Virtual Clinic is a technology backed initiative providing a platform for cloud-based unified health record and virtual interaction with doctors and patients through audio and video communication. It is a planned contact by the health care professional responsible for care with a patient for consultation, advice and treatment planning. Virtual Clinic is a social initiative by the Asian Health Meter. The user interface is a tablet PC. The platform of Virtual clinic provides the dashboard of all specialists in the district with a detailed description of their clinical expertise so that patient can choose the specialist on the basis of experience and proximity. It is a web-based technology which aims to provide a scheduled appointment with the doctor for consultancy.
In rural India, the patients get affected due to the non-availability of doctors for treating them with prompt and accurate diagnosis. In spite of huge efforts by the government, it had become almost impossible to reach specialist care to the rural population. The main purpose of initiating virtual clinic is to provide quality health care services.
The benefit of the virtual clinic is that it is possible to leverage the expertise of specialists who are not available nearby; it promotes the extensive outreach of specialist. It saves the transportation time along with the cost of transportation. The advantage of the virtual clinic is that it is available on a fingertip, convenient for both doctor and patient. Because of convenience, frequent consultation will improve the outcome in chronic illness like heart failure, diabetes and respiratory failure.
The growth in the concept of the virtual clinic is likely to lead medico-legal and ethical challenges in India. The challenges include the confidentiality of patients, the standard of treatment, consent from patients, professional misconduct, credentials of doctors, licensure, reimbursement, penalties and liabilities as per the various prevalent laws. The challenges may adversely affect the acceptance and adoption of a virtual clinic consultation.
Cons of virtual clinics:
Virtual Clinic has some downsides because of its virtual nature as it requires infrastructure and technical training. It may reduce the direct interaction of the patients with doctors without the impersonal interactions and to make a complete diagnosis; the physical examination needs to be done.
Once the relationship between doctors-patient is established, it is doctors responsibility to provide treatment and due care. It raises the two important questions as follows:
Can a physician be sued for medical malpractice in operating a virtual clinic?
Can medical practitioners be protected by medical indemnity insurance?
All medical practitioners must maintain and establish the duty of care to clarify the responsibility of the patient as well as other health care providers. The roles and responsibilities of healthcare professionals should be clearly defined with respect to various aspects and extents.
In-country like the US, the virtual clinics allow patients to connect with a healthcare provider through text, video chat or telephone. The medical services in the virtual clinic include consultation, tests and online prescribing.
Services of Virtual Clinic limits to patients with the same province or territory, but to interact with them in a different jurisdiction, it is necessary to consider whether the telemedicine license is required or applicable. The requirement for licenses varies from provinces and territories.
The ethical and legal obligation of the physician is to protect the personal health information of the patient. The virtual clinics satisfy that the security protocols of information transmitted electronically, including video call, chat, text messaging, etc. Each of these has unique privacy challenges covered. In order to provide services, the jurisdiction where the patient is located is a must.
The method of delivering care through a virtual clinic presents unique challenges in obtaining consent from the patient. Some additional consent requirements are recommended while using telemedicine and virtual care. It may include the information of the patient where physicians are located, what is the status of their license, how is the privacy of the patient is managed and all about personal health information.
It is essential that medical records are made and maintained for any patient through the virtual clinic. The information of the patient’s medical history and clinical interactions is vital to maintain as the medical records are the legal documents that can be served as evidence of the care provided or the services given to them. The physicians will have continued access to the medical records after the consultation, especially when a patient initiates a claim or complaint. The owner or the operator of the virtual clinic having the custodian of the medical record of the patient should maintain the same in proper order.
For instance, BRYAN Health under the telemedicine meets the demand for virtual care and is an award-winning health system in Nebraska; they achieved their strategic growth by developing a virtual care service line with Zipnosis, a platform which allows BRYAN telemedicine to leverage internal clinical expertise and offering care to the patients.
Virtual Clinics are a new upcoming reality to deliver healthcare. If India is thinking to evolve in the concept of a virtual clinic to provide the medical service, it is necessary to consider the medical-legal issues that can emerge. It is necessary to consider whether any special licensing requirements may apply, or the standards and guidelines concerning other medical technologies including privacy, security, consent and online prescribing are applicable.