INTRODUCTION:

The major target of service related to health management is to make public healthy, prosperous with extended life. Prophylaxis which is better than cure can reduces the health risk and requirement of health attention. This unique system thus access to provide healthcare support to decrease the probability of disorders or illness or injury. Better future can be predicted by the application of technology which has evolved over centuries therefore there is need for better technology with positive upgradations and more efficient affordable care.

Technology of telemedicine help both patients as well as service providers in multiple ways involving physicians, surgeons, pharmacists, paramedical staff, IT and electronics engineers, government, hospitals and end-user public. Location is now a days no problem and therefore there is no limitation of the availability of healthcare facilities to such location or remote location. The biggest role in such development is played by the communication technology which may provide healthcare services to every nook and corner of the location. The key factors involved in providing health care in different countries of unequal status, are access, equity, quality, and cost-effectiveness. In the year 1970, the word Telemedicine came into existence, meaning “healing at a distance”¹, implies application of ICT for improving the affected person outcomes by delivering ability to medical care and authentic knowledge. On reviewing more than 100 studies by WHO, the telemedicine can have many meaning but exactly it can be defined² as the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities³. Telemedicine is also described as an open evolutionary science, which inculcates new advancements in ICT as per the medical needs with reference to societies. Telemedicine can also be seen as science of service delivery by health professionals such as physicians, pharmacist, nurses and others. Many times, tele-health is used interchangeably^4-6.

Origin and Historical Development:

Initiation of the telemedicine can be observed from the middle to late ninetieth century⁷ with the evidenced of the transmission of first ECG data over through wired or telephonic communication⁸. In 1960 Telemedicine catered the need of space and defense sectors as well as in commercial equipment application^7,9. Early instances of teleconsultation can be traced when the conversion or visualization through television between doctors from the secondary hospital and other healthcare professional at Mental Care Centre¹⁰, next instance was reported of delivering medical health advices from academic hospital to Medical Airport Centre¹¹. Many such examples always propel the development of the field of telemedicine^12,13.

In the past advancements, increasing availability of ICTs and their utilization by the general public are the biggest propellers of telemedicine over the time, thus exploring novel opportunities for health care service and delivery for developed industrialized nations,developing countries¹⁴. In addition to this communication through digital mode instead of analogous mode, continuous reduction in the cost of information and communication technologies, internet introduction, web-based approaches such as email,teleconsultation and multimedia applications all cater the interest of researchers and field experts to initiate the developmental phase of tele health with continues exploring the new ways^7,9. Allied of Telemedicine is telesurgery, is defined as branch of medicine or telemedicine in which distant surgical procedure or surgery is performed by surgeon or surgical team on patient located remotely¹⁵ therefore it is also called remote surgery. Beside ignoring geographical boundaries this distant technology ensures the timely availability of surgeons.It utilizes the base of wireless networking and robotics¹⁶. In 1985 during a stereotaxic operation the first surgical robot, PUMA 560 perform biopsy by inserting a needle into the brain to avoid error from hand tremor as did frequently by humans. In 1988 PROBOT had done the operation of prostrate(transurethral),this is complex surgery required precision and accuracy however this surgical procedure involves the many cutting motions which are repetitive in nature. In the year 1992, IBM and an integrated surgical system (ISS) developed ROBODOC which was used for hip replacement, in this surgical operation the cavity was created in the femur in affected patients with greater precision and accuracy.

In India, due to large geographical areas, diversity and scare resources providing healthcare services is tough task but this challenge can be meet out with approach of telemedicine as this concept work well due to advantages of cost saving specially of rural and mountainous population. They not need to move long distances for getting physician consultations. There is urgent need to develop the infrastructure facilities. Telemedicine can drive vital role in subjects when the physical or geographical limitation is matter of concern. The telemedicine is well suited to the situation such as disasters and pandemics This has additional advantage of not exposing staff to microbes/infections.

The recently formulated digital health policy of India recommends the application of various ICT based techniques for enhancing the performance and result of the medical care system and emphasis the adoption of telemedicine, especially at the secondary hospitals, Community Health Centre and Public Health Centre, where there is loop linking of physician or surgeon with patients or end-user through technology-based tools and techniques^17,18.

