Ms. Atishaya Kaushal, Advocate
(9891952134/atishayakaushal@gmail.com)
CHRONOLOGY & FOUNDATIONS OF TELEHEALTH SERVICES IN INDIA DURING LAST 2 DECADES
Introduction
Telemedicine is a broad term encompassing all methods where the doctor-patient interaction is not on-site and some form of telecommunication is used. Also called telehealth, online health, or e-health, telemedicine has made long strides since its inception. Few Sub branches:
· TeleNutrition
· Telenursing
· Telepharmacy
· Teledentistry
· Teleaudiology
· Teleneurology
· Teleneuropsychology
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· Teletrauma care
· Telecardiology
· Telepsychiatry
· Telepathology
· Teledermatology
· Teleophthalmology
· Telesurgery
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Teleradiology is a branch of telemedicine in which telecommunication systems are used to transmit radiological images from one location to another. Interpretation of all noninvasive imaging studies, such as digitized x-rays, CT, MRI, ultrasound, and nuclear medicine studies, can be carried out in such a manner. The first successful use of teleradiology in India was in 1996 by a private-sector imaging center in Mumbai. A simple system for transferring images from the imaging center to the homes of the individual doctors was set up, primarily, to report emergency CT scans. The first public demonstration of teleradiology in practice was made by “Siemens” at the Annual Congress of the Indian Radiology and Imaging Association (IRIA) in 1997, where they demonstrated the transfer of radiological images from a Siemens ARC scanner to the conference site. Subsequently, “Wipro GE” demonstrated teleradiology capabilities for their entire range of scanners. The first teleradiology company in India, was set up in 2002 with its base in Bangalore, with all US board-certified radiologists, read scans for hospitals in the USA; these services were offered for places in Singapore and India as well using nighthawk and 3D reconstruction services.
THE CRADLE LEGISLATION, TELEMEDICINE DRAFT ACT, 2003?
In April 2003 it was proposed to draft code for regulation of telemedicine in India.
Broadly, the definition clause read as under:
“Institution” includes hospitals, health clinics, diagnostic centres, x-ray and pathology laboratories, scan centres and any other organization involved in or connected with the provision of healthcare services.
“Medicine” means modern scientific medicine in all its branches and includes surgery and obstetrics, but does not include veterinary medicine and surgery.
“Person” means any individual, institution, organization, partnership, joint venture, firm, corporation, company, association, trust or other enterprise (whether incorporated or not) or Government (central, state or otherwise), sovereign, or any agency, department, authority or political sub-division.
“Telemedicine” means the practice of medicine delivered across distances via telecommunications, including audio, visual and data communications, and interactive video technology, performed by licensed or otherwise legally authorized individuals
“Telemedicine Doctor” means a person who is authorized to practice telemedicine.
TELEMEDICINE AUTHORITY: Medical Council of India, as established under the Indian Medical Council Act, 1956, was the deemed Authority.
Duties and Functions of the Authority
To protect the interests of patients in India, and to promote the development of, and regulate the use of technology to provide healthcare services, by such measures as it thinks fit.
(i) stipulating and regulating the standards of telemedicine practice, and educational qualifications required for that purpose, including technical standards, directions to the concerned institutions and persons in order to implement and enforce these standards;
(ii) regulating the work of any person involved in the practice of telemedicine, either directly or indirectly, in any manner;
(iii) maintaining adequate records of the practice rendered by each telemedicine practitioner;
(iv) regulating the standards of privacy of information obtained during the practice of telemedicine;
(v) calling for information and records from any person who practices telemedicine or institution in which or through which telemedicine is practised in respect of any inspection for the purposes of awarding or withdrawing authorization to practise telemedicine;
(vi) performing such other functions as may be prescribed.
The Authority may, by an order, for reasons to be recorded in writing, in the interests of patients and the general provision of healthcare services, take any of the following measures, either pending investigation or inquiry or on completion of such investigation or inquiry, namely:
(i) prohibiting any person or institution from the practice of telemedicine; and
(ii) placing restrictions on the level at which telemedicine is practiced by any person or institution.
DUTIES AND LIABILITIES OF PERSONS PRACTICING TELEMEDICINE Were as under:
Every person authorized by the Authority to practice telemedicine shall submit an annual report to the Authority to confirm the particulars of such person and such person’s activities in the preceding year in such form as may be prescribed under the regulations.
Identification of Technology
In order to ensure adequate delivery of telemedicine, persons practicing telemedicine shall identify:
(i) all equipment (both hardware and software) used for telemedicine;
(ii) the owners and parties responsible for maintaining the equipment;
(iii) the format for transmitting medical information; and
(iv) the frequency and format of reports,
and maintain regular records of the same, and furnish brief particulars thereof part of the annual report submitted to the Authority.
General Principle for liabilities of persons practicing Telemedicine were as under:
Except as specifically provided in this Act, health care delivered through electronic means, regardless of form, shall be treated no differently from health care delivered face to face, directly between health care worker and patient.
Determination of Doctor Patient Relationship
For the purposes of determination of liability in relation to provision of telemedicine services, the following shall be taken into account:
(1) If the patient and the doctor practicing telemedicine have had a direct interaction either in person or through audio, visual or data communications;
Explanation- A conference between the telemedicine doctor and the treating doctor will be considered to be a direct interaction between the patient and the telemedicine doctor.
