods An online questionnaire-based, cross-sectional study was carried out involving diabetes care physicians. The study tool was developed after the identification of broad themes and constructs from published literature, national guidelines, and diabetes experts' recommendations, following which, it was validated by six experts and pilot-tested.An online open survey, hosted on a professional platform, was circulated to internists, endocrinologists, and other diabetes care physicians of various institutions, hospitals, and clinics from both public and private sectors across the country through individual and group emails and various mobile messenger services. Results Out of the 239 doctors who responded to the survey, 195 (81.6%) had provided telediabetes services since the COVID-19 outbreak, and 84.1% were actively providing teleconsultations for diabetes at the time of the survey. The majority of participants (63.2%) were private practitioners. Telediabetes engagement was 3.5 hours per day at the peak of the pandemic and reduced significantly to one hour after the end of the pandemic. Video calling was the most preferred modality for consultation, whereas messaging services were preferred for input from the patients. Printed prescription images followed by text messages were the common modalities for sending treatment advice. The overall perception towards telediabetes was positive (50.1%). Most physicians reported being reasonably and somewhat aware (65.6% and 20.5%, respectively) of telemedicine practice guidelines but were not sure about the extent of compliance. Conclusions Our study sheds light not only on the utilization of telediabetes from physicians' perspectives and practices but also on its acceptability while identifying areas requiring clarity and focus moving forward.

HAS TELEMEDICINE REDUCED THE BURDEN ON STRAINED HEALTHCARE SYSTEM OF INDIA DURING COVID-19 PANDEMIC? APOLLO TELEHEALTH’S “DOC ON CALL” SERVICE - A DESCRIPTIVE REVIEW

As a part of nding a solution to reduce the impact on the already overburdened healthcare system, Ministry of health and family welfare, Government of India and Medical council of India have ofcially released telemedicine practice guidelines in March 2020. Doc on Call audio Teleconsultation service by Apollo Telehealth (ATH) emerged out as a cornerstone to meet the sudden high demand during Covid-19. Doc on call provides immediate and round the clock telephone access to Apollo Telehealth’s general physicians and specialist doctors. The aim of the study was to understand the impact of Doc on Call audio Teleconsultation services in reducing the burden on strained healthcare system of India, during Covid-19 pandemic. A descriptive analysis of audio teleconsultations done through Doc on call service,related to Covid 19 from March 2020 to August 2021 was conducted. Doc on Call services expedited healthcare reach to isolated Covid-19 patients, if not, would have visited overburdened hospital affected by this crisis. Telemedicine through Doc on Call has proven to be a very formidable technological tool to help patients recover from COVID 19 under expert medical care without getting hospitalised unnecessarily

Telemedicine practice guidelines in India: Global implications in the wake of the COVID‐19 pandemic

Telemedicine is the delivery of healthcare services from a distance, by use of information and communication technology. There have been no statutory regulations or official guidelines in India specific for telemedicine practice and allied matters so far. For the first time, the government of India released telemedicine practice guidelines for Registered Medical Practitioners on March 25, 2020, amid the COVID‐19 outbreak. This review would initiate the discussion on the features of the guidelines, their limitations, and their significance in times of the COVID‐19 pandemic. The guidelines are with a restricted scope for providing medical consultation to patients, excluding other aspects of telemedicine such as research and evaluation and the continuing education of healthcare workers. The guidelines have elaborated on the eligibility for practicing Telemedicine in India, the modes and types of teleconsultations, delved into the doctor‐patient relationship, consent, and management protocols, and touched upon the data security and privacy aspects of Teleconsultation. After releasing the guidelines, the telescreening of the public for COVID‐19 symptoms is being advocated by the government of India. COVID‐19 National Teleconsultation Centre (CoNTeC) has been initiated, which connects the doctors across India to All India Institute of Medical Sciences (AIIMS) in real‐time for accessing expert guidance on the treatment of the COVID‐19 patients.

The prescriptions of psychotropic medications in telepsychiatry: An online survey of psychiatrists in India.

