The Use of Fitness Trackers for Telemedicine

The Use of Fitness Trackers for Telemedicine

Anay Shukla
Founding Partner, Arogya Legal – Health Laws Specialist Law Firm
Eshika Phadke

Associate, Arogya Legal – Health Laws Specialist Law Firm


Fitness trackers are increasingly being relied upon by people to monitor factors such as temperature, pulse rate, respiration rate, blood oxygenation, sleep patterns and exercise levels. Concurrently there has been a significant rise in remote consultations between patients and doctors. As a result, data from patients’ fitness trackers are making their way into telemedicine. However, doctors must proceed with caution while placing reliance on vitals that have been obtained from a fitness tracker.

First and foremost, even though fitness trackers offer medical device-like functionalities, they may or may not actually be medical devices. While a medical device is subject to regulatory scrutiny and has to undergo extensive clinical testing to ensure it’s accuracy before it is launched in the market, a fitness tracker does not undergo similar testing. Fitness trackers are, as the name would indicate, meant to track fitness levels and are targeted at healthy individuals. The manufacturers consciously elect to not pursue the medical device route, and do not intend for the device to be used to monitor vitals in a “patient”. They contain an explicit disclaimer on the packaging itself stating that the product is not a medical device and is not intended to be used for the diagnosis, treatment, cure or prevention of any disease. In addition, unlike a medical device, the health data of individuals collected by these trackers can be accessed by the manufacturer, and therefore while choosing a fitness tracker, doctors and patients should make an informed choice from data protection perspective on use of such health data by the manufacturer.

Second, the fitness trackers are not subject to conform with any uniform quality standards in India, and every fitness tracker uses a different technology and algorithm for tracking data and thus, hardly ever will two fitness trackers report similar numbers.

Further, fitness trackers are highly susceptible to human error and external conditions, and individuals are generally unaware of how to use the function correctly, so the data derived from a fitness tracker is not reliable. The reading would be affected by where the person is wearing it, how tight or loose the strap is, whether the person is wearing accessories that may hinder the sensor, whether the person is perspiring, whether they are correctly positioned, movement, the charge or the device, etc.

Therefore, while the utility of these devices is undeniable, their utility in medicine warrants abundant caution. The responsibility of a doctor to exercise great caution and professional discretion increases while discharging their professional services via telemedicine due to lack of physical contact with the patient. If a patient does use a fitness tracker and relays information from it to a doctor during teleconsultation, the doctor should refrain from taking the reading at face value or basing decisions solely on them. That being said, they may take it into consideration in combination with other symptoms and the patient’s history. The doctor could also peruse historical data from these devices to identify any patterns in the patient’s readings.

If a doctor does rely on any data that the patient obtained from a tracker, they should also note down the make and model of the device in their notes, if possible, so that they can also verify whether the tracker is a medical device or not. If it is, the doctor should also confirm with the patient that they used the device as per the manufacturer’s instructions.

Irrespective, before commencing a treatment plan on the basis of a information that had been obtained from a patient-operated device the vital signs of a patient should direct the patient to visit a doctor for and have their vitals measured and verified on a reliable device.

ISO 13131 Certification for Telehealth Services

Prof. K. Ganapathy
Past President, Telemedicine Society of India & Neurological Society of India | Hon Distinguished Professor The Tamilnadu Dr MGR Medical University | Emeritus Professor, National Academy of Medical Sciences | Formerly Adjunct Professor IIT Madras & Anna University | Director Apollo Telemedicine Networking Foundation &, Apollo Tele Health Services | URL:

December 10th 2021 is indeed a Red letter day for Indian Telehealth. On this day the ISO 13131-2021, certification for Telehealth Services was obtained for the first time anywhere, by Apollo Telehealth Services . This brief note points out the necessity for raising the bar and setting high standards, so that the world will strive to achieve India class.

For decades, Telemedicine/Telehealth services was not centre stage in the healthcare delivery system. COVID-19 changed this. The world has now accepted that the forced lockdown- enforced acceptance of Remote Health Care will become the new normal even after the pandemic is de notified. Universal acceptance, increases the responsibility of all health care providers deploying technology, to ensure constant high quality while bridging the urban rural health divide.

Quality is never an accident. It is always the result of deliberate intention, sincere effort, intelligent direction and skillful execution. Though Henry Ford opined that quality means doing it right when no one is looking, in the real world this is difficult to implement. ISO certification ensures that “Big Brother” is watching all the time. The necessity for re certification is like the Sword of Damocles hanging above us. However it drives home the message that Quality is everyone’s responsibility at all times and not during the audit alone. One has to keep running to stay where you are. To maintain the initial global recognition, maintaining quality needs to become a habit, a unique opportunity to transform one’s DNA if necessary!! Success is the sum of small efforts, repeated day-in and day-out. Standardising systems, processes, documentation and re documentation alone will ensure providing quality remote healthcare for anyone, anytime anywhere.

