Telemedicine Practice Guidelines 2020 — Complete Guide

Telemedicine Practice Guidelines 2020 (notified 25 March 2020) define telemedicine as 'the delivery of health care services, where distance is a critical factor, by all health care 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.'

Key principles:

• Only RMPs (Registered Medical Practitioners with NMC/state council registration) can practise telemedicine
• RMP must uphold the same standard of care as in-person consultation
• Telemedicine is appropriate for follow-up, second opinion,minor illness — NOT for emergencies
• RMP is fully responsible for the consultation — no anonymous platforms
• Pharmacist dispenses only on valid tele-prescription

Telemedicine consultation requires an established RMP-patient relationship. Two pathways:

1. First consultation: RMP examines patient via video. If video not available, audio (phone) permitted only if the patient is known to the RMP from previous in-person consultation OR has been referred by another RMP who has examined the patient.
2. Follow-up consultation: Patient is already known to the RMP from previous in-person consult within past 6 months for the same condition.

The RMP must verify patient identity — name, age, address, photo ID, phone number. RMP must identify himself/herself — name, registration number, qualification, photograph visible to patient.

Tele-prescription is restricted to safeguard patients:

List O (safe medications, can be prescribed via any mode including text):

• OTC medications — Paracetamol, ORS, antacids, etc.
• Refills of medications already prescribed in in-person consult within past 6 months for chronic stable conditions

List A (medications for specific conditions, require at least one video consult):

• Antihypertensives (already prescribed)
• Oral hypoglycaemics (already prescribed)
• Anti-asthma medications (already prescribed)
• Mental health medications (already prescribed)
• Thyroid medications (already prescribed)

Conditions: Patient has been previously examined in person, diagnosis is established, medication is part of ongoing treatment.

List B (medications requiring in-person consultation in past 6 months):

• Antibiotics (rationale: AMR threat, requires physical examination)
• Antidepressants, anxiolytics, antipsychotics (initial prescription)
• Hormone therapy
• Pain management medications including opioids, NSAIDs (long-term)
• Cardiac medications (initial prescription)

Prohibited medications: Narcotics and psychotropic substances listed under NDPS Act (Schedule X of Drugs and Cosmetics Act) — cannot be prescribed via telemedicine.

• RMP must maintain telemedicine records for 5 years (vs 3 years for in-person)
• Records must include: patient demographics, date/time of consult, RMP details, mode of consult (video/audio/text), presenting complaint, history, advice, prescription, follow-up plan
• Explicit patient consent for telemedicine consultation — verbal (audio/video) or implied (patient initiates the consult)
• Written consent required if patient is unable to give verbal (e.g., text-only consult)
• RMP may charge fees for telemedicine consult — receipt must be issued
• RMP may refuse telemedicine consult if condition requires in-person examination

Telemedicine Practice Guidelines 2020 are now a permanent part of Indian medical practice — every RMP must comply. For UPSC CMS aspirants, List O/A/B medications, RMP-patient relationship rules, and record-keeping requirements are highly testable topics.