Context:Over the years, telepsychiatry services have expanded in many institutes. The Telemedicine Practice Guidelines and Telepsychiatry Operational Guidelines (TPOG) released in 2020 have been received by the fraternity with a mixture of apprehension, relief, and dissatisfaction on the list of drugs provided in Lists O, A, B, and C. Many psychiatrists have raised the issues of having a consensus in the formulation of List A.Aims:To draw consensus on the medications that can be listed in Lists O, A, B, and C in TPOG-2020.Settings and Design:This was an online survey with ethics approval by the Indian Psychiatric Society Ethics Review Board. All psychiatrists, who are members of the Indian Psychiatric Society and whose E-mail address was available with the society, were sent the survey link by E-mail.Methodology:Opinions and suggestions on Lists O, A, B, and C of TPOG-2020 and reasons for the suggestions were collected.Statistical Analysis Used:Frequency, percentages, mean, and standard deviation were calculated. T-test and Chi-square tests were used to see the influence of demographics on the concurrence of the lists.Results:Responses from 340 responders were analyzed. Majority of the responders agreed that List O (277, 85.5%), List B (263, 82.4%), and List C (223, 69%) are apt except for List A (162, 50.3%).Conclusions:This online survey showed that majority of the responders agreed to the lists except for List A. The approach taken to include the medications in List A, which was to include the essential drugs, has various benefits. However, the lists are not final, and the results of this survey may become an impetus to modify the list in the next edition of TPOG.

Current telepsychiatry practice in India - An online survey of psychiatrists.

Context:Telemedicine Practice Guidelines and Telepsychiatry Operational Guidelines released in 2020 have provided legal backing for telepsychiatry practice.Aims:To understand the current telepsychiatry practices in India.Settings and Design:An online survey was conducted after ethics approval by the IPS Ethics Review Board. All psychiatrists, who are members of the Indian Psychiatric Society and whose email address was available with the society, were sent the survey link by email.Methods and Material:Information about existing telepsychiatry consultation practices in India was collected between June and July 2020.Statistical Analysis Used:Frequency, percentages, mean, and standard deviation were calculated.Results:340 responses were analyzed. Nearly three-fourths of the responders used smartphones (n = 260, 76.47%) for audio consultations (n = 196, 57.65%). Among those who were using a dedicated software (n = 36), one-third used the Zoom software (n = 12, 33.33%). Nearly three-fourths (n = 218, 73.4%) provided prescriptions with their registration number on a letterhead in the form of an email or text message. Two-thirds of the responders (n = 228, 67.06%) felt that in-person consultation is better. Many preferred a combination of voice, video, and text including emails (n = 134, 42.01%).Conclusions:This online survey showed that the use of technology has caught up with the practicing psychiatrists. Many are practicing telepsychiatry either formally or informally in India and are comfortable and satisfied with the telepractice.

A Review of Telemedicine Practice Guidelines for COVID-19 and Global Emergencies.

An incorrect version of this manuscript was published online and so has been withdrawn.

Ethical and Legal Issues in Psychotherapy.

Ethical and Legal Issues in Psychotherapy.

A survey of awareness, knowledge, attitude, and skills of telemedicine among healthcare professionals in India

BackgroundTelemedicine Practice Guidelines were promulgated in India in 2020. There is little information about the awareness, knowledge, attitude and skills (AKAS) of the healthcare professionals regarding telemedicine and its practice guidelines a year after. The aim of the study was to study the awareness, knowledge, attitudes and skills of the healthcare workers of the country about telemedicine especially in the context of telemedicine practice guidelines 2020. MethodsAn online survey was conducted over 12 weeks from active healthcare workers in India. A standard AKAS Questionnaire for telemedicine and other close and open ended questions were used. ResultsA total of 602 active healthcare workers participated in the study. It was seen that a majority of participants had high scores for awareness, knowledge, and attitude toward telemedicine but a mere 39.53% scored high for skills related to telemedicine. A majority of the respondents had no knowledge of the existence of telemedicine practice guidelines and very few had seen or read them. A majority of the respondents were keen to attend a course or training to enhance their understanding and practice of telemedicine. ConclusionThe results of the study show that the basic awareness and background knowledge regarding telemedicine exists in the healthcare professionals in the country. The requirement is to train and educate them about the skills and provisions of the telemedicine practice guidelines 2020 to ensure optimal use of telemedicine and to avoid medico-legal issues.