International Organization for Standardization (ISO) – An OVERVIEW

The, International Standards Organization, TC 215 Health Informatics Committee developed a Technical Specification, ISO/TS 13131 Telehealth services, based on a risk and quality management approach. This standard, supports healthcare planning, service and workforce planning, organization responsibilities, financial and IT management. ISO was established in 1947 in Geneva, Switzerland. An Independent, non-governmental international organization it develops standards that are recognized and respected globally. It brings experts together to improve quality and provide world-class healthcare services. Experts are from 166 national standard bodies. ISO standards are developed by various advisory groups. Presently ISO has 255 technical committees, 515 subcommittees, and 2498 working bodies. Since 1947, ISO’s technical experts have created more than 18,800 standards for all possible business. ISO standards ensure that administration and product/work flow systems are carried out legally, safely and effectively. ISO technical experts have developed several assessment protocols to ensure that certified organizations apply these guidelines in their workplace. The approved protocols aid organisations to ensure that their frameworks, devices and workforce are actually in compliance with ISO standards. ISO 13131 provides recommendations on guidelines for Telehealth services deploying Information and Communication Technology (ICT) to deliver quality healthcare services.

Implementing ISO/TS 13131 means facilitating cooperation and interoperability of its different health systems to ensure quality telehealth services. It also ensures a reliably high standard of service, irrespective of where a person lives, across the globe. This standard provides guidelines for developing quality plans and managing company resources, while putting the right policies in place to safeguard clients’ private data. Securing ISO 9001 for quality management and ISO 27001 for information security management reduces the complexity involved in getting the IOSO 13131 branding. Realising that excellence is always a moving target it was the logical next step in the company’s journey to go (to paraphrase Captain Kirk of Star Trek)“ where no Man had ever gone before”.

The decision to get certified though it was time consuming, labor intensive and expensive was the determination to set a benchmark for the whole telehealth sector. A leading market player faced with competition, the company needed reassurance that its high-quality standards would provide a stamp of recognition and help distinguish it from its competitors. As a pioneer in the field, it was important to set the conditions of competition, to prevent some potentially harmful practices of others, from compromising the reputation of all. Considering the high risks involved in securing patients’ data privacy, it was crucial for the organization to be sure it’s IT systems and processes were stringent, fulfilled the highest expectations in this sensitive sector and conformed to security legislation.. A preliminary gap analysis was conducted and where ISO/TS 13131 provided more specific criteria than the ones actually in place, these were ear marked for improvement. Consumers draw confidence from the stringent certification process. ISO standards will help organisations comply with new regulatory requirements, enhancing efficiency of internal processes and quality of remote health services provided. Documenting the much needed framework necessary for supply of services, improves value of the product. The more diverse and competitive the market, the more guidance consumers need, to be sure they are purchasing the service they want at the best price. International Standards helps maintain a healthy competition in the marketplace.

We need to identify the right quality metrics, and ensure that the information is readily available to patients, health systems and providers themselves. Consumers should be helped to gauge telehealth providers, and provide healthcare workers/systems with feedback for continuous improvement. Best practices for virtual care need to be standardised, notified and applauded so that it will be increasingly sought after. As the pandemic further disrupts the balance between in-person care and telemedicine, we no longer have the luxury of waiting. The time to define, implement and enforce quality in all aspects of telehealth is not tomorrow but today. Formal certification by an international organisation requires hundred percent fulfilment of stringent criteria. This pre supposes commitment of a very high order and the realisation that excellence is always a moving target. One can never ever rest on one’s laurels. We need to keep running to stay where we are.


School of Telemedicine & Biomedical Informatics, SGPGIMS, Lucknow hosted the 17th International Conference of Telemedicine Society of India from 12th Nov. to 14th Nov. 2021. It was an annual conference of the Telemedicine Society of India being held every year in different parts of the country to create awareness, sharing new experiences and learning from each other in the field of telemedicine and digital health.