Goal/Characteristics of Telemedicine:

• The main aim is to overcome physical obstacles, connecting users who are not in the similar geographical or remote location

• Therapy based assistance is also prime target.

• The facilitation is through the use of ICT.

• The final target is to improve health/medical outcomes.

Definition of Registered Medical Practitioner (RMP) in India:

It can be defined as “a person who is enrolled or registered in the State Medical Register or the Indian Medical Register under the IMC Act 1956”. However, there has been question on the telemedicine practice. Deficiency of transparent norms has developed significant ambiguity for physicians,pharmacists,nurses and other health care professional involved, questioning on the telemedicine working. The Bombay High court in his 2018 judgement had developed confusion on the legitimacy and practice of telemedicine due to the lack of appropriate framework for its practicing. In India, the existing provisions which primarily govern the practice of medicine and information technology are “Drugs and Cosmetics Act, 1940 and Rules 1945 (regulating pharmacy profession)”, “Indian Medical Council Act, 1956 (regulating medical profession in India)”, “Indian Medical Council (Professional Conduct, Etiquette and Ethics Regulation 2002)”, “Clinical Establishment (Registration and Regulation) Act,2010”, “Information Technology Act, 2000 and the Information Technology (Reasonable Security Practices and Procedures and Sensitive Personal Data or Information) Rules 2011”. Earlier there was no act or legislation or norms. But now telemedicines guidelines has been released by the govt in march 2020. The legislation gaps may pose a danger for physicians and patients therefore new guidelines on telemedicines may provide the transparency. There are some countries which follows legislative acts/regulation on the other hand different nation has adopted non-legislative practices.

Services Offered by Telemedicines:

Teleconsultation:

The consultation provided by the physicians to communicate the health and medical information as seeked by their end-user or patients through the use of information and communication technology.

Tele-diagnosis:

It is branch in which diagnosis and detection of patient are done by medical digital devices or instrument from distant boundaries.

Telemedicines for emergency subjects:

These type of care uses live parameters as well as images of the affected person gathered from collected from a distant place that must be communicated to the doctor clinic. Use of ICT may be through video conferencing or real time retrieval system.

Telemonitoring:

Telemonitoringprovides the facilities for the evaluation and taking care of affected person recovering at their house/clinic by the use of authentic data check.This whole work may involve the use of the body gadgets which captures the vital parameters by respective sensors which get collected within the body area network before being delivered collectively for subsequent data processing.

Tele-proctoring:

This is related with the surgical training in which there is training given for the various surgical processes to the trainees from remote place.

Telesurgery:

This field is specific to the area of remote surgery. Robots can perform the surgical operation on the instructions by the surgeon situated remotely. The introduction of 4G and 5G has made its acceptability in surgical practices¹⁹.

Communication Networks and Services:

Communication networks provide wide and various types of network services (Fig. 1) to wide spectrum of healthcare and medical professional services thus provide the platform through which health professional share their ideas,consultation or even perform remote surgeries.Inaddition to this patient record retrieval and inventory management can also be handled.

Fig. 1: Services provided by Telemedicines.

A simple Telemedicine system as depicted in block diagram (Fig. 2) consist of the numerous sensors, workstation, database and administrator. Various category of the data is collected then the data is analyzed and placed in database and this whole activity is evaluated by administrator platform.

Fig 2: A simplified telemedicine system.

The Basics of Wireless Communications²⁰

The most primitive communication forms the basis of wireless communication or fundamental telecommunication for instance when doctor and patient talk to each other the patient (sender) ask for medical advice his voice get communicated to doctor ear who listen the problem of patient and air is the medium of communication here therefore the telecommunication process involves (Fig. 3).

I. The transmitter (patient),

II. The receiver (doctor),

III. The channel

The process of communication can be expressed as: r(t) = s(t) + n(t)

where,“n(t) can take many different forms”; “s(t): The transmitter sends out information”; “s(t) notation is a function of time meaning the information content varies with time or the sent information at a given “time.” This passes through the communication channel and the receiver are presented via the channel with r(t)”

“r(t): the “received” information at a given time” Theoretically s(t) = r(t) i.e., they are identical but practically different.