Telemedicine and ethics: opportunities in India.

Prior to the Covid-19 pandemic, telemedicine was an upcoming modality of diagnosis and treatment, but was limited by inadequate guidelines and legislation. Now, during the pandemic, policy makers worldwide have found it prudent to set forth new telemedicine guidelines to ease and regulate operations. The Government of India, along with the Board of Governors (in supercession of the Medical Council of India), amended the Indian Medical Council Act, 1956, and published the Telemedicine Practice Guidelines in 2020 to lay down a framework for telemedicine practice in our country. This step will provide a medico-legal context for the delivery of online health services. However, the Guidelines in their present form only partly address the ethical aspects of telemedicine in India. Here, we briefly describe these Guidelines and highlight the ethical concerns surrounding the teleconsultation process in our country. We also suggest possible solutions to these ethical issues surrounding the practice of telemedicine.

Telemedicine in Geriatric Psychiatry: Relevance in India.

Telemedicine has evolved as a novel tool in delivering health care in the modern world. With the advancement in video conferencing technology at an affordable price and innovative digital medical instruments, it has grown from guiding paramedics in managing patients to aiding physicians in providing direct consultation. Delivering care for older adults has always been challenging due to comorbidities that may warrant a multidisciplinary approach leading to frequent visits across specialties. As per the preliminary reports of the Longitudinal Aging Study in India, 55% of this population suffers from any chronic illness, of which 40% have some form of disability and 20% deal with mental health issues. Over the years, telepsychiatry care for older adults has received increasing acceptability. Videoconferencing with improved connectivity and transmission rates has aided in evaluating, assessing, and providing mental health interventions at ease. The recent regulation of telemedicine practice in the country by rolling out the Telemedicine Practice Guidelines 2020 and Telepsychiatry Operational Guidelines 2020 has fast-tracked its utility during the COVID-19 pandemic. Concerns of physical examination, psychological satisfaction of consulting physician in person, confidentiality, and security of information shared are points that need better addressing in the future. However, Telemedicine is recommended to be used judiciously, taking the risk and benefit of older adults on a case basis as it can significantly bring down the financial and emotional burden.

Teledermatology: The New Normal?

Teledermatology: The New Normal?

The Telepsychiatry Operational Guidelines 2020 in India: a welcome step.

The release of the Telepsychiatry Operational Guidelines 2020 in India, during the COVID-19 pandemic, is a relief for both clinicians and patients. These guidelines embark on initiating and executing naive and recently started telepsychiatry services in India. The document is aligned with other ethical regulations, policies, laws and the 2020 Telemedicine Practice Guidelines in India. This paper discusses a few points about the broader applicability of the guideline for the benefit of humankind in the prevailing healthcare crisis. The guidelines may be extrapolated in policy-making for telepsychiatry services in other low- and middle-income countries sharing a similar socioeconomic, cultural and political milieu.

Incorporating Hahnemannian principles in the practice of tele-homoeopathy: Current scenario and future possibilities

Objectives: The COVID-19 pandemic prevented people from accessing medical care in person; in such a scenario, telemedicine emerged as a boon. Telemedicine helped to increase the availability of homoeopathy during the pandemic. The Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) formulated guidelines to enable registered homoeopathic practitioners (RHPs) to safely provide healthcare using telemedicine. In this study, we demonstrated the scope of telemedicine in homoeopathic practice by incorporating Hahnemannian principles in a case-based learning (CBL) module. Materials and Methods: A retrospective purposive study was conducted on 10 acute cases that were treated with homoeopathy through telemedicine during the COVID-19 lockdown. Patient-physician communications were analysed using Hahnemannian principles. Cases were assessed based on telecommunication application, type of consent, symptoms, signs, nosological provisional diagnosis, risk assessment, comorbidity, miasm and susceptibility status, totality of symptoms, repetition strategy and type of consult. Therapeutic management included building a logical framework of the case and auxiliary counselling. Patients were followed up to determine their health status. Results: All 10 cases were successfully treated with homoeopathy using AYUSH Telemedicine Practice Guidelines (ATPG) and incorporating Hahnemannian principles. Tele-homoeopathy was found to be effective in the pandemic by preventing disease spread and progression from mild to severe stage. Conclusion: Adhering to the ATPG and incorporating Hahnemannian principles can be effectively demonstrated through CBL modules; these enable RHPs to develop rational thinking and learn from clinical experiences.