First Day i.e. 12th Nov. 2021, the event started at 9.00 AM with welcome note of the Prof S.K. Mishra, Chairman, Local Organizing Committee, TELEMEDICON2021. First session was devoted only for beginners of Telemedicine where Prof. B.N. Mohanty, Prof. Jayant Mukhopadhya, IIT, Kharagpur, Prof. Meenu Singh, PGIMER, Chandigarh and other 46 National speaker, 20 Chairs & panelist shared their experiences in the field of Telemedicine & digital health and demonstrated how this technology can help for delivering health care in rural parts of India. Mr. Baastian Quast, ITU, Geneva, delivered talk on ITU-WHO Focus Group: Benchmarking AI and Health Solutions as a special Invited speaker. Workshops on Telemedicine & Digital Health Policy & Strategy and Legal & Regulatory Issues, & Telemedicine Practice Guidelines conducted in IV sessions. Following were participated from India and abroad during panel discussion; Prof. J.A. Jayl, Professor of Surgery., National President, Indian Medical Association, Dr. Achal Gulati, Director Principal & Director Professor of ENT in Dr Baba Saheb Ambedkar Medical College & Hospital, New Delhi, Dr. Balaji Ramachandran, Digital Health Transformation Expert, Bangalore, Mr. Anay Shukla, Founder Editor, Arogyalegal, Mumbai. A panel discussion on developing guidelines of Telecare for chronic diseases like diabetes, cancer, neurological disease was considered by ICMR, National Centre for Disease Informatics and Research, Bengaluru with the help of country wide experts. For the first time, IIT Bombay, which had just established Koita Centre for Digital Health (KCDH), participated in National telemedicine conference to conduct a workshop on future Health technologies with the collaboration of National Medical Commission experts, IMA and NGOs. Telemedicine Society senior members addressed legal ethical policies issues relating the Telemedicine and digital health and carried out a workshop.

A total of 700+ registered delegates from Medical Institutions, IITs, Dental Colleges, Technical Universities were participated in the first days of conference in virtual as well physical mode. The scientific programme ended at 8.00 PM.

Second Day i.e. 13th Nov. 2021, the event started at 8.00 AM with three parallel Hall under COVID award sessions which specially designed for the speakers to present their work done during the COVID time. Prof. Abhay Karandikar, Director, IIT, Kanpur delivered Key note Lecture on Wireless Health : Promising trends for equitable access to Healthcare. Dr. Pramod Gaur from USA delivered talk on the re-positioning in Post COVID Health, Prof. D.R. Sahu, Lucknow covered the socio-Technological Dilemma of Future Tele-Health. Ms. Surabhi Joshi from WHO, Geneva, Prof. Isao Nakajima, Japan delivered speech on Digital Technologies in Infectious disease Management particularly for Avian Influenza. Mr. Frank Lievens from Belgium, Prof. Thais Russomano from Brazil, Katarina Hradska from Ostrava Czech Republic shared the experience on the Global Telemedicine & Digital Health. Apart from International, 22 National speakers and 24 abstract presentations were conducted throughout the day.

Inauguration ceremony conducted at the evening where Prof. R.K. Dhiman,Director,SGPGIMS inaugurated the conference as Chief Guest and Prof. Arvind Rajvanshi, Executive Director, AIIMS, Raibareli delivered keynote address. Prof. S.K. Mishra, Chairman, organizing Committee welcome the dignitaries and Prof. P.K. Pradhan, Organizing Secretary delivered the vote of thanks. A total of 600+ delegates from Medical Institutions, IITs, Dental Colleges, Technical Universities were participated in the first days conference in virtual as well physical mode.The Programme ended at 7.00 PM. Subsequently,it was followed with a cultural programme of thematic Kathak dance on ramayan and dinner at hobby center of SGPGIMS,Lucknow.

Third & last day i.e. 14th Nov. 2021, the event again started at 8.00 AM with three parallel Hall under COVID award session which specially designed for the speakers to present their work done during the COVID time. Dr. Gulshan Rai, Former National Cyber Security Coordinator, Govt. of India delivered Key note Lecture on Need of Cyber Security in Health Sector. Dr. Maurice Mars, South Africa, Dr. Luiz Messina, Brazil and Prof. Saroj Mishra from India covered the area of Health 4.0, a vision for Smart Futuristic Healthcare in the symposium session. Prof. R.K. Dhiman, Director, SGPGI delivered the talk on Chronic Disease Telecare, personal perspective with remote monitoring and management of Hepatitis C, Prof. Rakesh Aggarwal, Director, JIPMER, Puducherry emphasize on Digital Health Technologies for the management of public Health Disaster,Prof P K Pradhan shared his experience of telefollow up in thyroid cancer: more than decade long experience and Prof.Sanjay Behari shared his experience of e-CCS in SGPGIMS. Apart from International, 62 National speakers, 36 Moderators and 47 abstract presentation were conducted throughout the day.