Fig. 3: Depiction of basic communication system.

Terminology of importance:

Additive noise:

It becomes part of the information because it is induced.

Distortion:

It is some form of noise and there is changing of information (Fig. 4).

Attenuation:

It is signal weakening on travelling.

Fig. 4: Communication system under the influence of noise.

In a telemedicine system, the information transferred over distance may be short or long, it is millimeters(Mm) in chips or many km across countries. In era of telecommunication more emphasis is given on increasing the speed so that more data can be communicated at high speed. Wireless communication systems are reliable, secure, faster and economical therefore find wide spectrum application are summarized in (Table 1)²⁰.

Table 1. Characteristics of used wireless network²⁰

Communication Network	Working Frequency	Speed Band (Megabyte per second)	Maximum Range
Blue tooth	2.4–2.485 GHz	Three	300 m
Infra-Red	100–200 THz	Sixteen	Infra-red-B 5 m
Wireless Fidelity	2.4–5 GHz	106	100 m
ZigBee	900 MHz	256 Kilo byte per second	10 m
Cellular Networks	850–1900 MHz	Twenty	5 Km
Worldwide interoperability for microwave access	10–66 GHz	Seventy-five	40 Km
LMDS	10–40 GHz	510	5 Km

Barrier To Telemedicines Reach:

Telemedicine can trigger great promises in reducing the variability of diagnoses and improving the health condition, clinical support and supply of health care services throughout the world by increasing the delivery, reliability and economics^7,21. Actually, teleconsultation can help the societies previously not served – It means to serve those tribal or mountainous region with lesser or no medical facilities because time-distance obstacles exist between health-care providers and end-user get nullified⁷. In addition to these evidences suggest vital socioeconomic advantages to affected person, deprived families, healthpractitioners and the health system, including increased patient accessed communication andeducational goals^22,23. In-spite of this the reach of telemedicines is restricted and it is yet to be applied in the healthcare system of both the industrialized and developing countries with the initial funding - some pilot projects has been started²². Many patients and health care providers unable to adopt this teleservice models that is different from traditional system or indigenous methods. Lack of awareness about ICT literacymay be another reason for less diffusion of telemedicines. Most challenging for the telemedicines is linguistic and cultural thinking between affected person (especially those not served) and teleservice caregiver^7,21. Less documentation is available for demonstrating telemedicine is asolid business model and thus underfunding for this model which demonstrate the shortcoming in infrastructures⁷. Legal issues are a big block to system upgradation. This may be due to the lacking ofan international legal system to allow caregivers to provide the services in different state jurisdictions that lacks affected person privacy policiesand secrecy such as information communication transfer, storage, and communicating between caregiver and state jurisdictions^24-26; doctor verification, specially electronic mails^25,27; and warn of health responsibility for the doctors providing teleconsultation facilities. There is risk of hardware and software failure which could enhance the death of affected person and the liability of caregiver²⁸. In order to establish the telemedicine as standard and overcome its limitation telemedicine must be regulated by standard norms globally^29-30.

Classification of Telemedicines Applications³¹

These are categorized into 4 fundamental categories as per-

A. Communication Medium

B. Information transmission timing

C. Consultation goal.

D. Individual interaction involving

I. Registered medical practitioner to patient

II. Care provider

III. Registered medical practitioner to Registered medical practitioner

On basis of Communication Medium:

· Video Communication: It includes various software applications, live video platforms,Live chatting system,telemedicines software tools.

· Audio Communication: It includes Mobile Phone, VOIP and software applications.

· Text Based Communication: It include general messaging/ text/ chat platforms WhatsApp, Google Hangouts, Facebook Telegram, Messenger, and Electronic mail.

According to timing of live information communicated through Video format or audio format or text:

These format of communication for swapping of reliable information for counseling, diagnosis, health education and medication.

Asynchronous interchange of relevant information/data:

Interchange of summary of patient complaints and diagnostic data including ultrasound, X-Ray, laboratory findings as well as radiological finding between stakeholders. Such auxiliary record can be forwarded to different entities at any time and can be retrieved as per convenience/need

According to the individuals involved-

Patient to Registered Medical Practitioner (RMP):

There is connection of patients with the physicians.

