The term telehealth includes a broad range of technologies and services to provide patient care and improve the healthcare delivery system as a whole. Telehealth is different from telemedicine because it refers to a broader scope of remote healthcare services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services. According to the World Health Organization, telehealth includes, “Surveillance, health promotion and public health functions.”
Telemedicine involves the use of electronic communications and software to provide clinical services to patients without an in-person visit. Telemedicine technology is frequently used for follow-up visits, management of chronic conditions, medication management, specialist consultation and a host of other clinical services that can be provided remotely via secure video and audio connections.
In the time of social distancing, telemedicine has emerged as the preferred means of seeking quality healthcare in the country. India’s telemedicine guidelines issued in March 2020 have clarified regulations for startups and investors. With the government’s new guidelines unlocking the prospects for the telemedicine industry, there have been numerous startups that are establishing and announcing their ventures in the segment.
This session provided clarity on the revised guidelines for the telemedicine industry, new prospects to improve access to healthcare at the grass-root level, and global business opportunities.
BOARD OF GOVERNORS In supersession of the Medical Council of India
Telemedicine Practice Guidelines Enabling Registered Medical Practitioners to Provide Healthcare Using Telemedicine
These Guidelines have been prepared in partnership with NITI Aayog
Telemedicine has moved to the forefront of healthcare, opening up opportunities for both practices and their patients. To help unpack some of the enormous amounts of new information, This presentation focuses on:
- Relaxing of Regulatory Issues
- How Telemedicine Can Help Your Practice
- Challenges
- The Future of Telemedicine
In the time of social distancing, telemedicine has emerged as the preferred means of seeking quality healthcare in the country. India’s telemedicine guidelines issued in March 2020 have clarified regulations for startups and investors. With the government’s new guidelines unlocking the prospects for the telemedicine industry, there have been numerous startups that are establishing and announcing their ventures in the segment.
This session provided clarity on the revised guidelines for the telemedicine industry, new prospects to improve access to healthcare at the grass-root level, and global business opportunities.
BOARD OF GOVERNORS In supersession of the Medical Council of India
Telemedicine Practice Guidelines Enabling Registered Medical Practitioners to Provide Healthcare Using Telemedicine
These Guidelines have been prepared in partnership with NITI Aayog
Telemedicine has moved to the forefront of healthcare, opening up opportunities for both practices and their patients. To help unpack some of the enormous amounts of new information, This presentation focuses on:
- Relaxing of Regulatory Issues
- How Telemedicine Can Help Your Practice
- Challenges
- The Future of Telemedicine
Telemedicine seems to be the cheapest way to bridge the urban- rural divide in access to health
care in India. Telemedicine has been successfully inplemented in many villages in India, but it is
only the tip of the ice berg. India being a Hub of IT, there is very good scope for further growth
of telemedicine, with support of greater technology, standardization and regulations.
Making tele-healthcare more accessible is possible only by the active involvement of all stakeholders
Government, hospitals, Technology providers, Support staff, Educational & Research Institutes, Insurance, Financiers and Patients
Prof Diana Schmidt's Talk at AIIMS on 8th January 2008Sukhdev Singh
Prof Diana Schmidt, School of Medical Informatics of Heidelberg University and Heilbronn University Germany, would be gave a talk on “Factors for success and failure of Telemedicine in Germany and USA” on 8th January 2008. She has permitted me to upload her presentation for the benefit of "Indian Association for Medical Informatics" members. It is being shared through IAMI Delhi Chapter Blog - http://iamidelhi.blogspot.com
Telecommunication systems applied to telemedicineShazia Iqbal
Telemedicine allows health care professionals to evaluate, diagnose and treat patients at a distance using telecommunications technology.
The approach has been through a striking evolution in the last decade and it is becoming an increasingly important.
This is a Telemedicine report I was asked to put together for some various hospitals in Michigan looking to add this technology and was asked by HIMSS members to publish.
This is the first report on Telehealth in India, and was authored in 2011 by Rajendra Pratap Gupta for Telemedicine Society of India , when he chaired the Organising Committee of the International Telemedicine Congress 2011 at Mumbai
This report gives a detailed overview of where India stands and what is the scope in future
Telemedicine: An opportunity in Healthcare in IndiaAmit Bhargava
Telemedicine, despite being an old subject, is presently receiving a huge push from government to address the healthcare inadequacy in India. The speciality health infrastructure is a need of the hour and presents an opportunity for telecom vendors, healthcare providers and policy makers to provide healthcare to masses.
This document identifies the opportunity in telemedicine and indicates the efforts so far.
Based on the recommendations of a committee set up by the Government of India, this document briefly present a set of guidelines of standard practice in Telemedicine in India.
Telehealth in India: The Apollo contribution and an overview Apollo Hospitals
The universal phenomenon of urban rural health divide is particularly striking in India. We have centres of medical excellence in the metros, better than the best. However 700 million Indians, have no direct access to secondary and tertiary care as 80% of India's specialists, primarily cater to 20% of the population. Additional brick and mortar hospitals is not a viable solution, as there is an acute shortage of both funds and health care personnel. In 1999, the author among others, foresaw that it could be possible, to extend the reach of urban doctors to suburban and rural India, virtually. This article traces the author's personal experience in introducing and developing telehealth in India over the last 14 years. Simple video conferencing, has given way to eHome Visits, providing international teleconsults,13,14 tele CME programmes, deployment of internet enabled peripheral medical devices, promoting Health Literacy through eEmpowerment,18,19 multi centre Grand rounds and, virtual visits to the ICU.20–22 With 894 million mobile phones mHealth is certainly the future.23 The Pan African, SAARC, ASEAN and the Central Asia e Network projects13,14,24–29 initiated by the Govt. of India has resulted in India's health expertise, being made available to many countries virtually. With exponential growth in Information and Communication Technology (ICT), a rural tele-density of 43%,23 India may eventually show the way to achieve quality, affordable, accessible health care to everyone, anytime, anywhere making distance meaningless and Geography History, by deploying telemedicine.
This is a prescriptive / generic roadmap for telemedicine, that can be used by Governments , NGOs, companies & individuals in deploying telemedicine and mHealth solutions.
This roadmap was developed by a global team of 17 experts led by Rajendra Pratap Gupta under the Innovation Working Group -Asia (IWG-A).
IWG-A was set up by the office of the UN Secretary General to harness the power of innovations for Health , specially for health related MDGs.
More details write to ea2rajendragupta@gmail.com
Telemedicine seems to be the cheapest way to bridge the urban- rural divide in access to health
care in India. Telemedicine has been successfully inplemented in many villages in India, but it is
only the tip of the ice berg. India being a Hub of IT, there is very good scope for further growth
of telemedicine, with support of greater technology, standardization and regulations.
Making tele-healthcare more accessible is possible only by the active involvement of all stakeholders
Government, hospitals, Technology providers, Support staff, Educational & Research Institutes, Insurance, Financiers and Patients
Prof Diana Schmidt's Talk at AIIMS on 8th January 2008Sukhdev Singh
Prof Diana Schmidt, School of Medical Informatics of Heidelberg University and Heilbronn University Germany, would be gave a talk on “Factors for success and failure of Telemedicine in Germany and USA” on 8th January 2008. She has permitted me to upload her presentation for the benefit of "Indian Association for Medical Informatics" members. It is being shared through IAMI Delhi Chapter Blog - http://iamidelhi.blogspot.com
Telecommunication systems applied to telemedicineShazia Iqbal
Telemedicine allows health care professionals to evaluate, diagnose and treat patients at a distance using telecommunications technology.
The approach has been through a striking evolution in the last decade and it is becoming an increasingly important.
This is a Telemedicine report I was asked to put together for some various hospitals in Michigan looking to add this technology and was asked by HIMSS members to publish.