Valedictory function conducted at the evening where Prof. Aneesh Srivastava, Dean, SGPGIMS chaired the function though could not attend the function due to medical emergency. Prof. S.K. Mishra, Chairman, organizing Committee welcome the President Col Dr. Aswani Goel, Secretary, Dr. RLN Murthy and other dignitaries. President handed over the Presidential Medallion to President Elect Prof. P.K. Pradhan virtually and Prof. P.K. Pradhan, Organizing Secretary delivered the vote of thanks.

Brief on Conference.

  1. Participants: A total of 700+ delegates from Medical Institutions, IITs, Dental Colleges, Technical Universities were participated in the first days conference virtual as well physical.
  2. Invited Speakers/Chairs/Moderators and presenter;
    The Scientific Programme consists of 02 Key Note Lectures from Director, IIT Kanpur and Ex Cyber Security Chief, Govt. of India, 15 International Invited Lectures, 10 Symposia, Three Panels and 09 free paper sessions having 54 slots for oral presentations. Besides there are three Poster Presentation Sessions covering 18 posters and 12 Industry presentations highlighting technical solutions for telemedicine & digital health. A total 234 speaker/chairs/panelist taken part in this international conference. Best Oral and Poster presentations award and CME Points for all attendees is provided as per U.P. Medical Council regulations. Two Free paper sessions dedicated COVID-19 on Tele-care and Tele-education practices undertaken during COVID-19 Pandemic.
  3. Industry Participation: A total of 15 industry participated and extend their active support for this event.
  4. Knowledge partner Institution: Indian Institute of Technology (IIT), Kanpur, Koita Centre for Digital Health (KCDH), Indian Institute of Technology(IIT), Bombay and Technology Information Forecasting and Assessment Council (TIFAC), New Delhi supported this conference as knowledge partner.

Promoting Telemedicine in Tamil Nadu

To promote Telemedicine, a hybrid program, themed “Telemedicine – the Untapped Potential” was organized by the Telemedicine Society of India (TSI) – TN Chapter, at The Tamil Nadu Dr. M.G.R. Medical University in Guindy, Chennai on November 19, 2021. This event was supported by TeleOphthalmology Society of India (TOSI) and Tamil Nadu Ophthalmic Association (TNOA).

The online conference commenced with Dr. K. Selvakumar introducing the event and welcoming everyone. This was followed by brief lectures on History and Definition of Telemedicine by Prof. Dr. K Ganapathy; Modes of Communication, Bandwidth by Dr. S Dheeraj Krishnaa; and Mobile Health by Dr. Sheila John.

Next, Dr. Sunil Shroff walked the audience through Telemedicine Practice and Guidelines from Government of India in detail, to help them easily understand the subject, and a lecture on Producing a “Wow” effect – Using Telemedicine by Prof. Dr. K Ganapathy followed.

The guest of honour for the occasion was Dr. J Radhakrishnan IAS – Health Secretary of Tamil Nadu. The formal welcome address was delivered by Dr. Sunil Shroff, President – TSI TN Chapter and Dr. Sudha Seshayyan – Vice Chancellor, The Tamil Nadu Dr. M.G.R. Medical University delivered the inaugural address. Dr. J Radhakrishnan IAS spoke in brief about the future of Telemedicine and highlighted its effectiveness during the pandemic. Special addresses by Dr. Mohan Rajan and Padmashri Dr. S Natarajan were followed by vote of thanks by Dr T Senthil.

After a short break, Dr. Ikramullah moderated a Panel Discussion on Specialty Practice in Telemedicine, featuring the following TSI members as speakers:

  • Dr. Senthil
  • Dr. Sheila John
  • Dr. Vidya Ramkumar
  • Dr. Lovelena Munawar and
  • Dr. Kim R

Dr. Sunil Shroff briefed about the courses in Telemedicine that are going to be offered in the near future. Dr. Masood Ikram chaired a session on How to Set up Telemedicine in your Practice.
Dr. Natarajan presented his key note address on “Teleophthalmology for Blind-Free Tamil Nadu 2025.” A second panel discussion on Promoting Telemedicine in Tamil Nadu was moderated by Dr. Natarajan and the speakers were:

  • Dr. Kim R
  • Dr. Ganapathy
  • Dr. Prabhu Rajagopal and
  • Dr. Selva Kumar

The final segment featured participant discussions and the concluding remarks were delivered by Mr. D. Satheesh Kumar.

