Telemedicine
Telemedicine is the term used to give medical assistance from a distance through technology (i.e.: video calls, internet). Telemedicine is conducted by doctors for used of diagnosing diseases, treatment of patients, preventing health problems, and for educational and research purposes of training and teaching health care providers.
Telemedicine: Terms and Issues
1.1 What is Telemedicine
According to WHO telemedicine is the provision of health care services which distance plays a key role in. Health care professionals use information and communication technologies (ICT) for exchange of valid info which goes into diagnosis, treatment and prevention of diseases and injuries. Also telemedicine is used for research, evaluation and ongoing education of health care workers which in turn improves the health of the individual and the community.
1.2 Telehealth definition
According to NEJM Catalyst telehealth is the broad term for the delivery and which includes health and health related services. This includes medical care, provider and patient education, health info services, and self care which we do via telecom and digital communication technologies.
In other words telemedicine is for clinical services delivered by a Registered Medical Practitioner (RMP) which also includes diagnosis and treatment over a distance, telehealth on the other hand is a broader term which also includes a range of other health care services.
1.3 Description of Registered Medical Practitioner (RMP)
In this context a Registered Medical Practitioner (RMP) is a health care professional that has registered in the State Medical Register or the Indian Medical Register as per the National Medical Commission Act (NMC Act) of 2019. Only registered individuals are allowed to practice medicine which includes telemedicine.
2. Telehealth Guidelines
- These telemedicine guidelines are under the NMC Act, 2019 and are for registered medical practitioners only. We have put them out to help RMPs which in turn will allow them to better use telemedicine to improve health care services and make them available to a greater number of people.
- These apply only to RMPs which are registered under the NMC Act, 2019.
- They have put in place the rules and standards which RMPs must adhere to regarding telemedicine.
- Telehealth as per these guidelines is defined to include all communication methods we use with patients. This includes voice calls, video calls, text messages, and digital data transfer via info tech platforms.
Exclusions
The guidelines do not include some areas. They do not cover:
- Hardware and software details as well as infrastructure design and implementation.
- In the area of data management which includes standards and interoperability.
- Remote use of digital technology in surgery.
- Other issues related to telehealth which include research, evaluation, and health care worker training.
- Medical care which is rendered out of the Indian jurisdiction.
1.3 Registered Medical Practitioners (RMPs) and Telemedicine Practice
1.3.1 Entitlement to Practice Telemedicine
All Registered Medical Practitioners (RMPs) in India are entitled to practice telemedicine across the country. As per the current guidelines.
1.3.2 Professional and Ethical Standards
RMPs using telemedicine should follow the same professional and ethical norms and standards as in-person care. They should maintain quality within the limitations of telemedicine (no physical examination).
1.3.3 Mandatory Online Course
To ensure all RMPs are aware of the telemedicine guidelines and process and limitations:
- An online course will be developed and made available by the Board of Governors (replacing Medical Council of India).
- All RMPs who want to practice online should complete this course within 3 years from the date of notification.
- Till then they should follow the principles in the current guidelines.
- After 3 years, completing and passing the course will be mandatory to practice telemedicine.
1.4 Telemedicine Applications
1.4.1 Tools for Telemedicine Practice
RMPs can use any suitable telemedicine tool to conduct patient consultations. These tools can be:
- Telephones (mobile and landline)
- Video platforms (telemedicine apps, video calls on chat platforms, Skype, FaceTime, etc.)
- Devices connected over LAN, WAN, Internet
- Chat platforms like WhatsApp, Facebook Messenger, Google Hangouts
- Mobile apps or other internet-based digital platforms
- Email or fax for data transmission
Regardless of the tool used, the core principles and ethical standards of telemedicine practice remain the same.
1.4.2 Classification of Telemedicine Applications
Telemedicine applications can be classified based on:
- Mode of communication
- Timing of information transmission (synchronous or asynchronous)
- Purpose of the consultation
- Type of interaction (RMP to patient/caregiver or RMP to RMP)
1.4.2.1 Based on Mode of Communication
Telemedicine tools are broadly categorized into:
- Video-based communication (e.g. Telemedicine facilities, video calls on apps, Skype, FaceTime)
- Audio-based communication (e.g. phone calls, VOIP apps)
- Text-based communication: Telemedicine chat apps (specialized apps, websites, digital platforms), General chat platforms (WhatsApp, Google Hangouts, Facebook Messenger)
- Asynchronous (email and fax) where information is not real-time.
1.4.2.2 Classification Based on Type of Transmitted Information
Telemedicine consultations may be classified by when information is exchanged:
- Live, on-location, in-person, or via real-time interactive hub.
- Includes real-time video, audio, or text conversation between the RMP and the patient (or patient’s caregiver).
- Supports real-time sharing of patient-specific information to support diagnosis, medication, education, and counseling.
