Clinical Guidelines for Telemedicine in Nepal 2021

 Although the industry is still far from establishing a common collection of telemedicine guidelines, the Nepalese Telemedicine Association has compiled guidelines for a variety of specialties based on a survey of hundreds of research studies. What health, scientific, and administrative guidelines does a medical practice obey when introducing telemedicine? What are the best telemedicine procedures, aside from the state's minimum legal requirements?

The Nepalese Medical Association has developed a detailed set of recommendations for clinicians using telemedicine in primary and urgent care – a sector that is rapidly embracing telemedicine to improve basic healthcare coverage – based on more than 600 studies. When launching a telemedicine service, a primary care or urgent care center should follow the following specific guidelines and laws.

When do you use telemedicine?

Although several conditions not on this list can be handled with telemedicine, the following are particularly well-suited to it: Allergies and asthma, Chronic bronchitis, Conjunctivitis, UTIs, Low back pain, Otitis media, Rashes, Upper respiratory infections, Diabetes, Hypertension, Mental illness/behavioral wellbeing, Prevention and wellness programs are only a few of the services available.

Because of serious symptoms, certain protocol-driven procedures, or violent treatments, telemedicine should not be used for any condition where an in-person test is needed. Patients can also go to the ER or call 911 if they have a medical emergency.

When deciding whether or not telemedicine is sufficient, healthcare professionals should use their professional judgment.

When is it necessary to prescribe?

For live-video telemedicine sessions, where the visit will replace an in-person test, prescribing is permissible. For telephone appointments, prescribing is acceptable as long as the physician has a prior relationship with the patient.

Keeping the patient informed

Just a few states have legislation requiring healthcare providers to receive informed consent from patients before using telemedicine. Regardless of whether the state needs it, this is still good practice. Providers should clarify to patients how telemedicine functions (when service is available, scheduling, privacy, etc. ), any confidentiality limitations, the risk of technological failure, procedures for communication between virtual visits, prescribing policies, and coordinating treatment with other health professionals before the first telemedicine visit. All should be explained in simple, easy-to-understand words.

Build the perfect atmosphere for telemedicine visits.

To ensure anonymity, adequate lighting and audio, and prevent interruptions, healthcare providers should create a dedicated area for telemedicine visits. Providers can mount their camera on a level stand and aim it at eye level wherever possible.

Have a plan for emergency situations and referrals.

Make an emergency plan and let the patient know about it before the visit. Make sure you have all of the necessary details on hand for referrals and transfer requests.

Management and Evaluation of Patients

Always communicate with the patient in a culturally competent manner and in the patient's native language. Telemedicine should not be used if the patient cannot understand due to a language barrier.

The healthcare provider must use clinical judgment to assess when telemedicine is suitable for the patient's case and when it is not. In addition, if possible, the patient diagnosis should be focused on the patient's medical history and access to their medical record.

To help guide these decisions, the provider should establish clinical procedures that include the condition to be handled (with ICD code), the nature of the condition that can be treated using telemedicine, diagnostic criteria (what is a phone call appropriate vs. live video), documentation required to adequately determine the patient's condition, and parameters for when the condition can and cannot be treated. While this section offers general telemedicine guidance, it is best practice for healthcare providers to develop more comprehensive procedures for and condition they plan to treat.

The following information is required for diagnosis:

Identifying the origins of the history chief complaint's details

Signs and symptoms of the current disease in the past

medication analysis allergies previous medical history family history personal and social history

a thorough examination of the symptoms

patient self-examination driven by the provider (including mobile medical devices if needed)

Assurance of Quality

Daily safety audits on telemedicine systems should be performed by healthcare providers to detect any possible threats or shortcomings (such as with equipment or connectivity, and patient or provider complaints).

Invoices

Where appropriate, clinicians should warn patients about the cost of their care prior to their visit.

In general, adhere to the same guidelines that apply to in-person medical facilities.

Providers should continue to adhere to the same guidelines as they would for any in-person medical appointment. They should, for example, conform to the same code of ethics, obey HIPAA security protocols, provide proper reporting to the patient's primary care provider, and adhere to their licensing and credentialing requirements.

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