Name Affiliation
Dr. K. Selvakumar Prof and Head Neurosurgery, SRMC and RI (Retd)
Past President Telemedicine Society of India
Dr. K. Ganapathy Director Apollo Telemedicine Networking Foundation
Hon Distinguished Professor
The TN Dr MGR Medical University
Dr. S Dheeraj Krishnaa Head Telemedicine – Star Health Insurance
Dr. Sheila John Head Teleophthalmology Sankara Nethralaya
Dr. Sunil Shroff President TSI TN Chapter
Senior Consultant Urologist & Transplant Surgeon
Madras Medical Mission Hospital, Chennai, India
Dr. Mohan Rajan President TNOA
Padmashri Dr. S Natarajan Chief Clinical Services Aditya Jyot Eye Hospital Mumbai
Chief Vitreo Retinal Services Dr Agarwal’s Group of Eye Hospitals
Visiting Emeritus Professor of Ophthalmology, The TN MGR Medical University
President Teleophthalmology Society of India
Dr. T. Senthil Treasurer TSI TN Chapter
Dr. Ikramullah   Vice President TSI TN Chapter
Dr. Masood Ikram MD – Mellon AI

Documentation for Teleconsultations

Documentation for Teleconsultations

Anay Shukla
Founding Partner, Arogya Legal – Health Laws Specialist Law Firm
Eshika Phadke

Associate, Arogya Legal – Health Laws Specialist Law Firm


The legal significance of well-maintained medical records cannot be emphasized enough. Especially for telemedicine where the jurisprudence is still in its primitive stages, it is of utmost important for doctors to maintain detailed records of their teleconsultations.

The Telemedicine Practice Guidelines 2020 specify the minimum information that must be documented in a patient’s telemedicine records. In this article, we outline the mandatory information that should be recorded, as well as additional best practices to ensure maximum legal protection.

Patient’s Location
It is advisable to record where the patient is located at the time of consultation. In the event that the patient is situated in a place where the doctor is not licensed to practice, he/she should refrain from continuing with the consultation, and should advice the patient to seek medical advice from a licensed professional. If the patient is a regular patient of the doctor who is temporarily located outside of the area where the doctor is licensed, the doctor may, if he deems necessary, proceed with the consultation, and should note down the peculiarity of the situation in the patient’s records.

Patients Consent
Explicit consent must be sought from the patient if the consultation is being initiated by anyone other than the patient (such as a relative, friend, another doctor or a health worker). The doctor may elect to have the patient state his/her consent during the consultation or send their consent via email, text message or an audio/video recording.

If the patient is a minor or mentally incapacitated, a guardian or caregiver may consent on their behalf. The identity of such person should be ascertained and recorded along with the consent.

If the doctor wishes to record the sessions, explicit written consent must be sought from the patient for recording and storing the session.

Patient information
If the doctor requests any identity or age proof in the course of the consultation, details of the same should be noted. The doctor must maintain records of the patient’s case history, doctor’s notes, investigation reports, images, etc that they rely upon to arrive at a diagnosis or treatment plan.

If the patient shares information about pulse, blood oxygenation, blood pressure, blood sugar, etc which they/their caregivers have recorded, it is advisable to record what device was used for measuring the levels.

The doctor should record how the consultation was carried out, and maintain the logs of the same for future reference.

During the course of the consultation, if the doctor deems that it is necessary to change to another mode of consultation (from text/audio to video or in-person), the reasons for same should be recorded. If the patient refuses, the doctor should be sure to capture the same in their records.

The doctor may either issue a signed paper-prescription and share a photograph or scanned copy of the same, or issue an e-prescription. A recommended format has been annexed to the Telemedicine Practice Guidelines. The doctor must maintain copies of all prescriptions that are issued as he/she would for in-person consultations.

Comprehensive Records
Note that if the teleconsultation is taking place across various mediums (for example, the initial discussion over voice call, prescription for pathology tests issued over text message, results shared via email, etc), the doctor should ensure that copies of all communications and records are stored in a common folder, along with any records from in-person consultations, so that the records for the patient are complete and easily accessible.

The background to the Telemedicine Practice Guidelines 2020 specifies that one of the key advantages to telemedicine is a higher likelihood of maintenance of records and written documentation. Thus, while it may seem cumbersome to maintain detailed records of telemedicine consultations, the law expects meticulous documentation.


History of Teleophthalmology at Sankara Nethralaya

History of Teleophthalmology at Sankara Nethralaya

Dr. Sheila John
Head of Teleophthalmology and E-Learning Department,
Sankara Nethralaya, Chennai.




Teleophthalmology holds great potential to improve the quality, access, and affordability in health care. For patients, it can reduce the need for travel and provide the access to a super-specialist. Ophthalmology lends itself easily to telemedicine as it is a largely image based diagnosis. The rapid progress achieved in the field of Telecommunications renders Teleophthalmology easily feasible.

