On 25th march, 2020, the Ministry of Health and Family Welfare issued
the Telemedicine Practice Guidelines, 2020  under the Indian Medical Council
Act, 1956 and which superseded the Indian Medical Council (Professional Conduct,
Etiquette and Ethics Regulation, 2002.
The guidelines, which have borrowed the definition of telemedicine from the
World Health Organisation, provide that telemedicine would include the
delivery of healthcare services by health care professional using information
and communication technologies, not just for diagnosis, prevention and treatment
of diseases, but also for research purposes and education of health care
The Background to the guidelines states that the purpose of issuing the
guidelines is to enable delivery of timely and faster health care services so
that the limitations relating to geographical distances do not hamper equal
access to quality healthcare for all. The practice is in line with similar
actions taken by other common law jurisdictions as well. Also, digital health
care services assist in better maintenance of large volume of records and data.
The guidelines provide that the mode of delivery of tele health care services
shall include any platform which enables digital data exchange, be it, audio,
text video, or email/fax. While the first three modes, the guidelines provide,
may be used for real time interaction and communication between either an RMP to
the patient or his caregiver, or between two or more RMPs, the last one may be
used for exchange of information for example, lab reports, images or data
related to radiological investigations.
Also, the guidelines are applicable to telemedicine consultations in 4
- When the patient initiates the consultation by first approaching the RMP
- When the patient is under the supervision of a caregiver, either present
physically with the patient or taking care virtually, the RMP may be approached
by the caregiver directly. The RMP may then give instructions to the caregiver
to better support the patient.
- The RMP may be approached by a health care worker currently treating the
patient. This could be a nurse, mid-level worker in the hospital etc.
- Lastly, an RMP can approach another RMP for advice or opinion on
particular case and the same may be done via telemedicine consultation.
The general points that are of relevance for Registered Medical Professionals (RMPs)
are as under:
- They shall be continued to be bound by the same degree of ethical and
professional norms and standards as were applicable for conventional
- The guidelines cannot be used to provide consultation outside India.
- The guidelines specifically exclude surgeries and other invasive
procedures from their purview.
- The Board of Governors (which shall supersede the Medical Council of
India) shall soon develop an online training program and it shall be
mandatory for all RMPs interested in continuing to provide tele health care services to
undergo the course within a maximum of 3 years within its notification.
- The delivery of tele health care services is dependent entirely on the
discretion based on the Professional Judgement of the RMP. Such discretion
should not compromise on the quality of the care.
- The consultation can be of three types: (a) first-time consultation, (b)
follow-up consultation and (c) consultation in emergency situations. While
the consultations in the first two situations may be done if the RMP is satisfied
that telehealth care services may be appropriately provided in the instant case,
the third type of consultation can only be done in case when in-person services
are not available to the patient. Additionally, the patient must be referred to
in-person care as soon as the same becomes available.
In addition to these general obligations, there are specific obligations imposed
on the RMP at different stages of the process.
Safeguards before the Consultation Begins
- The RMP shall display his registration number prominently on
his website, email, video or chat platform.
- The RMP shall first verify the identity of the patient
including details relating to age.
- If the patient is minor, the consultation cannot be done except when the
patient is accompanied by the guardian.
- The RMP must take necessarily take the consent of the patient
and record the same in case the telemedicine consultation was initiated by the
health worker, RMP or caregiver.
- The RMP must try to gather information about the patient, his
medical history etc. and must not proceed with telemedicine consultation if he
is of the opinion that a physical examination is necessary.
- RMPs cannot solicit patients for telemedicine consultation by
way of advertisement or insist on telemedicine consultation when the patient has
expressed willing to physically visit the facility/clinic.
Obligations During the Consultation
- The RMP may either provide education counselling or
prescription service to the patient. Education services relate to general
guidelines for prevention of diseases, diet, exercise etc.
Counselling refers to customized advice on peculiar condition of patient.
The RMP may also prescribe medicines to the patient.
- †In cases of first time consultation, the RMP may prescribe
any medicine mentioned under List A and List O. The medicines under List O are
those which are generally otherwise available over the counter without specific
prescription and therefore there arenít many restrictions on their prescriptions
even for telemedicine consultation.
For follow-up consultations, the RMP may prescribe medicines given under List A,
List B and List O.
The RMP is prevented from prescribing any medicine named under Schedule X of the
Drugs and Cosmetics Act, 1940 and corresponding rules thereunder or under the
Narcotic Drugs and Psychotropic Substances Act, 1985.
- The RMP must maintain record of all or any prescription given.
Obligations Post the Telemedicine Consultation
- The RMP shall maintain all patient records including case
history, investigation reports, images, diagnostics etc. as appropriate.
- The RMP should give receipt/invoice for the fee charged for
the telemedicine consultation.
- The RMP should respect the privacy and confidentiality rights
of the patient under the Information Technology Act, 2000, data protection or
under the Professional Conduct and Etiquette Regulations of 2002.
Though the guidelines do provide for penalties to be imposed on the RMP in case
of breach of any obligations, not all responsibilities are that of the RMP. The
guidelines explicitly provide that the obligation to provide accurate
information lies on the patient.
Also, in cases where telemedicine consultation is facilitated by an intermediary
platform, a lot of the responsibilities/burdens get shifted to the platform
instead. For instance, the platform shall ensure that the RMPs on their platform
are duly registered with the national or State medical councils.
They must also
conduct their due diligence on the RMPs and make such information available to
the patients. Any event of non-compliance must be reported to the Board of
Governors and the platform must also provide their end-customers for a query
related and grievance redressal mechanism. However, the platform is prohibited
from counselling the patient directly and all that the technology enabled
platform can do is to assist and support the RMP.
Telemedicine guidelines were the need of hour, considering the given that
current circumstances warrant maintenance of social distancing and most services
are taking to the digital platform wherever possible. While the medical industry
has conventionally operated in manner where physical examination by the
practitioner was deemed indispensable, with the advent of technology, many
professionals are also of the opinion that rendering consultation via the
digital mode is indeed possible and also efficient in certain cases.
guidelines have taken due caution to exclude cases serious cases such as those
necessitating surgery from their scope and also while imposing safeguards for
emergency situations, while also ensuring that cases which may not be very
serious but do require constant attention of the doctor should not suffer due to
the current circumstances.
Therefore, they will prove extremely helpful in
scenarios where the patient has already visited the RMP previously and the RMP
is aware of medical history etc. By way of telemedicine consultation, the
patient can get continued access to professional healthcare, with adequate