Education and Training for Ethical Practice of Telemedicine for Registered Medical Practitioners in India

The Telemedicine Practice Guidelines (TPG) released in 2020 provide legal framework for registered medical practitioners (RMPs) to consult with patients deploying Information and Communication Technology. Necessary compliance requirements have also been included. This article analyses the effectiveness of the ‘Train to Practice’ course designed by the Telemedicine Society of India to train doctors in India to follow ethical and safe standards of practice of telemedicine. The online course was taught by a faculty of 18 members, over a period of 6 months using four modules. The course comprised of a pre-course assessment, live lectures, and a post-course assessment to ascertain the level of preparedness and knowledge imparted to the RMPs by way of the course. The article highlights that the RMPs had a preliminary understanding of the concept of telemedicine prior to the course. Post-course assessment indicated improvement in knowledge levels. Pre- and post-course assessments were conducted using multiple choice Yes or No response-based questionnaires. Participating RMPs exhibited a real drive to understand the legalities and operational procedures of the practice of telemedicine as was evidenced by queries posed to the lecturers. While the course was rated generously by all the attendee RMPs, there were also evidences of a lack of seriousness from certain RMPs who did not have to pay for participating in the course. The researchers have also suggested that the presence of a TPG qualification paper online and the swift introduction of TPG aligned courses in medical schools would streamline implementation challenges in the future. The researchers have also recommended the amendment of the TPG and the Medical Council of India (MCI) Code of Ethics Regulations, 2002, to provide better protection to RMPs from possible litigation occurring during telemedicine practice.

Telepsychiatry During the COVID Pandemic: Reflection from India

Introduction: Recent advancements in information technology and access to smartphone have expanded the scope of healthcare delivery services across the globe. Telemedicine is making healthcare affordable and more accessible to the needy in situations like the present pandemic. Although telepsychiatry services were underutilised initially in India due to various barriers, its role in delivering healthcare services, has gained pace since the last few years. During the coronavirus disease (COVID-19) pandemic, India introduced telemedicine practice guidelines (March, 2020), and telepsychiatry operational guidelines (May, 2020), to remove barriers and promote equitable access. In the wake of COVID-19 pandemic various mental health institutes across India relied heavily upon telepsychiatry services to provide care. National Institute of Mental Health and Neuro Sciences, Bangalore being an Institute of National Importance has introduced different modules to provide clinical care to the mentally ill. Objectives: In this article, the authors provide an experiential account of various clinical services provided by our institute through telepsychiatry means across India during the COVID-19 pandemic. Conclusion: These clinical service modules have tremendous potential to increase the use of technology in providing quality care to the unreached population, bridging the treatment gap for psychiatric disorders globally and developing countries in particular.

Telemedicine : Guidelines in India and its Importance in COVID Pandemic

Social Distancing became the new norm in the COVID 19 pandemic. While at one side the world-widemedical fraternity is finding ways to combat the viral infection, there were patients with existing illness whoneeded follow-up care. The role of Telemedicine became important under such circumstances.A study conducted by Earnst & Young (EY) in association with Indian Pharmaceutical Alliance (IPA)[Mar’20], estimated the Telemedicine market in India to reach $5.5 billion By 2025[3]. These telemedicinecompanies offer services like teleconsultation, e-prescription, e-pharmacy and online ordering & schedulingof laboratory investigations.Just after the start of statutory lockdown in India in view of COVID pandemic, on 25 March’2020, theBOARD OF GOVERNORS in supersession of the Medical Council of India notified the “TelemedicinePractice Guidelines” to enable R.M.P.s to provide healthcare using Telemedicine [7]. [This constitutesAppendix 5 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics Regulation, 2002]Although the practice of Telemedicine was going on in some form or the other in the last two decades, butthere was a question with respect to its legitimacy and acceptance by the medical fraternity at large. Thenotification of these guidelines has cleared the picture to a large extent and lays the foundation for this newtool of medicine practice.This article is a peak into the current guidelines of Telemedicine in India and its usefulness in the COVIDpandemic.