This is the first report on Telehealth in India, and was authored in 2011 by Rajendra Pratap Gupta for Telemedicine Society of India , when he chaired the Organising Committee of the International Telemedicine Congress 2011 at Mumbai
This report gives a detailed overview of where India stands and what is the scope in future
Telemedicine: An opportunity in Healthcare in IndiaAmit Bhargava
Telemedicine, despite being an old subject, is presently receiving a huge push from government to address the healthcare inadequacy in India. The speciality health infrastructure is a need of the hour and presents an opportunity for telecom vendors, healthcare providers and policy makers to provide healthcare to masses.
This document identifies the opportunity in telemedicine and indicates the efforts so far.
Based on the recommendations of a committee set up by the Government of India, this document briefly present a set of guidelines of standard practice in Telemedicine in India.
Telehealth in India: The Apollo contribution and an overview Apollo Hospitals
The universal phenomenon of urban rural health divide is particularly striking in India. We have centres of medical excellence in the metros, better than the best. However 700 million Indians, have no direct access to secondary and tertiary care as 80% of India's specialists, primarily cater to 20% of the population. Additional brick and mortar hospitals is not a viable solution, as there is an acute shortage of both funds and health care personnel. In 1999, the author among others, foresaw that it could be possible, to extend the reach of urban doctors to suburban and rural India, virtually. This article traces the author's personal experience in introducing and developing telehealth in India over the last 14 years. Simple video conferencing, has given way to eHome Visits, providing international teleconsults,13,14 tele CME programmes, deployment of internet enabled peripheral medical devices, promoting Health Literacy through eEmpowerment,18,19 multi centre Grand rounds and, virtual visits to the ICU.20–22 With 894 million mobile phones mHealth is certainly the future.23 The Pan African, SAARC, ASEAN and the Central Asia e Network projects13,14,24–29 initiated by the Govt. of India has resulted in India's health expertise, being made available to many countries virtually. With exponential growth in Information and Communication Technology (ICT), a rural tele-density of 43%,23 India may eventually show the way to achieve quality, affordable, accessible health care to everyone, anytime, anywhere making distance meaningless and Geography History, by deploying telemedicine.
This is a prescriptive / generic roadmap for telemedicine, that can be used by Governments , NGOs, companies & individuals in deploying telemedicine and mHealth solutions.
This roadmap was developed by a global team of 17 experts led by Rajendra Pratap Gupta under the Innovation Working Group -Asia (IWG-A).
IWG-A was set up by the office of the UN Secretary General to harness the power of innovations for Health , specially for health related MDGs.
More details write to ea2rajendragupta@gmail.com
The 2017 Texas Legislature adopted a new definition and a new approach to telemedicine and the remote delivery of health care. Two health care lawyers prepared this deck to help Texas physicians understand the new law, how it came about, and what it could mean for the practice of medicine in Texas.
"Telemedicine and Digital Health: New Texas Law, Opportunities, and Challenges" was presented at the Texas Medical Association 2017 Fall Conference, Sept. 16, 2017, as the Philip R. Overton Annual Lectureship in Medicine and the Law.
Challenges of the Healthcare Industry in Indiadrparul6375
he healthcare industry in India faces several challenges, ranging from infrastructure and access to healthcare services to regulatory issues and affordability. Some of the key challenges include:
Infrastructure and Resource Constraints: India's healthcare infrastructure is often inadequate, especially in rural areas. There is a shortage of hospitals, clinics, beds, medical professionals, and essential medical equipment. This imbalance between demand and supply leads to overcrowding in healthcare facilities and compromises the quality of care.
Accessibility and Geographic Disparities: Accessibility to healthcare services varies significantly across different regions of India. Rural areas often lack basic healthcare facilities, forcing people to travel long distances for treatment. This geographic disparity exacerbates healthcare inequalities, with urban populations having better access to healthcare compared to rural populations.
Affordability and Financial Barriers: Healthcare costs in India can be prohibitively expensive for many people, particularly those from low-income backgrounds. Out-of-pocket expenditure on healthcare is high, pushing many families into poverty. Lack of comprehensive health insurance coverage further exacerbates financial barriers to accessing quality healthcare services.
This presentation was presented online by Dr.Vinothini as a part of PG Seminar Presentation and the full video presentation can be found in official YouTube channel of IAPSM eConnect
Link for the video: https://www.youtube.com/watch?v=eqR1J9jjCgs
7 legal issues associated with telemedicine servicesmosmedicalreview
Like traditional medicine, telehealth also involves medical chart reviews and other investigations. There are certain legal issues related to telemedicine.
This presentation is from the TMLT webinar, Telemedicine: Managing Your Risks. The presentation reviews regulatory requirements for physicians and health care organizations using telemedicine in Texas.
Telemedicine is a collection of means or methods for enhancing health care, public health and health education delivery and support using telecommunications technologies. With more than 95% of adults, and 100% of young adults between the age of 18-29 owning a cell phone in the United States, a technology-based health intervention can be available to hard-to-reach populations or underserved areas.
Panelists will engage a rich dialogue and showcase innovative and effective ways to create prevention programs for HIV and STDs using the potential telehealth can offer, specifically with linking young people to HIV pre-exposure prophylaxis, or PrEP. This plenary brings together leaders in the field of HIV prevention, research and policy along with private organizations and companies that are currently active on the field of biomedical prevention.
m-Health: Engaging Patients at Every TouchpointCognizant
Today, people want fast, easy and secure access to their health records, from wherever they may be and from whatever device they choose. Electronic health records (EHR) can alleviate this issue, and encourage proactive, preventive care, all within a robust, integrated, interoperable, and inclusive health system that serves the best interests of patients, physician practices, hospitals, public health, and the population at large.
Electronic health record (EHR) is a computerized patient-centric history of an individual’s health
care record that includes data from the multiple sources of care that the patient has used.
Title XIII of ARRA, also known as the Health Information Technology for Economic and Clinical Health Act (HITECH Act), reserves $22 billion to "advance the use of health information technology" -- in large part so the U.S. will be able to move to e-health records by President Obama\'s 2014 deadline.
4 Steps for a Successful Telehealth Appointment.pdfOlivia Adams
The increase in telehealth usage in the healthcare sector since 2020 will be very remarkable. Additionally, it is evident that patients are satisfied with telehealth services and were prepared and able to make use of them while relaxing in their own homes. We cannot claim that the telehealth platform just appeals to a certain age bracket.
Similar to Telehealth medico legal aspects by dr alka mukherjee nagpur ms india (20)
Management of anaemia in pregnancy BY DR ALKA MUKHERJEE DR APURVA MUKHERJEE N...alka mukherjee
Prenatal vitamins typically contain iron. Taking a prenatal vitamin that contains iron can help prevent and treat iron deficiency anemia during pregnancy. In some cases, your health care provider might recommend a separate iron supplement. During pregnancy, you need 27 milligrams of iron a day.
Good nutrition also can prevent iron deficiency anemia during pregnancy. Dietary sources of iron include lean red meat, poultry and fish. Other options include iron-fortified breakfast cereals, prune juice, dried beans and peas.
The iron from animal products, such as meat, is most easily absorbed. To enhance the absorption of iron from plant sources and supplements, pair them with a food or drink high in vitamin C — such as orange juice, tomato juice or strawberries. If you take iron supplements with orange juice, avoid the calcium-fortified variety. Although calcium is an essential nutrient during pregnancy, calcium can decrease iron absorption.
How is iron deficiency anemia during pregnancy treated?