A pilot project was started by Sankara Nethralaya, Chennai, linking two of its eye care centers that were separated by a distance of 3 km. A junior ophthalmologist at the distant center examined about 100 patients, and has their medical information transferred to the Sankara Nethralaya main hospital by LAN over a fiber optic cable. After looking at the images, a senior ophthalmologist at Sankara Nethralaya diagnosed and discussed the treatment modalities with the junior consultant.

The next step, which was accomplished in 2002, was to link Sankara Nethralaya Eye Hospital, Chennai, with Sankara Nethralaya Eye Hospital at Bangalore. The Bangalore branch located 400 km away from Chennai is headed by a vitreo-retinal consultant. Patients who required secondary consultations were subjected to routine examinations and their images were captured and sent to Sankara Nethralaya, Chennai.

A unique teleophthalmology project was started in villages within a 100 km radius of Chennai with a mobile bus offering primary eye care. It was inaugurated by the former President of India, Dr. APJ Abdul Kalam, in 2003. The key to the project was a mobile bus, designed by a team from Sankara Nethralaya with assistance from the Indian Space Research organization.

The Mobile teleophthalmology unit has expanded its services all over India.

Rural Mobile Teleophthalmology units in five States of India.

ISRO mobile unit at Tamil Nadu and Andhra Pradesh inaugurated on 10th Oct 2003
World Diabetic Foundation mobile unit at Karnataka inaugurated on 7th Oct 2005
M. S. Swaminathan Research Foundation mobile unit at Tamil Nadu (Thanjur and Thirunelveli districts) started on 24th April 2007
Vidarbha mobile unit at Maharashtra started on 7th October 2007
Kolkata Teleophthalmology -Inauguration on Jan 23 2009

Central Hub- Procedure
The selected patients have their slit lamp anterior segment, diffuse illumination, slit photos, and usually their non-mydriatic fundus photos taken inside the bus. Patients who subsequently have findings in the fundus are dilated and photographs are taken again. Patients who have squint or other extra ocular problems are also photographed with a digital still camera capable of taking external photographs with zoom capability. Telecommunication between rural camp and Sankara Nethralaya, Chennai is achieved by satellite connection through VSAT, which has a bandwidth of 384 Kb/ps. Now presently we are using internet connectivity with bandwidth of 512 kb/ps to 1Mpbs.

The senior ophthalmologist at Sankara Nethralaya, Chennai examines the images received and comes to a provisional diagnosis. An anterior segment video may be requested in special situations. Demonstration of extra procedures like eye movements may also be requested. The ophthalmologist maintains electronic medical records of all the patients, segregates interesting cases, maintains a file for discussion with peers or seniors, and is involved in the training of fellow ophthalmologists, paramedical ophthalmic assistants, and nursing staff in rural and semi urban areas. During the course of the teleconsultation, the ophthalmologist counsels the patient about familial eye diseases, preventive aspects and eye care.

Expert Opinion and Tele-Continuing Medical Education
Sankara Nethralaya has worked with other hospitals to spread the concept of Teleophthalmology for second opinion for diagnosis of sick patients , this includes the Southern Railways Eye Hospital, Perambur, G P Pant Hospital, Andaman & Nicobar Island , Shri Ganpati Nethralaya, Jalna, Maharashtra, Sri Sankaradeva Nethralaya, Guwahati , Assam and SN, Kolkatta. We are also connected to many institutions through the online mode for -Continuing Medical Education.

Dr. S. S. Badrinath, Chairman of Sankara Nethralaya was the first president of the Telemedicine Society of India.

Presently, the rural mobile teleophthalmology units at Tamilnadu and Kolkata are functioning and have examined more than more six lakh patients. Other units have been transferred to other ophthalmologists in the respective states to implement the program. Due to Covid19 and social distancing, tele counselling and teleconsultations have been implemented for paying patients from April 2020 till date and more than 10,000 patients have benefitted.

Informed Consent for Telemedicine

Informed Consent for Telemedicine

Anay Shukla
Founding Partner, Arogya Legal – Health Laws Specialist Law Firm
Eshika Phadke

Associate, Arogya Legal – Health Laws Specialist Law Firm


The developments in the field of information technology have resulted in geographic borders becoming increasingly redundant. Within the healthcare system, this has had a marked impact on the access that patients have to medical care since it is becoming increasingly common for doctors to consult a patient remotely. The Telemedicine Practice Guidelines have re-affirmed that inter-state teleconsultations within India are lawful and permitted.

However, the liberty to practice across country lines is not without limitation; international consultations are still restricted by geographic boundaries. The Telemedicine Practice Guidelines, 2020 explicitly excludes consultations outside the jurisdiction of India.