Telemedicine practice guidelines in India: Medico legal implications

Providing in-person healthcare services is challenging, especially in a vast country like India, where most of its citizens reside in the rural area. In this scenario, telemedicine can provide faster and timely healthcare services to the needy ones where distance is the critical factor. Healthcare seekers need not travel long miles for obtaining treatment and consultation. In most situation, telemedicine services are beneficial to the patients. A person staying in far remote area may access healthcare facility through telemedicine, thus avoiding issues related to mobility of the patient especially in elderly and debilitated patients. On the other side, telemedicine has its own limitation due to its virtuality. The person staying in remote area may not have access of tools required to access telemedicine facility. Internet connectivity in remote area is another issue. Telemedicine services could change face of providing medical services to the person residing at distant or in remote area if implemented effectively. Proper infrastructure is must to achieve this target. Information technology related instruments and services needs to be strengthened up at grass root level to provide better coverage of telemedicine facilities to needy ones. Telemedicine provides the safety of physicians and the patients, especially where there is a high risk of infection spread, such as in the present COVOD-19 pandemic. Mainstreaming telemedicine in the health system will improve the efficiency and outcome of the country's healthcare system.

Telemedicine practice guidelines of India, 2020: Implications and challenges.

Telemedicine Guidelines of India, 2020 promises to pave a road map for regularization and diversification of teleconsultation services across the country. This guideline is the need of the hour, especially during the current coronavirus disease pandemic. All modes of communications (text, audio, video, etc.) between the service provider and user are included in the broad rubric of the guidelines. Scope, inclusions, exclusions, and restrictions are clearly specified in the guideline. Medications are grouped and listed for the specific type of consultation, and restricted drugs are notified. This guideline especially helps mitigate the gaps in legislation and reduces the uncertainty while providing a practical, safe, and cost-effective framework to improve healthcare service delivery in this article; the authors discuss the implications of this new guideline and the challenges during the implementation of teleconsultation services across the country.

Tele-sleep Medicine: An Opportunity in a Crisis

The countrywide lockdown in India has necessitated healthcare providers consider alternate options for providing care during the COVID-19 pandemic. While there has been a tremendous focus in coping with emergency and inpatient care for COVID-19 related illness, there is also an increasing need to address management of non-communicable disease. The pandemic and the associated lockdown have witnessed the onset or worsening of sleep disorders often related to changing lifestyle, including inactivity, fear of the disease, and generalised anxiety caused by the uncertainty of the future. We propose the term ‘Lockdown Sleep Syndrome’ to describe this grouping of signs and symptoms. The wide coverage and extensive use of smartphones and more importantly, the appropriately timed Telemedicine Practice Guidelines from the Government of India, have made telehealth an attractive option, particularly in specialities such as Sleep Medicine which involves minimal physical examination. The experience of restricting personal visits to the clinic and promoting teleconsultation during the initial fifty days of lockdown is described. It was observed that two thirds of consultations shifted to a telehealth platform, and this was effective in giving satisfactory care and valid prescriptions, including to those outside the city of Chennai. Telemedicine not only helped provide uncompromised care to existing patients but also helped in identifying and managing the onset of new sleep problems with a pattern of signs and symptoms which are described as “Lockdown Sleep Syndrome”.

Setting Up and Providing Telepsychiatry Services in India.

The exponential growth of technology in the past few decades has benefitted the healthcare sector. Telemedicine is a newer advancement which is making healthcare affordable and more accessible to the needy in recent times. This article discusses how to set up telepsychiatry services, the procedure of telepsychiatry consultation, how to record and maintain the electronic health records, the potential challenges, ethical and legal aspects concerning telepsychiatry while ensuring the good practice guidelines, medical ethics, patient rights, and the minimum requirements as established by the Information Technology Act and the telemedicine practice guidelines (TPG) 2020 issued by the Indian Medical Council.