- Asynchronous interaction:
- Includes the sharing of patient data at discharge, admission and beyond.
- Summary of patient’s complaints, photos, lab results or radiology studies sent directly to the RMP.
- Known as store-and-forward telemedicine.
1.4.2.3 Classification Based on the Intent of the Visit
- Non-Emergency Question/Consultation:
- New patient appointments, return visits, follow-ups, education, or counseling.
- Rapid Response Consultation:
- Used with caveats in emergencies. Not a substitute for in-person care.
- Can offer first aid, life-saving advice, or mental health support until face-to-face care is available.
Strengths and Limitations of Communication Modes
Video Mode
- Strengths: Closest to in-person, supports visual inspection, body language.
- Limitations: Requires good internet, potential privacy risks.
Audio Mode
- Strengths: Fast, accessible, good for emergencies, private.
- Limitations: No visual or body language cues.
Text Mode
- Strengths: Quick, good for documentation, follow-up, second opinions.
- Limitations: No visual/verbal cues; harder to build rapport.
Guidelines for Telemedicine in India
All telemedicine consultations should be guided by the professional judgment of a Registered Medical Practitioner (RMP). The RMP decides whether a tele-consultation is appropriate or if an in-person visit is required.
Key Considerations:
- Context
- Identification of RMP and Patient
- Mode of Communication
- Consent
- Type of Consultation
- Patient Evaluation
- Patient Management
3.1 Appropriateness of Telemedicine
- 3.1.1 RMP’s Judgment: Must decide if the technology and context are sufficient for proper diagnosis and care.
- 3.1.2 Complexity of Condition: Simple issues like headaches may be fine for telemedicine. Serious emergencies like diabetic ketoacidosis need in-person care.
3.2 Identification
- 3.2.1 Mutual Identification: Both patient and RMP must know each other’s identity.
- 3.2.2 Verification: RMP should verify patient’s name, age, contact info, and vice versa to ensure transparency and protection.
Conclusion
Telemedicine is more than just a technological advancement—it’s a bridge to better, more accessible healthcare for millions. In a country as vast and diverse as India, where timely medical care can often be a challenge, telemedicine empowers both doctors and patients to connect without the barriers of distance.
While it cannot fully replace the warmth and precision of an in-person examination, telemedicine brings healthcare within reach for those who might otherwise go without it. By using these tools responsibly, following ethical guidelines, and staying informed through ongoing education, Registered Medical Practitioners can offer high-quality, patient-centered care—no matter where their patients are.
As we move forward under the guidance of the National Medical Commission Act, 2019, the hope is clear: to create a healthcare system that is compassionate, inclusive, and equipped for the future. Telemedicine is not just a service—it’s a commitment to reaching every patient, everywhere.
Case Studies
1. KIDROP (Karnataka Internet Assisted Diagnosis of Retinopathy of Prematurity)
Overview: KIDROP is a pioneering telemedicine initiative aimed at screening and treating retinopathy of prematurity (ROP) in underserved rural areas of Karnataka. The program utilizes wide-field retinal imaging and telemedicine to provide timely diagnosis and intervention, preventing blindness in premature infants.
Key Achievements:
- Over 51,000 imaging sessions conducted across 81 neonatal units.
- Sensitivity of 95.7% and specificity of 93.2% in detecting treatment-requiring ROP.
- Significant reduction in blindness-related costs, with potential savings of over $100 million annually.
2. Sankara Nethralaya Teleophthalmology Program
Overview: Sankara Nethralaya, a leading eye hospital in Chennai, has implemented a comprehensive teleophthalmology program to extend eye care services to rural and underserved populations. The program includes mobile eye care units, online consultations, and collaboration with optical shops to reach patients without internet access
Key Achievements:
- Conducted over 54,000 eye examinations across multiple states.
- Expanded services during the COVID-19 pandemic to include online consultations for new and existing patients.
- Developed partnerships with optical shops to provide teleconsultations for patients without internet access.
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Written by Team Member(s) and Ms. Sonal Rai.
References
- Anand Vinekar, MD, FRCS, Chaitra Jayadev, MD, Noel Bauer, MD, PhD. “Need for Telemedicine in Retinopathy of Prematurity in Middle-Income Countries: e-ROP vs KIDROP.” JAMA Ophthalmology, 2015.
- Rachapalle Reddi Sudhir. “Teleophthalmology case study: Sankara Nethralaya, India.” Community Eye Health Journal, 2022.
- e-Sanjeevani – National Telemedicine Service
Ministry of Health and Family Welfare, Government of India
https://esanjeevani.mohfw.gov.in - Evolution of Teleconsultation in India
India Brand Equity Foundation (IBEF), 2023 - Ayushman Bharat Digital Mission (ABDM)
National Health Authority, Government of India
https://abdm.gov.in