If you are taking a prenatal vitamin that contains iron and you are anemic, your health care provider might recommend testing to determine other possible causes. In some cases, you might need to see a doctor who specializes in treating blood disorders (hematologist). If the cause is iron deficiency, additional supplemental iron might be suggested. If you have a history of gastric bypass or small bowel surgery or are unable to tolerate oral iron, you might need intravenous iron administration. Oral iron is recommended as the first line treatment, with repeated checking of Hb at 2 to 3 weeks after starting treatment to assess compliance, correct administration and response to treatmentOnce Hb reaches the normal range, it is recommended that iron replacement should continue for three months and until at least six weeks postpartumIntravenous (IV) iron is recommended for women who could not tolerate or respond to oral iron, and for those with moderately severe to severe anemia (Hb ≤ 90 g/LHb be measured within 24 to 48 hours after delivery in women with blood loss more than 500 mL, those with uncorrected anemia detected during pregnancy or those with symptoms suggestive of anemia postnatallyOral iron is recommended for women with Hb <100 g/L postpartum, who are hemodynamically stable, asymptomatic or mild symptomatic
Anemia signs and symptoms include:
• Fatigue
• Weakness
• Pale or yellowish skin
• Irregular heartbeats
• Shortness of breath
• Dizziness or lightheadedness
• Chest pain
• Cold hands and feet
• Headache
Keep in mind, however, that symptoms of anemia are often similar to general pregnancy symptoms. Regardless of whether or not you have symptoms, you'll have blood tests to screen for anemia during pregnancy. If you're concerned about your level of fatigue or any other symptoms, talk to your health care provider.
Secondary amenorrhoea by dr alka mukherjee dr apurva mukherjeealka mukherjee
The first step in the evaluation of any patient with secondary amenorrhea is a urine pregnancy test. Every contraceptive method has a failure rate, and anyone who is menstruating is potentially fertile, regardless of age. [5][6]
If the pregnancy test is negative, consider the clinical picture: hirsutism, acne, and a long history of infrequent and irregular menses suggest polycystic ovarian syndrome. By the Rotterdam criteria, a patient may be diagnosed with PCOS if she has two of the following: clinical or chemical hyperandrogenism, oligo- or amenorrhea, or polycystic ovaries on ultrasound. So if a patient has evidence of hirsutism and oligo- or amenorrhea, she can be diagnosed with PCOS without further laboratory testing or imaging.
If history and physical exam are not consistent with PCOS, a TSH should be ordered. Both hyper- and hypothyroidism can lead to menstrual dysfunction.
If TSH is normal, check a serum prolactin. Elevated serum prolactin suggests prolactinoma.
Early pregnancy loss by dr alka mukherjee dr apurva mukherjee nagpur ms indiaalka mukherjee
Early pregnancy loss, or loss of an intrauterine pregnancy within the first trimester, is encountered commonly in clinical practice. Obstetricians and gynecologists should understand the use of various diagnostic tools to differentiate between viable and nonviable pregnancies and offer the full range of therapeutic options to patients, including expectant, medical, and surgical management.
Early pregnancy loss is defined as a nonviable, intrauterine pregnancy with either an empty gestational sac or a gestational sac containing an embryo or fetus without fetal heart activity within the first 12 6/7 weeks of gestation 1. In the first trimester, the terms miscarriage, spontaneous abortion, and early pregnancy loss are used interchangeably, and there is no consensus on terminology in the literature.
Pprom by dr alka mukherjee dr apurva mukherjee nagpur indiaalka mukherjee
Preterm premature rupture of the membranes (PPROM) is a pregnancy complication. In this condition, the sac (amniotic membrane) surrounding your baby breaks (ruptures) before week 37 of pregnancy. Once the sac breaks, you have an increased risk for infection. You also have a higher chance of having your baby born early.
In most cases of PPROM, the cause is not known.
These things may increase risk:
• Having a preterm birth in a previous pregnancy
• Having an infection in your reproductive system
• Vaginal bleeding during pregnancy
• Smoking during pregnancy
Symptoms can occur a bit differently in each pregnancy. They can include:
• A sudden gush of fluid from your vagina
• Leaking of fluid from your vagina
• A feeling of wetness in your vagina or underwear
Call your healthcare provider right away if you have these symptoms.
The symptoms of this health problem may be similar to symptoms of other conditions. See your healthcare provider for a diagnosis.
Diagnosis
• pH (acid-base) balance testing. The pH balance of amniotic fluid is different from vaginal fluid and urine. Your healthcare provider will put the fluid on a test strip to check the balance.
• Looking at a sample under a microscope. When amniotic fluid is dry, it has a fern-like pattern.
• ultrasound exam. This is done to check the amount of amniotic fluid around baby.
Public education on breast cancer hindi by dr alka mukherjee nagpur ms i...alka mukherjee
Abnormal lump — Breast cancer can be discovered when a lump or other change in the breast or armpit is found by a woman herself or by her healthcare provider. In addition to a lump, other abnormal changes may include dimpling of the skin, a change in the size or shape of one breast, retraction (pulling in) of the nipple when it previously pointed outward, or a discoloration of the skin of the breast not related to infection or skin conditions such as psoriasis or eczema.Mammogram — A mammogram is a very low-dose X-ray of the breast. The breast tissue is compressed for the X-ray, which decreases the thickness of the tissue and holds the breast in position, so the radiologist can find abnormalities more accurately. Each breast is compressed between two panels and X-rayed from two directions (top-down and side-to-side) to make sure all the tissue is examined. Mammograms are currently the best screening modality to detect breast cancer. Some mammograms capture images digitally, offering better clarity, the ability to adjust the image, and a decreased likelihood that the woman will need to return on a different day for repeat pictures.
Cancer cervix awareness in hindi by dr alka mukherjee nagpur ms indiaalka mukherjee
Cervical cancer occurs when the cells in the cervix grow abnormally or out of control. The cervix is part of the female reproductive system. The exact cause of cervical cancer is unknown. Certain strains of the human papillomavirus (HPV), a sexually transmitted disease, cause the majority of cervical cancer.
A new vaccine is available to prevent infection against the two types of HPV that are responsible for the majority of cervical cancer cases and the two types of HPV that are responsible for the majority of genital wart cases. A pap smear test is a preventive measure that can detect precancerous or cancerous cells. Precancerous cells are 100% curable.
Evolution and current practices in emergency contraceptives BY DR ALKA MUKHER...alka mukherjee
ey facts
Emergency contraception (EC) can prevent up to over 95% of pregnancies when taken within 5 days after intercourse.
EC can be used in the following situations: unprotected intercourse, concerns about possible contraceptive failure, incorrect use of contraceptives, and sexual assault if without contraception coverage.
Methods of emergency contraception are the copper-bearing intrauterine devices (IUDs) and the emergency contraceptive pills (ECPs).
A copper-bearing IUD is the most effective form of emergency contraception available.
The emergency contraceptive pill regimens recommended by WHO are ulipristal acetate, levonorgestrel, or combined oral contraceptives (COCs) consisting of ethinyl estradiol plus levonorgestrel.