What amounts to practise of medicine? Would telemedicine be included?
Practising medicine involves any or all of the following: diagnosing, treating, operating or prescribing medicines or other remedies for any ailment, disease, injury, pain, deformity, or physical condition. Irrespective of whether such activity takes place in person or remotely through a teleconsultation, it would amount to the practise of medicine.

What is eligible to practise medicine?
To be eligible to practice medicine (including offering teleconsultations) in India, a doctor must be registered with the National Medical Commission (erstwhile Medical Council of India) or a State Medical Council.

Similarly, it is safe to assume that the other countries may have laws which restrict who can practice medicine in those countries.

Whose location is relevant for determining the license requirements?
A frequently asked question is whether the doctor is required to be licensed in the jurisdiction where he/she is physically located, or where the patient is located. However, the issue is quite nuanced, and there is no clear cut answer.

It is important to understand that the laws that regulate medical professionals and services typically envisage a scenario where both parties are located in the same room. While some countries, including India, have come up with guidelines that specifically address remote consultations, these guidelines are still in tune with the parent laws for medical professionals and services, and do not have the power to confer the right to a medical practitioner who is not duly licensed in that region to practise medicine. Thus, while the Telemedicine Practice Guidelines endorse a doctor’s right to practise pan-India irrespective of which state medical council they are registered with, it does not give them the authority to practise in a territory where the regulator has no jurisdiction whatsoever. In the Indian context, if a patient was aggrieved and wanted to complain against a doctor, he/she would still be able to approach the medical council of the state where the doctor is registered. However, if the doctor was registered with an authority in another country, the patient would not be able to approach the NMC/state medical council to seek relief. The patient would be rendered helpless. Thus, the law may be interpreted in a way to support the patient, and take a position that the doctor who offers teleconsultation should be licensed to practice medicine in the place where the patient is located.

Are cross border second opinions permitted?
A doctor or patient may, in the course of a consultation or treatment plan, deem that it would be advisable to seek a second opinion from a specialist located overseas. It is important to note that, in such cases, the consultation takes place between two doctors (and not between a doctor and a patient located in different jurisdictions). The doctor who has been approached for a second opinion discusses the case with the treating doctor, and provides his/her inputs to the treating doctor. It is up to the treating doctor to evaluate all the information and provide suitable advice to the patient. The doctor who is providing the second opinion is not practising medicine per se, and is thus not bound by the borders imposed by his/her license.

17th Annual International Conference (TELEMEDICON2021) of Telemedicine Society of India

17th Annual International Conference (TELEMEDICON2021) of Telemedicine Society of India

The 17th Annual International Conference (TELEMEDCICON2021) of Telemedicine Society of India to be held on 12th-14th November, 2021. The theme of the conference is – ‘Tele-health Trends in the 21st Century.’ This issue of the newsletter carries the program for your perusal. Due to COVID the number of participants who would be physically attending are limited, however it is expected that like the last year there will be an overwhelming response. The sessions for free papers and posters are still open. Do make your submission to make the meeting a success.

Click here to Register for TELEMEDICON2021


Click here to view the latest Scientific Program

Problems that exists in Rural India to Adapt Telehealth

Ms. Saranya Gupta
Mentor: Manvee Bansal / Abhimanyu Rathore
Pathways World School, Aravali (IB)


Telemedicine has recently emerged and gained popularity as a new hope to remove the bottlenecks in the healthcare seeking. While telehealth technology and its use are not new, widespread adoption among patients, especially in rural areas, beyond simple telephone correspondence has been relatively slow. Many professional medical societies endorse telehealth services and provide guidance for medical practice in this evolving landscape.

One such example are the incessant advocacy efforts of the Telemedicine Society of India (TSI) that have paid off with the approval of Telemedicine Practice Guidelines by Ministry of Health and Family Welfare, Government of India in March 2020. TSI, now with an enhanced vitality is determined to reduce Urban-rural healthcare disparity.

My detailed research has looked at the problem that exists in rural India and why people residing there are hesitant to adapt to telehealth as a prime medium to acquire healthcare services. Thereafter, it goes into further detail of how this can be destigmatised through solutions like overcoming the language barrier, hiring ambassadors for spreading awareness, and regularly updating the content on the company website.

Lastly, it also includes a state-wise analysis of the 11 states that TSI principally targets, which discusses the problem that a certain state faces and a recommended solution for that problem. For example, people in Maharashtra have concerns about the privacy guidelines around the uptake of telemedicine and to resolve this problem, a recommendation was to revise the guidelines to address the weaknesses and to establish an ongoing system of evaluation to permit future improvements in the guidelines to make them increasingly comprehensive.