(2) The following factors (whether individually, or by a combination of two or more factors) shall be relevant for the determination of existence of a doctor patient relationship:
(i) whether the doctor and the patient have met;
(ii) whether the doctor examined the patient;
(iii) whether the patient's records were viewed by the doctor;
(iv) whether the doctor knows the patient's name;
(v) whether the doctor was paid a fee;
(vi) whether the patient has failed to follow the doctor's advice; and/or
(vii) whether the doctor-patient interaction arose because of an
emergency situation where the doctor was forced to treat the
patient.
Duties of Referring Doctor:
Where healthcare services are being provided by means of telemedicine on basis of a reference made by one doctor, the following principles shall be observed.
(1) The referring doctor shall take reasonable steps:
(i) to provide for safe storage and/or transmission of the patient’s records by utilizing an adequate encryption system; and
(ii) to prevent anyone other than himself and his accredited colleagues from obtaining the encryption key.
(2) The referring doctor and the telemedicine doctor shall both be responsible to advise the patient that no medical record, paper or electronic, is completely confidential and that security breaches may occur with either.
IT IS HOPED THAT A DETAILED LAW ON TELEMEDICINE PRACTICE IS ENACTED BY THE GOVERNMENT SOON.
TREATMENT BY VIDEO CONFERENCING
www.cschealth.in is the Government of India project providing for video conferencing with the doctors from its centres,
Telemedicine is the form of primary care offered through a CSC, where the patient seeks the doctor’s advice about non-emergency medical problems, which don’t require immediate doctor‘s location visit. It doesn’t replace face-to-face consultation when it is needed, but complements it.
With the aim to provide grass root level access points for health consultation among the communities, to change health seeking behavior of adopting digital services and to promote preventive health care services among the rural India, CSC is offering video based tele-consultation service throughout India at affordable rates, using CSC “DigitalSeva transaction portal.
There are two platforms:
· Apollo Telemedicine Platform
· CSC Telemedicine Platform
Providing:
- Allopathy
- Ayurveda
- Homeopathy
- e-pashu
Rs. 50 is to be paid by the patient.
Patient will get consultation from doctor through video calling at his nearest CSC Centre.
Equipment at the Centre is Laptop/Desktop, internet connectivity, web-camera, headphones with Mic & Printer via 512kbps for Apollo Telemedicine and 216kbps for CSC Telemedicine Platform.
One can reach from:
- · Log in Digital Seva Portal
- · Click on Health Services
- · Choose CSC Telemedicine
- · Click on “Dashboard” then “View”.
In CSC Telemedicine patients can consult doctors from 8am to 8pm (Monday-Sunday) whereas Apollo Telemedicine is on an appointment basis.
Public- Private Partnerships
ISRO (Indian Space Research Organization) made a modest beginning in telemedicine in India with a Telemedicine Pilot Project in 2001, linking Chennai's Apollo Hospital with the Apollo Rural Hospital at Aragonda village in the Chittoor district of Andhra Pradesh. Initiatives taken by ISRO, Department of Information Technology (DIT), Ministry of External Affairs, Ministry of Health and Family Welfare and the state governments played a vital role in the development of telemedicine services in India.
In an attempt to coalesce the available public health data and provide easy access, the Ministry of Health in the Government of India has taken up projects like Integrated Disease Surveillance Project (IDSP), National Cancer Network (ONCONET), National Rural Telemedicine Network, National Medical College Network and the Digital Medical Library Network. Setting up of standardized telemedicine practice guidelines by the Department of Information Technology in the Government of India, and setting up of a National Telemedicine Task Force by the Health Ministry, in 2005, were some of the other positive steps by the government. International projects like the Pan-African eNetwork Project and the SAARC (South Asian Association for Regional Co-operation) Telemedicine Network Projects have also been taken up as an initiative of the External Affairs Ministry, strategically placing Indian telemedicine in the global scenario.
A few noteworthy examples of the successfully established telemedicine services in India include mammography services at Sri Ganga Ram Hospital, Delhi; oncology at Regional cancer center, Trivandrum;surgical services at Sanjay Gandhi Postgraduate Institute of Medical Sciences, School of Telemedicine and Biomedical Informatics, and many more. Telemedicine also finds its use in places where large populations occasionally/periodically gather at a point of time, where provision of medical care becomes the need of the hour; for example, the Government of Uttar Pradesh practices telemedicine during Maha Kumbhamelas.
Telemedicine is one field which was successful in invoking a keen interest in the private sector and making them take an active part in public health management. Some of the current major Indian private sector players in telemedicine include Narayana Hrudayalaya, Apollo Telemedicine Enterprises, Asia Heart Foundation, Escorts Heart Institute, Amrita Institute of Medical Sciences and Aravind Eye Care. They function with support from the central and state governments and from organizations like ISRO who guide them with appropriate and updated technology.
In the past few years, ISRO's telemedicine network has come a long way. It has expanded to connect 45 remote and rural hospitals and 15 super specialty hospitals. The remote nodes include the islands of Andaman and Nicobar and Lakshadweep, the hilly regions of Jammu and Kashmir, Medical College hospitals in Orissa and some of the rural/district hospitals in other states.
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