Screening for gestational diabetes an update by dr alka mukherjee nagpur ms i...alka mukherjee
Gestational Diabetes Mellitus (GDM) is defined as any glucose intolerance with the onset or first recognition during pregnancy. This definition helps for diagnosis of unrecognized pre-existing Diabetes also. Hyperglycemia in pregnancy is associated with adverse maternal and prenatal outcome. It is important to screen, diagnose and treat Hyperglycemia in pregnancy to prevent an adverse outcome. There is no international consensus regarding timing of screening method and the optimal cut-off points for diagnosis and intervention of GDM. DIPSI recommends non-fasting Oral Glucose Tolerance Test (OGTT) with 75g of glucose with a cut-off of ≥ 140 mg/dl after 2-hours, whereas WHO (1999) recommends a fasting OGTT after 75g glucose with a cut-off plasma glucose of ≥ 140 mg/dl after 2-hour. The recommendations by ADA/IADPSG for screening women at risk of diabetes is as follows, for first and subsequent trimester at 24-28 weeks a criteria of diagnosis of GDM is made by 75 g OGTT and fasting 5.1mmol/l, 1 hour 10.0mmol/l, 2 hour 8.5mmol/l by universal glucose tolerance testing. Critics of these criteria state that it causes over diagnosis of GDM and unnecessary interventions, the controversy however continues. The ACOG still prefer a 2 step procedure, GCT with 50g glucose non-fasting if value > 7.8mmol/l followed by 3-hour OGTT for confirmation of diagnosis. In conclusion based on Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study as mild degree of dysglycemia are associated with adverse outcome and high prevalence of Type II DM to have international consensus It recommends IADPSG criteria, though controversy exists. The IADPSG criteria is the only outcome based criteria, it has the ability to diagnose and treat GDM earlier, thereby reducing the fetal and maternal complications associated with GDM. This one step method has an advantage of simplicity in execution, more patient friendly, accurate in diagnosis and close to international consensus. Keeping in the mind the diversity and variability of Indian population, judging international criteria may not be conclusive, thus further comparative studies are required on different diagnostic criteria in relation to adverse pregnancy outcomes
Hague convention for inter country adoption by dr alka mukherjee nagpur ms indiaalka mukherjee
The Hague Convention on the Protection of Children and Co-operation in Respect of Intercountry Adoption (Convention) is an international agreement to safeguard intercountry adoptions. Concluded on May 29, 1993 in The Hague, the Netherlands, the Convention establishes international standards of practices for intercountry adoptions. The United States signed the Convention in 1994, and the Convention entered into force for the United States on April 1, 2008The Convention applies to all adoptions by U.S. citizens habitually resident in the United States of children habitually resident in any country outside of the United States that is a party to the Convention (Convention countries). Adopting a child from a Convention country is similar in many ways to adopting a child from a country not party to the Convention. However, there are some key differences. In particular, those seeking to adopt may receive greater protections if they adopt from a Convention country.
The Convention requires that countries who are party to it establish a Central Authority to be the authoritative source of information and point of contact in that country. The Department of State is the U.S. Central Authorityfor the Convention.
The Convention aims to prevent the abduction, sale of, or trafficking in children, and it works to ensure that intercountry adoptions are in the best interests of children.
The Convention recognizes intercountry adoption as a means of offering the advantage of a permanent home to a child when a suitable family has not been found in the child's country of origin. It enables intercountry adoption to take place when, among other steps:
1. The child has been deemed eligible for adoption by the child's country of origin; and
2. Due consideration has been given to finding an adoption placement for the child in its country of origin.
The role of judiciary & the legal procedure in an adoption case by dr alka mu...alka mukherjee
Central Adoption Resource Authority (CARA) is the nodal agency to monitor and regulate in-country and intra-country adoption and is a part of Ministry of Women and child care.
Following are the certain essential conditions in order to be eligible to adopt a child:
• The procedure for adoption is different in case of Indian citizen, NRI or a foreign citizen and a child can be adopted by any of the three.
• Irrespective of their gender or marital status, any person is eligible to adopt.
• Provided that a couple is adopting a child, they should have completed two years of stable marriage and both should agree for the adoption.
• 25 years should be the minimum age difference between the child and the adoptive parents.
WHEN CAN A CHILD BE ELIGIBLE TO BE ADOPTED?
• Any orphan, surrendered or abandoned child is legally declared free for adoption by the child welfare committee as per the guidelines of the Central Government of India.
• A child without a legal parent or a guardian or the parents are not capable of taking care of the child anymore is said to be an orphan.
• When a child is deserted or unaccompanied by parents or a guardian and the child welfare committee has declared the child to be abandoned, a child is considered to be abandoned.
• Renounce on account of physical, social and emotional factors that are beyond the control of parents or the guardian is called a surrendered child as declared by the child welfare committee.
• In case of adoption, a child requires to be “legally free”. A child is considered to be legally free if even after trying their level best the police fails to find the true parent or guardian of the child.
WHAT ARE THE NORMAL CONDITIONS TO BE FULFILLED BY PARENTS?
• The adoptive parents need to be mentally, physically and emotionally stable.
• The adoptive parents should be financially stable.
• The adoptive parents should not be suffering from any life- threatening diseases.
• Apart from cases of special needs children, couples with three or more kids are not allowed for adoption.
• A single female is allowed to adopt a child of any gender but a single male is not allowed to adopt a girl child.
• The maximum age limit of a single parents should be 55 years.
Laws , rules & regulations governing adoptions in india by dr alka mukherjee ...alka mukherjee
ADOPTION IN INDIA
The custom and practice of adoption in India dates back to the ancient times. Although the act of adoption remains the same, the objective with which this act is carried out has differed. It usually ranged from the humanitarian motive of caring and bringing up a neglected or destitute child, to a natural desire for a kid as an object of affection, a caretaker in old age, and an heir after death.[iii]
But since adoption comes under the ambit of personal laws, there has not been a scope in the Indian scenario to incorporate a uniform law among the different communities which consist of this melting pot. Hence, this law is governed by various personal laws of different religions.
Adoption is not permitted in the personal laws of Muslims, Christians, Parsis and Jews in India. Hence they usually opt for guardianship of a child through the Guardians and Wards Act, 1890.
Indian citizens who are Hindus, Jains, Sikhs, or Buddhists are allowed to formally adopt a child. The adoption is under the Hindu Adoption and Maintenance Act of 1956 that was enacted in India as a part of the Hindu Code Bills. It brought about a few reforms that liberalized the institution of adoption.
Tuberculosis in prenancy by dr alka mukherjee dr apurva mukherjee nagpur ms i...alka mukherjee
Prevention of Tuberculosis
The BCG vaccine has been incorporated into the National immunization policy of many countries, especially the high burden countries, thereby conferring active immunity from childhood. Nonimmune women travelling to tuberculosis endemic countries should also be vaccinated. It must, however, be noted that the vaccine is contraindicated in pregnancy [72].
The prevention, however, goes beyond this as it is essentially a disease of poverty. Improved living condition is, therefore, encouraged with good ventilation, while overcrowding should be avoided. Improvement in nutritional status is another important aspect of the prevention.
Pregnant women living with HIV are at higher risk for TB, which can adversely influence maternal and perinatal outcomes [73]. As much as 1.1 million people were diagnosed with the co-infection in 2009 alone [2]. Primary prevention of HIV/AIDS is, therefore, another major step in the prevention of tuberculosis in pregnancy. Screening of all pregnant women living with HIV for active tuberculosis is recommended even in the absence of overt clinical signs of the disease.
Isoniazid preventive therapy (IPT) is another innovation of the World Health Organisation that is aimed at reducing the infection in HIV positive pregnant women based on evidence and experience and it has been concluded that pregnancy should not be a contraindication to receiving IPT. However, patient's individualisation and rational clinical judgement is required for decisions such as the best time to provide IPT to pregnant women
Torch infections during pregnancy by dr alka mukherjee nagpur ms indiaalka mukherjee
TORCH Syndrome refers to infection of a developing fetus or newborn by any of a group of infectious agents. "TORCH" is an acronym meaning (T)oxoplasmosis, (O)ther Agents, (R)ubella (also known as German Measles), (C)ytomegalovirus, and (H)erpes Simplex. Infection with any of these agents (i.e., Toxoplasma gondii, rubella virus, cytomegalovirus, herpes simplex viruses) may cause a constellation of similar symptoms in affected newborns. These may include fever; difficulties feeding; small areas of bleeding under the skin, causing the appearance of small reddish or purplish spots; enlargement of the liver and spleen (hepatosplenomegaly); yellowish discoloration of the skin, whites of the eyes, and mucous membranes (jaundice); hearing impairment; abnormalities of the eyes; and/or other symptoms and findings. Each infectious agent may also result in additional abnormalities that may be variable, depending upon a number of factors (e.g., stage of fetal development
How to develope your personality by dr alka mukherjee nagpur ms indiaalka mukherjee
Personality is what makes a person a unique person, and it is recognizable soon after birth. A child's personality has several components: temperament, environment, and character. Temperament is the set of genetically determined traits that determine the child's approach to the world and how the child learns about the world. There are no genes that specify personality traits, but some genes do control the development of the nervous system, which in turn controls behavior.