Caretaker to Registered Medical Practitioner:

There is service connection of caregiver with the RMP.

Technology Used and Mode of Communications:

There is more than one technology which is used for the application of the concept of telemedicines. Depending upon the medium of the communication three format mainly exist video format,Text format and Audioformat.These are many advantages and disadvantages (Table 2) of each format responsible for the implementation of the concept of telemedicines. However orthodox system involving physical examination is also very important and also the diagnosis part of this system.The advancement in the technology enable to make physical examination made possible through haptic technology which is further help in the conduction of Robotic telesurgery. The lagging in the latency is certainly the limiting factor, to overcome this highspeed data transmission is need of the hour. Implementation of 5G may provide breakthrough in the field of telemedicines, telesurgery and telecommunication. Multiple technologies can be used to deliver telemedicine consultation.

Guidelines For Practising Telemedicines In India³¹

Under the IMC Act 1956 guidelines for practicing telemedicines in India are for the registered medical practitioner and will be published. These guidelines consist of various norms,standard in order to provide the consultation in whole of India involving the maximum tools and platform of the communication.

Seven Characteristics regarding Consultation via Telemedicines

• Context

• Recognization

• Medium of Communication

• Permission

• Categories of Consultation

• Patient Screening

• Managing the patients

Context:

Telemedicines consultation should be as per context must be appropriate. Professional judgement of RMP is the crucial factor for the teleconsultation in the interest of patients.They must choose the available diagnostic tool for detection before optioning to move any mode of consultation may be any health education/counselling.

Complexity of Patient’s health condition present challenge to the doctor as each patient’s case their health situation may be separate, for example there is diagnosis of renal stone in the patient suffering from stomach pain or urinary tract infection occur in such situations.The complication of diabetic acidosis can occur in case of the diabetic patient. Many times, pain below navel is of appendicitis, similarly heart burn can be given rise to the complication of ulcer or problem in the heart or hernia misdiagnosis.

Recognition:

For teleconsultation identification of both physician and patients is important.It involves the verification and confirmation of name, address, age, mobile number email id or other identification criteria as per condition. The verification and confirmation of the registered medical practitioner as well as their contact details to the patient is similarly important.

For delivering a prescription, the Registered Medical Practitioner required to verify the age of the patient, and if necessary, seek age proof. In case when the person is below eighteen years.the confirmation of his/her age is done. It is instructed that minor must be accompanied by a person who is not minor or must have age above the eighteen years, after confirming the age, tele consultation is allowed as per the guidelines. The accompanied person must describe his/her history of treatment or can take care of his dose regimen on the other hand physician should inform or display the patients about his registration and qualification

Medium of communication:

Numerous technologies such as Video, Audio or Text can be used to deliver telemedicine all possess their respective advantages, disadvantages and limitations as per the requirement or judgement by doctor mode of technology is selected a real-time consultation may be primary choice mode. Conditions where Doctors demand visual inspection it must be strictly followed sometimes voice interaction is sufficient if demands by RMP.It is better to rely on RMP to select the various option or modes available as per the situation or conditions of the patients.

Permission:

Patient consent is primarily requirement to start for any telemedicine There are two types of consent.In the implied consent is known that the person has given his consent to the consult. When the person comes in an outpatient department, then the permission for the consultation is considered as the same. It can be said that most of teleconsultation are implied in nature on the other hand in an explicit consent, consultation is needed when doctor or other health professional start the consultation process from their end. The consultation work can be on any mode of the communication such as on audio, video or text

Medical information interchangefor patient evaluation:

Relevant knowledge such as patient history. severity of disease progression, patient’s condition can be collected prior to treatment.

Patient’s History / Information:

The information such as

• History of the patient

• Examination findings of the patients

• Investigation reports of the patients

• Allergic or drug-drug interaction profile

• Previous records of the patient.

