The Telemedicine Practice Guidelines had been issued on 25^th March 2020 by the Ministry of Health and Family Welfare (MoHFW), in collaboration with NITI Aayog and Board of Governors (BoG) Medical Council of India (MCI). In earlier times, there was no statutory framework on the practice of telemedicine. The World Health Organization has defined the telemedicine as " The delivery of health-care services, where distance is a critical factor, by all health-care professionals using information and communications technologies for the exchange of valid information for the diagnosis, treatment and prevention of disease and injuries, research and evaluation, and the continuing education of health-care workers, with the aim of advancing the health of individuals and communities."

These guidelines states that the telemedicine practice can prevent the risk of transmission of infectious diseases like COVID-19 to both healthcare workers and patients. Only the registered medical practitioners (RMP) are entitled to practice telemedicine. A Registered Medical Practitioner is a person who is enrolled in the State Medical Register or the Indian Medical Register under the Indian Medical Council Act 1956. Under telemedicine, there are two types of patient consultations known as the first consult and the follow-up consult. All the RMPs will have to take an online course on the practice of Telemedicine. The Telemedicine Guidelines (https://www.mohfw.gov.in/pdf/Telemedicine.pdf)  states the following provisions:

• The seven elements that must be taken into consideration before any telemedicine consultations are Context, Identification of RMP and Patient, Mode of Communication, Consent, Types of Consultation, Patient Evaluation and Patient Management.
• The RMP should exercise their professional judgment to decide whether a telemedicine consultation is appropriate in a given situation, or there is a requirement of an in-person consultation. They should also consider the mode/technologies available and their adequacy for a diagnosis before choosing to proceed with any health education or counselling or medication. There are three modes: Audio-Video or Text (chat, images, messaging, email, fax, etc.).
• Both the patient and the RMP should know about each other’s identity.An RMP should verify and confirm patient’s identity by name, age, address, email ID, phone number, registered ID, or any other identification. The RMP should also ensure that there is a mechanism for a patient to verify the credentials and contact details of the RMP.
• In case of a minor patient, the teleconsultation would be allowed only if the minor is consulting along-with an adult. The identity of such an adult must be ascertained.
• An RMP should begin the consultation by informing the patient about his name and qualifications.
• It is required that every RMP should display the registration number on prescriptions, website, electronic communication (i.e. through WhatsApp/ email etc.) and receipts etc. that are given to his patients.
• It is necessary to get the patient’s consent for any telemedicine consultation. The consent can be eitherimplied or explicit,depending on the situation. Explicit consent can be recorded in any form. The RMP must record the explicit consent in the patient records for future reference.
• The RMP must gather sufficient medical information about the patient’s condition before making any professional judgment.
• The RMP should maintain all patient records, including case history, investigation reports, images, etc.
• Based on the type of consultation, the RMP may proceed with a professional judgment relating to Health Educationor Counseling that are related to the specific clinical conditionor Prescribing medicines.
• The RMP may prescribe medicines via telemedicine at his professional discretion only when he is satisfied that he has gathered all adequate and relevant information relating to the patient’s medical condition and prescribed medicines that are inthe best interest of the patient.However, there are certain limitations on prescribing medicines on consult via telemedicine depending uponthe type of consultation and mode of consultation.
• There are certain categories of medicines that can be prescribed via telemedicine. They are mentioned under list O, A and B. The List O contains those medicines which are safe to be prescribed through any mode of teleconsultation.The List A contains those medications which can be prescribed during the first consult through video consultation and are being re-prescribed for re-fill, in case of follow-up consult.The List B contains a list of medication which the RMP can prescribe to a patient who is undergoing follow-up consultation in addition to those which have been prescribed during an in-person consult for the same medical condition.
• There is also a Prohibited List which contains a list of medicine which the RMP cannot prescribe to a patient via telemedicine.
• The RMP must issue a prescription as per the Indian Medical Council Regulations, and it should not contravene the provisions that are mentioned under the Drugs and Cosmetics Act and Rules.
• All the Principles of medical ethics, including the professional norms such as protecting patient privacy and confidentiality as per the Indian Medical Council Regulations 2002 Act shall be binding on the RMP and it must be upheld and practisedby an RMP at the time of telemedicine consultations.The RMP is also required to fully abide by the IT Act, Data protection and privacy laws or any applicable rules that are notifiedfrom time to time in order to protect patient privacy and confidentiality and regarding thehandling and transfer of such personal information of the patient.
• The RMP will not be held responsible for breach of confidentiality in case if there is reasonable evidence to believe that patient’s privacy and confidentiality has beencompromised by a technology breach or by any other person except an RMP. The RMPs mustensure that there is a reasonable degree of care which has been undertaken while hiring such services.
• The RMP must retain the Patient records, reports, documents, images, diagnostics, data etc. (Digital or non-Digital)that are utilized in the telemedicine consultation.
• The RMP is required to maintainthe prescription records in the same way as it was required for the in-person consultations.
• An RMP may charge an appropriate fee for providing the Telemedicine consultation. From a fee perspective, the telemedicine consultations are treated in the same way as in-person consultations.
• An RMP must give a receipt or invoice for the fee that has been charged by him while providing telemedicine-based consultation.

• There are certain actions of an RMP which are not permissible under the telemedicine guidelines. Following are some of the examples:-

• When the patient is willing to travel to a hospital/clinic or requests an in-person consultation, then an RMP cannot insist such patient for telemedicine consultations.
• The RMP cannot misuse patient images and data.
• The RMP cannot use telemedicine to prescribe medicines that are mentioned in a restricted list.
• The RMPshould not solicit patients for telemedicine through any advertisements.
• Any other act which contravenes the provisions that are mentioned under the telemedicine guidelines 2020.

Hence, these Telemedicine Guidelines recognize the significance and value of the practice of telemedicine in the times of pandemic and infectious diseases. It reduces the exposure of doctors, patients and medical staff to potential infections through remote screening and consultation. It also reduces the costs on time, expenditure and cuts travel of long distances for consultation and treatment in cases where there is no necessity for physical access, follow-up consultations, etc. With the beginning of the Covid-19 outbreak in India, there is amassive rise in e-consultation across companies. Post the lockdown, many governments, hospitals, e-pharmacies and even corporations have adopted to telemedicine in their employee wellness strategies. Hence, one can see that Telemedicine has started to grow in India.