A second component of personality comes from adaptive patterns related to a child's specific environment. Most psychologists agree that these two factors—temperament and environment—influence the development of a person's personality the most. Temperament, with its dependence on genetic factors, is sometimes referred to as "nature," while the environmental factors are called "nurture."
While there is still controversy as to which factor ranks higher in affecting personality development, all experts agree that high-quality parenting plays a critical role in the development of a child's personality. When parents understand how their child responds to certain situations, they can anticipate issues that might be problematic for their child. They can prepare the child for the situation or in some cases they may avoid a potentially difficult situation altogether. Parents who know how to adapt their parenting approach to the particular temperament of their child can best provide guidance and ensure the successful development of their child's personality.
Finally, the third component of personality is character—the set of emotional, cognitive, and behavioral patterns learned from experience that determines how a person thinks, feels, and behaves. A person's character continues to evolve throughout life, although much depends on inborn traits and early experiences. Character is also dependent on a person's moral development .
Personality by dr alka mukherjee nagpur ms indiaalka mukherjee
The word personality itself stems from the Latin word persona, which refers to a theatrical mask worn by performers in order to either project different roles or disguise their identities.
At its most basic, personality is the characteristic patterns of thoughts, feelings, and behaviors that make a person unique. It is believed that personality arises from within the individual and remains fairly consistent throughout life.
While there are many different definitions of personality, most focus on the pattern of behaviors and characteristics that can help predict and explain a person's behavior.
Explanations for personality can focus on a variety of influences, ranging from genetic explanations for personality traits to the role of the environment and experience in shaping an individual's personality.
Qualitative blood loss in obstetric hemorrhage by dr alka mukherjee indiaalka mukherjee
• Quantitative methods of measuring obstetric blood loss have been shown to be more accurate than visual estimation in determining obstetric blood loss.
• Studies that have compared visual estimation to quantitative measurement have found that visual estimation is more likely to underestimate the actual blood loss when volumes are high and overestimate when volumes are low.
• Although quantitative measurement is more accurate than visual estimation for identifying obstetric blood loss, the effectiveness of quantitative blood loss measurement on clinical outcomes has not been demonstrated.
• Implementation of quantitative assessment of blood loss includes the following two items: 1) use of direct measurement of obstetric blood loss (quantitative blood loss) and 2) protocols for collecting and reporting a cumulative record of blood loss postdelivery.
Dysmenorrhea and related disorders by dr alka mukherjee dr apurva mukherjee n...alka mukherjee
Dysmenorrhea is a common symptom secondary to various gynecological disorders, but it is also represented in most women as a primary form of disease. Pain associated with dysmenorrhea is caused by hypersecretion of prostaglandins and an increased uterine contractility. The primary dysmenorrhea is quite frequent in young women and remains with a good prognosis, even though it is associated with low quality of life. The secondary forms of dysmenorrhea are associated with endometriosis and adenomyosis and may represent the key symptom. The diagnosis is suspected on the basis of the clinical history and the physical examination and can be confirmed by ultrasound, which is very useful to exclude some secondary causes of dysmenorrhea, such as endometriosis and adenomyosis. The treatment options include non-steroidal anti-inflammatory drugs alone or combined with oral contraceptives or progestins.
Dyspareunia & vulvodynia by dr alka mukherjee dr apurva mukherjee nagpur m.s....alka mukherjee
Pain during or after sexual intercourse is known as dyspareunia. Although this problem can affect men, it is more common in women. Women with dyspareunia may have pain in the vagina, clitoris or labia. There are numerous causes of dyspareunia, many of which are treatable. Common causes include the following:
• Vaginal dryness
• Atrophic vaginitis, a common condition causing thinning of the vaginal lining in postmenopausal women
• Side effects of drugs such as antihistamines and tamoxifen (Nolvadex and other brands)
• An allergic reaction to clothing, spermicides or douches
• Endometriosis, an often painful condition in which tissue from the uterine lining migrates and grows abnormally inside the pelvis
• Inflammation of the area surrounding the vaginal opening, called vulvar vestibulitis
• Skin diseases, such as lichen planus and lichen sclerosus, affecting the vaginal area
• Urinary tract infections, vaginal yeast infections, or sexually transmitted diseases
• Psychological trauma, often stemming from a past history of sexual abuse or trauma
Symptoms
Women with dyspareunia may feel superficial pain at the entrance of the vagina, or deeper pain during penetration or thrusting of the penis. Some women also may experience severe tightening of the vaginal muscles during penetration, a condition called vaginismus.
Chronic pelvic pain by dr alka mukherjee dr apurva mukherjee nagpur m.s. indiaalka mukherjee
Chronic pelvic pain in women is defined as persistent, noncyclic pain perceived to be in structures related to the pelvis and lasting more than six months. Often no specific etiology can be identified, and it can be conceptualized as a chronic regional pain syndrome or functional somatic pain syndrome. It is typically associated with other functional somatic pain syndromes (e.g., irritable bowel syndrome, nonspecific chronic fatigue syndrome) and mental health disorders (e.g., posttraumatic stress disorder, depression). Diagnosis is based on findings from the history and physical examination. Pelvic ultrasonography is indicated to rule out anatomic abnormalities. Referral for diagnostic evaluation of endometriosis by laparoscopy is usually indicated in severe cases. Curative treatment is elusive, and evidence-based therapies are limited. Patient engagement in a biopsychosocial approach is recommended, with treatment of any identifiable disease process such as endometriosis, interstitial cystitis/painful bladder syndrome, and comorbid depression. Potentially beneficial medications include depot medroxyprogesterone, gabapentin, nonsteroidal anti-inflammatory drugs, and gonadotropin-releasing hormone agonists with add-back hormone therapy. Pelvic floor physical therapy may be helpful. Behavioral therapy is an integral part of treatment. In select cases, neuromodulation of sacral nerves may be appropriate. Hysterectomy may be considered as a last resort if pain seems to be of uterine origin, although significant improvement occurs in only about one-half of cases. Chronic pelvic pain should be managed with a collaborative, patient-centered approach.
Intrauterine growth restriction when to deliver by dr alka mukherjee & dr apu...alka mukherjee
Molecular basis of IUGR. –
1. Atypical expression of enzymes governed by TGFβ causes the placental apoptosis and altered expression of TGFβ due to hyper alimentation causes impairment of lung function.
