Step-by-step approach to set up a telemedicine practice

In the digital era, doctors are not surrounded by the patients but by digital data that help them reduce error and improve accuracy. The digital transformation journey of healthcare organisations has been expedited in recent times due to advancement in technology and external factors e.g, the pandemic, which forged distances- a critical factor for setting up telemedicine platforms. Dr Jaideep J Rayapudi (MD Physiology) has shared a step-by-step guide to set up telemedicine practice. 

What is Telemedicine?

Telemedicine may be defined as the delivery of healthcare services where distance is a critical factor by all types of healthcare professionals using ICT and for diagnosis, treatment, prevention, research, education and advancing the health of individuals. 

Why Telemedicine?

Telemedicine has become a widely preferred option due to factors like cost, control, consistency, connectivity and convenience. In telemedicine, the costs fall because one doesn’t have to maintain a huge brick and mortar complex. It removes all the transportation costs so many of the logistical costs come down. Healthcare professionals have better control over your ecosystem and its timing. They can consistently deliver the same quality of care to your patients. Because of telemedicine, their connectivity is better and they don’t have to wait for an appointment time. Professionals can connect and send reports or send messages to patients at any time. And there is the convenience of doing it all, from one’s home. That is absolutely great.

Telemedicine application classification

Telemedicine applications can be classified into four basic types, according to the mode of communication (video, audio, text), the timing of the information transmitted (real-time, Asynchronous), the purpose of the consultation (emergency, non-emergency, first consultation, follow-up consultation) and the interaction between the individuals involved (patient to RMP, caregiver to RMP, RMP to RMP, Health worker to RMP). 

Who is a Registered Medical Practitioner?

A Registered Medical Practitioner [RMP] is a person who is enrolled in the State Medical Register or the Indian Medical Register under the Indian Medical Council Act 1956.

Types of Telemedicine

• Store-and-forward telemedicine (email)
• Remote patient monitoring (RPM equipment)
• Real-time telemedicine (Live video and audio conferencing)

Telemedicine delivery in 3 phases

Delivery of telemedicine can be done in three phases of the patient or journey of health and disease. So, the first is the Promotion of health. Telemedicine and digitally enhanced digital health care should be utilised to promote health. The next stage is Prevention. It should be ensured that people are healthy, then very specifically you prevent diseases. Prevention is always better than cure. Now, we have technologies that help to gather data and prevent disease or prevent the morbidity associated with the disease. Finally, when the person has already got the disease. There we will see the actual teleconsultation happening which will end up with having the Prescription and maybe the next stage would be to have a follow-up and rehabilitation.

Levels of engagement with patient

We see different levels of engagement that a practitioner can have with the patient. The engagement can be through basic voicemails, the internet (e.g- WhatsApp, Facebook, Skype, Zoom, Google meet), AI-based algorithms (e.g- ada, kahun), wearables (e.g- temperature tracker, period tracker, pedometer) and full-stack. 

To get a complete picture, a practitioner has to have all kinds of data to come together from the medical wearables, electronic medical records and the medical opinion. 

Healthcare services provided via Telemedicine

We can provide primary care, follow up care, urgent care and remote patient monitoring via telemedicine. Other services provided through telemedicine include psychiatric services and counselling, specialist consultations, school-based care, assisted living support and online-only medical services. Primary care or the first consultation is something that many of the practitioners are doing right now and then follow up for chronic diseases diabetes, hypertension and repeat medication. Often, patients have queries like Where should they go if they are having terrible pain? What should they do? All the required guidance and assistance provided in those situations come under urgent services. 

Telemedicine for specialists

• Cardiology
• Dermatology
• Endocrinology
• Gastroenterology
• Haematology/Oncology
• Infectious disease
• Nephrology
• OB/GYN
• Pulmonology
• Urology

Support systems needed for telemedicine

• Laboratory
• Imaging
• Pharmacy
• Counselling

Where to start?

• Type of Telemedicine- Decide the technology you’re going to use. What is your practice? What is your speciality? So you decide the type of elements that you want to get into.
• Types of patients- You have to see the type of patients you’re getting into. So is it just new patients? Or will there be repeat patients? Or only the COVID patients will get into telemedicine.

How to start?

• Have a vision for what you’re trying to do. Set SMART goals.
• Try to see what kind of technology you’re going to use. Is it just one device or all kinds of devices?
• Try to find support systems. Are you going to do it alone? Are you part of a larger group? Do you have any nurses to assist you? Do you have any office people to assist you?
• You have to figure out a way to reach out to people. How are people going to know that you’re actually providing a service?
• If you are doing well, find out ways to expand your services.

Business plan 

Prepare a business plan. Do you want to do it for charity where anybody can call any time for free advice? Or you’re doing it commercially. If somebody was going to pay you, how are they going to pay you? What is the kind of tax system that you’re going to have? How are you going to receive money? So what are your commissions? How are you going to share it with the rest of the people in your staff? 

Ground rules for practise

For any good practice, you must have some ground rules. How do you deal with the issues that crop up during practice? What are your SOPs (standard operating procedures)? How much time are you going to spend with each patient?

Patient satisfaction and assessment

You must take feedback from patients as well as get their ratings. It is very important to understand their pain points so that their services keep on getting better.

Handling legal issues

All medical practitioners should get indemnity insurance. And that is applicable whether you’re doing telemedicine or physical practice. Your data security is very important. The data security of the platform which you’re going to use must be absolutely assured. Similarly, the privacy of the data has to be assured and you have to be aware of your rights and the patient’s rights as far as the Consumer Protection Act is concerned.