The information mentioned is necessary for the supervision, health monitoring and for the selection of appropriate drug –dosage regimen. All the gathered allied information must also be taken into consideration while teleconsultation. The doctor can demand additional information of patient history or family history. The patient can be asked to conduct different types of laboratory tests- hormone test,blood test or pathological tests. Even the reports of MRI CT scan can be asked to submit depending on the progression of disease /disorder so the consultation can be stopped and patients are given time for these tests and their appointment get rescheduled.Teleconsultation has many restrictions for complete diagnosis. If RMP find physical diagnosis is very important then it has to be followed without hesitation or compromise. The recommendation can be-

• Video examination

• Diagnosis by another physician / health professional

• In-person or patient consultation

Various categories for consultation:

First consult/ follow-up consultation is basically fall in two categories-

a) First consult

b) Follow-up consult.

a) First Consult refers to-

· For first time the person is taking consultation with Health professional; or

· In case the six months period of the consultation has not expired.

· Earlier consultation for a new health problem / disease / disorder or complication.

b) Follow-Up Consult(s) refers to-

· Treatment continuation of the earlier existing health scenario with the same physician within the period of six months from date of earlier consultation.

Not A Case Of Follow Up:

if:

· New symptoms emerge different from previous health condition

· Physician/Surgeon are not able to memorize the past therapy.

Managing The Patients:

In the process of teleconsultation may be any type based on any medium of the communication the physician or doctor can take decision to

· Give Health knowledge as fit better in the situation; and/or

· Gives Counseling with respect to medical or pathological condition; and/or

· As per the requirement prescription of medicines can be done.

Patient Counseling: There is specific advice on-

· Minor ailments.

· Diet planning and limitation.

· Compulsory yes or no for the patient.

· Drug –Drug Interactions.

· Food-Drug Interactions.

· Different type of first aid in different wound/burn/accidents.

· Muscle exercises.

· Lifestyle

Prescription of Medicines:

Prescribing medications, via Telemedicine consultation may also require prescription of medicines as per the health condition and as per the fair judgement of doctor. The same responsibility and liability are fixed as in the orthodox type in-patient consultation. If a health situation demands specific standard to detect or analyses the health condition then on satisfaction doctor may prescribe medicines via telemedicine in the maximum interest of the patient.The classification of medicines or drugs for the prescription are enumerated as-

Category O drugs/Medicines list:

These drugs are safe to be suggested through any medium of communication-

· ‘OTC Medicines - used in common conditions e.g., NSAIDs,Oral rehydration salt packages.

· Medicines that may be deemed necessary during public health emergencies.

Category A Drugs / Medicines list:

· The first consult prescription drugs/medicines where video conferencing is the medium of the communication.

· They are safe medicines with low potential for abuse

List Category B drugs:

This is list of medication additionally for their prescription.

List of restricted categories of drugs:

This list of medication includes those drugs or medicines with high potential of abuse and can deteriorate the society on its irrational useA doctor providing consultation via telemedicine cannot prescribemedicines in this list. Drugs are morphine, codeine, heroine, semisynthetic derivatives of opium, naloxone, naltrexone, and nalorphine these are scheduled under Drug and Cosmetic Act and N and P Substances Act 1985.

Medicine/ Drug Enumeration:

O Category list of medicines/drugs:

OTC Drugs

a) NSAIDs

b) Temperature reducing medications

c) Lozenges

d) For the sputum congestion in nose/neck/lungs various decongestants, expectorants,mucolytics, Cough reflex suppressors.

e) Oral Rehydration Solution Packets

f) Zinc Syrup

g) Iron and Folic Acid Supplements

h) Calcium supplements Vitamin D

Emergency Drugs for emergencies or epidemic:

Antimalarials: Hydroxychloroquine,Primaquine,Quinine for eradication of malaria,disease caused by plasmodium and spread by mosquitoes.

List A Medicines and DRUGs:^32-34

1st Drug Consultation (consultation via video conferencing then detection)

Various antifungal lotions, creams and soaps. Cream for psoriasis, Antifungal Clotrimazole creams, lotion for the removal of skin scaling.

• Gatifloxacin,Ciprofloxacin, Dexamethasone drops for eye problems.

• Otogesic drops, acetic acid drops for the problems of the ear.