2. Crosstalk of cAMP with protein kinases plays a prominent role in the regulation of cortisol levels.
3. Increasing levels of NOD1 proteins leads to development of IUGR by increasing the levels of inflammatory mediators.
4. Increase in leptin synthesis in placental trophoblast cells is associated with IUGR.
A positive history for risk factors of IUGR can raise the problem of an increased surveillance with the specific goal of an early detection of growth insufficiency [23]. Further diagnostic tests could have a better relevance in a selected high-risk population
Serum markers linked to IUGR
The placentation process starts with the migration of trophoblastic cells that invade the walls of spiral arteries and transform them from small caliber high resistant vessels into wide caliber low resistant vessels that deliver blood at low pressure to the intervillous space. Then, the utero-placental circulation develops in two stages: the first stage (until the 10th week of gestation) consists in endovascular plugging of the spiral arteries by trophoblastic cells, subsequently followed by invasion and destruction of the intradecidual spiral arteries; the second stage (between 14-16 weeks of gestation) consists in the invasion of the inner miometrial part of the spiral arteries [27]. The impaired spiral artery transformation is leading to weak development of the utero-placental circulation and is implied in the pathology of preeclampsia and IUGR
Pregnancy associated plasma protein A (PAPP-A), an Insulin–like Growth Factor Binding Protein Protease whose levels depend on placental volume and function, was assessed in several studies with congruent results. In 2000, Ong et al. evaluated 5584 singleton pregnancies at 10-14 weeks of gestation and measured maternal serum free beta human chorionic gonadotropin (β-hCG) and PAPP-A, concluding that low levels of maternal serum PAPP-A or β-hCG were associated with subsequent development of pregnancy
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Telehealth medico legal aspects by dr alka mukherjee nagpur ms india
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DDIIRREECCTTOORR –– MMUUKKHHEERRJJEEEE MMUULLTTIISSPPEECCIIAALLTTYY HHOOSSPPIITTAALL,, NNAAGGPPUURR MMSS
MEDICO LEGAL DOCUMENTATION MANAGEMENT & TELEMEDICINE
LEGAL ASPECTS OF TELEMEDICINE: TELEMEDICAL JURISPRUDENCE
Telemedicine consultation(or “teleconsultation”) has beenofferedby
doctors in India since the year 2000. However, inthe absence of statutory
basis and support, it was not clear whether it was legal or not. In fact,
there have beennews reports that State Medical Councils hadbannedthe
practice of teleconsultation.
As per Section 27 of the Medical Council of India Act, 1956, any person
who is enrolled in Indian Medical Register, can practice in any state of
India. Hence inter-state telemedicine service was legal, though it was not
formalized.
Telemedicine services were governed by the IT Act, 2000, but there were
no clear guidelines regarding privacy, security, the confidentiality of
patient data, and misuse of electronic data records related to the
healthcare industry.
Looking at the severity of the situation during the Covid-19 pandemic, the
Indian government had launched guidelines for telemedicine solutions on
2. March 25, 2020. Previously, telemedicine operations were governed by
several statutory guidelines in India.
The current telemedicine guidelines in India provides a more
comprehensive framework for applications, mode of communication,
medical ethics, data privacy and confidentiality, document requirements,
fees, process, drug list, technological platformsandmore.
The development of informationtechnology has had a dramatic impact
on society.
Telemedicine is the transfer of medical informationand expertise via
telecommunications andcomputer technologies, tofacilitate diagnosis,
treatment andmanagement of patients.
Telehealthincludes distance learning, medical peer review, patient
educationinitiatives, etc. The internet, cell phones ande-mail are
nowadays not a new area, and if healthcare providers want toenter this
domain, they shouldbe well acquaintedand do so withcautionas there
are medicolegal implications of telemedicine relating toregistration,
licensing, insurance, quality, privacy andconfidentiality issues, as well as
other risks associatedwithelectronic healthcare communication.
The next important aspect is the physicianpatient relationship, the
standardof care and informedconsent. These are very intricate issues
which can be a reasonfor litigation.
Further issues intelemedicine, telehealth, teleconsultation,
telemonitoring, teletreatment andpatient informationrecordalsoneed
to be addressed.
Evidence suggests that telehealth provides comparable healthoutcomes
when comparedwithtraditional methods of health care delivery without
compromising the patient–physicianrelationship, andit alsohas been
shown toenhance patient satisfactionandimprove patient engagement.
Obstetrician–gynecologistsandother physicians whopractice telehealth
shouldmake certainthat they have the necessary hardware, software,
and a reliable, secureinternet connectiontoensure quality care and
patient safety.
3. To implement atelehealthprogrameffectively, participating
sites must undergoresource assessments toevaluate equipment
readiness.
Since telemedicine uses technology todiagnose andmonitor patients
there are chances of medico-legal issues if they are not managed
properly.
The professional judgment of a RegisteredMedical Practitioner shouldbe
the guiding principle for all telemedicine consultations.
An RMP is well positionedtodecide whether atechnology-based
consultationis sufficient or anin-personreviewis needed. Practitioner
shall exercise proper discretionandnot compromise on the quality of
care.
Seven elements need to be considered before beginning any telemedicine
consultation.
1 Context
2 Identificationof RMP and Patient
3 Mode of Communication
4 Consent
5 Type of Consultation
6 Patient Evaluation
7 Patient management
First of all let us see detailed definitions intelemedicine:
1. TELEMEDICINE
4. ‘The delivery of healthcare services, where distance is acritical factor, by all
healthcare professionals using informationandcommunicationtechnologies
for the exchange of validinformationfor diagnosis, treatment andpreventionof
disease andinjuries, researchandevaluation, and for the continuing education
of healthcare providers, all in the interests of advancing the healthof
individuals and their communities.’
2. TELEHEALTH
‘The delivery andfacilitationof healthand health-relatedservicesincluding
medical care, provider and patient education, healthinformationservices, and
self-care viatelecommunications anddigital communicationtechnologies.’
3. REGISTERED MEDICAL PRACTITIONER
‘A RegisteredMedical Practitioner [RMP]is apersonwho is enrolledinthe State
Medical Register or the IndianMedical Register under the IndianMedical
Council Act 1956.’ [IMC Act, 1956]
THE FOLLOWING MEASURES SHOULD BETAKEN TO AVOID MEDICO-LEGAL
ISSUES:
a) Legal and Regulatory affairs
Obstetrician–gynecologistsandother physicians whoprovide tele-health
shouldmeet the safety measures before providing tele-health. This
includes federal, state, andlocal regulatory laws and license
requirements.1
Licensing is state specific for all physicians whoprovide telehealth, thus
making it difficult for physicians toprovide guidance across states.1
Telemedicine parity refers tothe equivalent healthinsurance
reimbursement for similar in-person andtelehealthservices. Becausenot
all states have parity laws, obstetrician–gynecologists considering
offering telehealthservicesshouldbe aware of relevant state policies.
b) Identificationof the patient and the medical practitioner
The medical practitioner giving teleconsultationshouldconfirmthe name,
age, address, email address, phone number and registeredID of the
patient.2
5. The practitioner shouldbeginconsultationby providing name and
qualifications.2
The practitioner shouldbe credentialedat the facility where the patientis
located.1
It is important for the practitioner to display the registrationnumber
allottedby the by the State Medical Council/MCI, onprescriptions,
website, electronic communicationandreceipts etc. giventothe
patients.2
c) Patient Consent
Patient consent is necessary for any telemedicine consultation. The
consent can be Impliedor explicit depending onthe following situations:
If, the patient initiates the telemedicine consultation, then the consent is
implied2
An Explicit patient consent is needed if: A Health worker, RMP or a
Caregiver initiates aTelemedicine consultation.
An Explicit consent can be recorded in any form. Patient can send an
email, text or audio/video message. Patient can state his/her intent on
phone/video to the RMP (e.g. “Yes, I consent to avail consultation via
telemedicine” or any such communication in simple words). The RMP
must recordthis in his patient records.
d) Integrationof Electronic Medical Records
Electronic medical records (EMRs) canbe customizedonthe basis of the
individual site requirements. Phones andmobile apps can be pairedwith
EMRs toinsert and recover patient information.1
If more than one type of EMR software is usedbetweenorganizations, and
the connecting software is not possible, other means of secure
standardizationdataexchange that satisfy security requirements should
be incorporatedtoensure continuity of patient care.1
If EMR integrationis not possible physicianandstaff members shouldalso
communicate by secure methods like fax or email.1
e) MAINTAIN DIGITAL TRAIL/DOCUMENTATION OF CONSULTATION
It is incumbent on RMP to maintain the following records/ documents for
the period as prescribed from time to time: Log or record of Telemedicine
6. interaction (e.g. Phone logs, email records, chat/ text record, video
interactionlogs etc.).