The recommendations for adaptation of telehealth in rural areas include –

 1.  proper training of doctors and other healthcare professionals to deliver the telemedicine technology effectively, including vastly improved Internet services;

 2. A much higher level of public-private partnerships related to telemedicine activities;

 3. Developing more cohesive privacy policies and guidelines for TSI to ensure that patients feel secure and integrate telemedicine with the existing health system;

 4. An efficient management structure for monitoring quality standards of telemedicine practice in the country;

 5. Efforts should be made to educate public about telemedicine and its   related benefits.

This kind of research was necessary because of the growing relevance of telehealth services in today’s rapidly revolutionising, technology-dependent world. It is also prominent in the situation of the pandemic in which we are living in today, given the requirement to stay at home and reduce physical contact. In terms of focusing on rural areas of India as a prime target audience for this research, there was a crying need for habitants of these areas to accept newer approaches as the world progresses.

To obtain a full copy of my research, please write a mail to my mentors –

Informed Consent for Telemedicine

Anay Shukla
Founding Partner, Arogya Legal – Health Laws Specialist Law Firm

Eshika Phadke
Associate, Arogya Legal – Health Laws Specialist Law Firm


The Telemedicine Practice Guidelines specify that consent may be implied when a patient initiates a teleconsultation; however, there are certain situations wherein a doctor is legally required to obtain consent from the patient.

Consultation not initiated by the patient
If someone other than the patient – including their family member, a healthcare professional, another doctor, or even the doctor who is consulting the patient themselves – initiates the consultation, explicit consent must be taken from the patient.

If a healthcare professional seeks a medical consultation for a patient through telemedicine, both the healthcare professional and the consulting doctor would need to obtain explicit consent from the patient. The healthcare professional would be required to counsel the patient on the risks and limitations of telemedicine, and the doctor would be required to seek the patient’s consent to proceed with the consultation.

No capacity to consent
If the patient is a minor or does not have the mental capacity to legally provide consent, the person’s caregiver is authorised to consult with a doctor and take decisions on their behalf. However, the doctor must first confirm that the person is the patient’s caregiver by asking to see either a formal authorisation to that effect, or a government-issued document that establishes the person’s relationship with the patient. This would not be required if the doctor has previously treated the patient in-person, and is aware of their relationship with the caregiver. For the sake of documentation in such cases, the doctor ought to record that they have treated the patient in-person prior to the teleconsultation, and may even request that the caregiver confirm the same through a text message or email.

If the doctor will be recording the consultation, they ought to inform the patient and seek their consent for the same. This is especially vital for specialists like psychiatrists, venereologists, gynaecologists, etc, who discuss highly sensitive and personal information and may receive private visuals from the patients.

Refusal to comply
If the doctor is of the impression that the patient ought to go for an in-person consultation for their condition but the patient refuse, the doctor should inform them of the risks and consequnces of not seeking in-person treatment. If the patient still refuses, the doctor should require the patient to send a statement that they were informed of the risks and elected to proceed with the teleconsultation against medical advice in writing or as a voice note, and the doctor should preserve the consent with the records that he/she maintains for the consultation.

Transmitting Prescription to Pharmacy
If the doctor issues a prescription post a teleconsultation and the patient wishes that the prescription be sent directly to a pharmacy of their choosing, the doctor must obtain explicit consent from the patient prior to doing so, since without consent, the act of transmitting a patient’s prescription to a pharmacy would constitute a breach of confidentiality.

Support groups
If the doctor starts virtual support groups for patients suffering from or people affected by a disease/condition where they will be sharing information and/or allowing the group members to provide emotional support to one another, the doctor must seek explicit consent from a patient/person before adding them to the group, since the patient’s identity would be revealed to other members of the group, and confidentiality would thus be compromised.

Limitations of Telemedicine
It is advisable that doctor’s refrain from tending to spontaneous teleconsultations unless it is an emergency; they should put in place a process whereby the patient takes an appointment. Along with the appointment confirmation, the doctor should send a brief statement outlining the risks and limitations of teleconsultation, and informing the patient that by proceeding with the consultation, they are providing their consent.

How to record consent
For the teleconsultation itself, the consent will be implied if a patient proceeds to initiate the consultation after being informed of the risks involved.

For situations where explicit consent is required or advisable, the doctor may ask the patient to record it in any form – they could send an email, text, audio note, video recording stating that they are providing their consent for telemedicine (and any other context that may be required). The doctor must always record the fact of receipt of consent in his notes which should be preserved with the patient’s records.

Telemedicine Practice Guidelines