Patient records, reports, documents, images, diagnostics, dataetc.
(Digital or non-Digital), utilizedinthe telemedicineconsultationshould
be retained by the RMP.
Specifically, incase a prescriptionis sharedwiththe patient, the RMP is
requiredtomaintainthe prescriptionrecords as requiredfor in-person
consultations.
f) Treatment and prescriptions
If the RMP has prescribed medicines, RMP shall issue a prescription
as per the Indian Medical Council (Professional Conduct, Etiquette
and Ethics) Regulations and shall not contravene the provisions of
the Drugs and Cosmetics Act andRules.
RMP shall provide photo, scan, digital copy of a signed prescription
or e-Prescriptiontothe patient viaemail or any messaging platform
In case the RMP is transmitting the prescription directly to a
pharmacy, he/ she must ensure explicit consent of the patient that
entitles him/her to get the medicines dispensed from any pharmacy
of his/her choice.
They should follow the same treatment guidelines of in-patient
visits andshouldobey the available laws and regulations.1
The standardformat of prescriptionshouldbe followed.
A picture of the signed prescription or E-prescription should be kept
for records.2
g) Billing andPayment - Fee for Telemedicine Consultation
The payment of a telemedicine consultation should be treated the
same way as the in-personconsultations.2
The healthcare provider shouldgive areceipt or an invoice tothe
Patient for the fee charged.2
DUTIES AND RESPONSIBILITIES OF A RMP IN GENERAL (applicable to ob-gy also)-
MEDICAL ETHICS, DATA PRIVACY & CONFIDENTIAILITY
7. Principles of medical ethics, including professional norms for protecting
patient privacy and confidentiality as per IMC Act shall be binding and
must be upheldand practiced.
RegisteredMedical Practitioner would be required to fully abide by Indian
Medical Council (Professional conduct, Etiquette and Ethics) Regulations,
2002 and with the relevant provisions of the IT Act, Data protection and
privacy laws or any applicable rules notified from time to time for
protecting patient privacy and confidentiality and regarding the handling
and transfer of such personal information regarding the patient. This shall
be binding and must be upheld and practiced.
RegisteredMedical Practitioners will not be held responsible for breach of
confidentiality if there is a reasonable evidence to believe that patient’s
privacy and confidentiality has been compromised by a technology breach
or by a person other than RMP. The RMPs should ensure that reasonable
degree of care undertakenduring hiring such services.
MISCONDUCT
It is specifically noted that in addition to all general requirements under the MCI
Act for professional conduct, ethics etc, while using telemedicine all actions that
willfully compromise patient care or privacy and confidentiality, or violate any
prevailing laware explicitly not permissible.
Some examples of actions that are not permissible:
RMPs insisting on Telemedicine, when the patient is willing to travel to a
facility and/or requests anin-personconsultation
RMPs misusing patient images and data, especially private and sensitive
in nature (e.g. RMP uploads an explicit picture of patient on social media
etc)
RMPs who use telemedicine to prescribe medicines from the specific
restrictedlist
RMPs are not permitted to solicit patients for telemedicine through any
advertisements or inducements
CERTAIN IMPORTANTPOINTS FOR OBSTETRICIAN&GYNECOLOGIST:
Obstetrician–gynecologist’s ability to communicate information
effectively and compassionately is key to a successful patient–physician
relationshipinpregnant patients.
8. Synchronous modalities have the advantage of immediate, clear, and
accurate informationin real-time like video conferencing can allow for the
exchange of verbal and nonverbal cues, which forms base for effective
patient–physician relationship.
Doctor should teleconference in a quiet professional environment and
should dedicate time specifically for video conferencing patients, as if the
patient were physically present.
Doctor should offer the same level of care to patients receiving
telemedicine as they provide topatients inperson.
Doctor should follow the same treatment guidelines they would follow
for in-person visits and should comply with applicable laws and
regulations and should examine their state laws and medical board
definitions closely and periodically to ensure that their practices are
compliant.
There are many liability insurance options for physicians so before
choosing a liability insurer, physicians who provide telehealth should
request proof in writing that the liability insurance policies cover
telemedicine malpractice and that the coverage extends to other states in
which they are practicing, if applicable.
Additionally, physicians who provide telehealth should check with liability
insurers for requirements or limitations to the provision of telehealth
services under the insurance policy. Requirements or limitations should
be documented clearly and physicians who provide telehealth should
weighrisk versus the benefit of policy.
Telemedicine will reduce the time of consultations and improve the
quality of healthcare services in rural areas, removing many of
infrastructural challenges. The telemedicine market in India is expected to
reachUS$5.4 Bn by 2025 withaCAGR of 31%.
Do’s and Don’t’s for Doctors:
1. Patient identificationis mandatory during first consultation:
9. At first consultation of the patient - ask patient’s name or age or address
or email I.D. or phone number or any other identification
Patient identity confirmation is not mandatory during follow-up
consultation, but may be carried out on need basis: It is not mandatory to
identify the patient during a follow-up teleconsultation with a known
patient, especially if the doctor is communicating through the registered
user id, email idor phone number.
In case of doubt, the doctor should confirm patient identity as during the
first consultation.
2. Caregiver identity andauthorizationshouldbe checked:
If the patient is not a minor or is not incapacitated, then a caregiver
cannot consult on behalf of the patient unless he or she has a
formal authorization such as a signed authority letter by the patient
or his/her legal representatives (family members) or, where the
caregiver is a family member himself or herself, if he or she has a
document that verifies his or her relationship with the patient such
as a government identity proof.
The caregiver’s identity and authorization should be checked by the
doctor before offering teleconsultation.
In the case of minors, the identity of the caregiver should be
confirmed.
3. Doctor should identify himself/herself to the patient before start of every
teleconsultation:
A doctor should begin any teleconsultation by informing the patient
about his/her name and qualification. This may be uncomfortable
to be done every time, especially toaknown patient.
This is the requirement of Telemedicine Guidelinesat present.
4. Doctor should display his/her registration number at every touch-point
withpatient:
A doctor who provides teleconsultation is required to display his/her
registration number provided by respective State Medical Council on
his/her prescription, website, electronic communications
10. (WhatsApp/Message/Email etc.) and fee receipts given to his/her
patients.
5. Doctor shouldnot continue withteleconsultationif it not appropriate:
If the doctor is not satisfied with the information provided by the patient
to provide specific treatment, i.e. prescription or health advice, then
he/she should provide limited consultation as appropriate and refer the
patient for an in-personconsultation.
6. Doctor shouldmaintain patient records of teleconsultation:
For in-person O.P.D. consultations in India, the doctors, in general,
do not maintain patient records. Appropriate patient history,
observations and findings are recorded on the prescription and it is
handed over to the patient.
But or teleconsultation, it is mandatory for doctors to prepare,
maintain and preserve the patient’s records (e.g. case history,
investigation reports, images, etc.), copy of prescription issued and
proof of teleconsultation (e.g. phone call history, email records,
chat/ text record, videointeractionlogs etc.).
Generally recommendedtomaintainthese records for three years.
7. Patient’s personal data should not be disclosed or transferred without
writtenconsent of the patient:
Since teleconsultation happens on an electronic medium, the Indian
law that protects personal information including medical and
health-related information of patients, squarely applies to doctors
who provide teleconsultation and receive such information from
patients.
This is in additionto the ethical obligationto protect patient privacy
that is recognized inthe Code of Conduct.
The most important thing to note here is that Doctors who provide
teleconsultation should not disclose or transfer any information
that may identify the patient without the prior written consent of
the patient.
11. 8. Doctor should not deny emergency teleconsultation, but limit it for
immediate assistance or first aid:
o Emergency teleconsultation should not be provided remotely
except when it is the only way to provide timely care. Even then,
such emergency teleconsultation should be limited to first aid, life-
saving measures, counselling andadvice onreferral.
o Every emergency teleconsultation must end with an advise to the
patient or his/her carer for in-person interaction with a Doctor at
the earliest.
9. Limitationon prescribing medicines topatients:
The most significant limitation imposed by Telemedicine Guidelines on
the practice of telemedicine in India. In order to prevent abuse, the
Telemedicine Guidelines require every doctor to “prescribe medicines via
telemedicine ONLY when (the doctor) is satisfied that he/ she has
gathered adequate and relevant information about the patient’s medical
condition and prescribed medicines are in the best interest of the
patient.” Prescribing Medicines without an appropriate
diagnosis/provisional diagnosis will amount toprofessional misconduct.
10.Before issuing a prescription through teleconsultation, every doctor is
supposed to inquire about the age of the patient. If there is any doubt
about the age of the patient, thenthe doctor should seek age proof. If the
patient turns out to be a minor, then further teleconsultation should be
done and prescription should be issued only in the presence of an adult,
whose identity shouldalsobe ascertainedby the doctor.
11.If the teleconsultation with the patient does not take place over video,
then the concerned doctor cannot prescribe drugs to the patient other
than common over-the-counter (“O.T.C.”) medications such as
paracetamol, O.R.S. solutions, cough lozenges etc. Such patient also
cannot be prescribed medication for which diagnosis is possible only by
video consultation such as antifungal medications for Tinea Cruris,
Ciprofloxacillineye drops for Conjunctivitis etc.
The doctor may, however, prescribe ‘add-on’ medication to such patient
to optimize the existing treatment through drugs if such existing
12. treatment was prescribed in an in-person consultation less than six
months ago.
Very important to note here there is no bar in prescribing emergency
medications, even if they are not O.T.C. medicines, as and when notified
by the government, through any form of teleconsultation, whether video
or not.
o List O – common OTC medicines - can be prescribed without video
teleconsultation
o List B - A list of ‘add-on’ medications to optimize existing treatment
is described
o List O - emergency medications would be included in the list of
O.T.C. medications, i.e. If the patient is examined through video,
then the doctor may prescribe medications other than O.T.C.
medicines described inList A of Appendix 5 of Code of Conduct.
o
Some examples of suchmedicines are:
Ointments/Lotion for skin ailments: Ointments Clotrimazole, Mupirocin,
Calamine Lotion, Benzyl Benzoate Lotionetc.
Local Ophthalmological drops such as: Ciprofloxacillin for Conjunctivitis,
etc
Local Ear Drops such as: Clotrimazole ear drops, drops for ear wax etc.
12.The doctor may also prescribe a ‘refill’ of medication already prescribed
during an in-person consultation for chronic illnesses (hypertension,
diabetes, asthma etc.) or an ‘add-on’ medication to optimize the existing
treatment (like inthe case of non-videoconsultation).
13.No doctor is permitted to prescribe habit forming drugs (i.e. drugs in
Schedule X of Drugs and Cosmetics Rules, 1945) or narcotic or
psychotropic drug (i.e. drugs regulated by Narcotic Drugs and
Psychotropic Substances Act, 1985) through any medium of
teleconsultation.
MANDATORY TRAINING IN TELEMEDICINE
At some point of time in future, the Board of Governors in supersession of
Medical Council or National Medical Commission would introduce training
programs in telemedicine.
13. It will be mandatory to participate in those training programs for all
doctors who intendtooffer teleconsultations topatients.
However, until those training programs are developed, there is no
restriction in terms of prior training or qualification for registered doctors
to engage in teleconsultation.
The Telemedicine Guidelines do not apply to practitioners of Ayurveda, Yoga,
Homeopathy, Unani or Siddha.
Impact of 2018 judgement of Deepa Sanjeev Pawaskar and Anr. v. State of
Maharashtraon Telemedicine Practice Guidelines
In 2018, a judgement of High Court of Bombay caused panic amongst doctors
who offered teleconsultation. In that case, two gynaecologists were denied
anticipatory bail on the grounds that, prima facie, they were criminally
negligent towards their patient who unfortunately died while under their care.
The material facts of the case are that the deceased patient had presented
herself with a complaint of fever and severe vomiting. She was admitted to the
nursing home of the accused doctors by the hospital staff without examination,
as the doctors were out of town. One of the doctors started treatment for the
patient telephonically, by instructing the on duty nurse. Unfortunately, the
patient died. The Court held that the patient died because, amongst other
things, she was prescribed treatment over telephone without appropriate
diagnosis, and found such practice to be an act of criminal negligence. The
application of the doctors for bail in anticipation of arrest was rejected.
However, the doctors were successful in receiving the bail in appeal and were
not arrested.
This judgement was interpreted by some doctors as deeming the practice of
telemedicine and teleconsultation itself illegal. However, such an interpretation
is without basis and incorrect. The Court was only concerned failure of the
doctor to diagnose the patient. The fact that the drugs for treatment of patient
were communicated by the doctor through telephone is only incidental to the
outcome of the judgement. It is not the basis of the judgement. In other words,
had the doctor communicated the same drugs to the nurse orally while being
physically present but without examining the patient, and then patient would
have died, the Court would have come to the same conclusion. Thus, the
judgement should not be extrapolated to state that the practice of telemedicine
and teleconsultationitself is illegal.
14. Therefore, the above judgement of Bombay High Court does not interfere with
the Telemedicine Guidelines at all. In fact, it supports it. The Telemedicine
Guidelines require doctors who provide teleconsultation to start patient
treatment only if the doctor is satisfied that he/ she has gathered adequate and
relevant information about the patient’s medical condition and prescription of
medicines which are in the best interest of the patient. Else, the doctor should
not prescribe medication to the patient. If the doctor prescribes patient in
violation of the Telemedicine Guidelines, he/she risks losing his/her registration
with respective State Medical Council i.e. the license to practice medicine on
grounds of professional misconduct.
ENFORCEMENTOF THETELEMEDICINEGUIDELINES
The Telemedicine Guidelines have been published in form of an
amendment to the Code of Conduct. Therefore, any violation of the
Telemedicine Guidelines will be looked at as a ‘misconduct’ at hands of
the concerneddoctor under the Code of Conduct.
A patient, who suffers due to misconduct, has the right to complain to the
respective State Medical Council with whom the doctor is registered
about the misconduct.
If the doctor is found guilty of the misconduct, he or she may be
reprimanded, or his/her registration may be suspended or cancelled. A
suspension or cancellation of registration would effectively stop the
doctor from carrying on his/her medical practice.
CONCLUSION:
The notification of the Telemedicine Guidelines marks the dawn of a new
erain the practice of modernmedicine.
The law has finally caught up with the reality and necessity of modern
times.
The Telemedicine Guidelines enable doctors to confidently provide
teleconsultation via any medium (such as email, phone call, message, fax,
WhatsApp, other mobile and computer applications such as Skype,
Google Hangouts etc.) to the patients.
15. At the same time, they protect patient interest by mandating doctors to
identify themselves before consultations, disclose their registration
number, and offer the same standard of care to patients as during in-
person consultation and limit medicines that can be prescribed through a
teleconsultation.
Indians will now be able to enjoy access to quality healthcare remotely,
and doctors will be able to extend their services to many more needy
patients.