Drug Refilling for chronic disorders

• High Blood Pressure: Lisinopril, Propranolol

• High Blood Sugar Level: Tolbutamide,

• Lungs related problems: Steroids, Antihistaminic Stimulants,Deriphylline,Theophylline.

B Category List

Management of Drug therapy or Drugs followup for chronic disorders

Problem of high blood pressure: e.g., Drug acting on the kidney such as loop diuretic in conjunction with beta blockers.

Problem of Hyperglycemia: Drugs that reduce the blood glucose level can be prescribed e.g., Antidiabetic drugs.

Online Course Requirement:

· As per the guidelines Registered Medical Practioner is entitled to practice telemedicines in India.

· He has to complete online course on telemedicines and complete it within three years of its notification.

· While practicing Telemedicines the maintenance of professionalism as per standards is very important.

· The doctor can provide teleconsultation from any part of India.

· MCI has the responsibility for the designing this online course.

Telemedicine Software:

Telemedicine software are the best telecommunications technologies used by the tele medicines companies to fill the gap between medical professionals and patients. Telemedicine softwares is thus used for online medical visits by patients for treatment from RMP - doctors, specialists or other health care professional³⁵.

The core services provided by the software of telehealth to the patients are thereferral, appointments, care plans, treatment, specialist doctor visits and teleconsultation Telemedicine devices act as core healthcare mechanisms for patients and health care professional.

Both patients and health professionals can benefit from Telemedicine software's because of their characteristics such as they are cheap, less time consumption, easy reimbursement, revenue-generating and easy access capabilities.

Applications of Telemedicine Software:

Platform of various telemedicine software are having numerous advantages. Some of the important telehealth examples are:

Specialized Care and Treatment:

Teleconsultation by specialist doctors through online medical visits is great boon to the patients, even bed ridden patients can consult health professionals through virtual talk or meetings by using this software.

Diagnosing Ailments as a Team:

Video conferencing, audio and text are the mode of communication through which doctors and health care provider can diagnose the illnesses or disorder of a patient and suggest a health care plan accordingly.

Emergency Healthcare:

This find the great application in the emergency situation where time is the important factors. The doctor will monitor the patient on his journey from his home to the hospital in an ambulance through the tele gadgets.

Clinical Trials/Studies:

Pharmaceutical biotech research-based companies use these technologies for conducting clinical trials and studies for testing various drugs their results, hypothesis and reports³⁶.

Post-Hospitalization Care:

Doctors can monitor the progress of patients after hospitalization and keep track of his lifestyle, side effect of medicines and post hospitalization complications³².

Second Expert Opinions:

Patients and doctors can take second opinions from an expert sitting at remote places with help of software or App.

Types of Telemedicines:

Real time Telemedicines or Live Telemedicines:

In this the interaction or discussion availability of doctors and patient at any time /anywhere. Videoconsultation and mobile consultations is the type of communication possible in this system of telemedicines Visual examination,medical record documentation psychometric evaluation or ophthalmological assessment can be possible under live telemedicines³¹.

Remote Patient Monitoring Telemedicines:

The main work of this type is to monitor the patient located remotely.It is effective for the chronic disease condition for examples cardiovascular diseases,kidney diseases, cancer asthma etc. Physicians exchange data with patients through cutting-edge equipment.

Stop and forward Telemedicines:

This help in the preparation of patient medical records more accessible across remote distances.The added advantage of this type of telemedicines is not requirement of simultaneous kind attention of delivering and end-user party.This is asynchronous platform which doesnot require appointment.The medical fields like pathology,radiology,dermatology dependent on this type of telemedicines on daily basis.

Approach of Telemedicines in Our Country:

The credit of initiation in the field of telemedicines goes to Indian space research agency to ISRO Bengaluru.In the beginning of last decade pilot work was started which loop link Apollo medical hospital madras with the small rural area of Chitoor district, A.P.³⁷. In addition to this the credit also fall in the hands of external affair and health department³⁸. The initiation of “integrated disease surveillance projects, national cancer network, national medical college network and the digital medical library network, National Digital Health Authority of India is on the way to revolutionize the field of telemedicines^39-44.

Established Telemedicine Facilities in Country:

• Sri Ganga Ram Hospital New Delhi

• Cancer Centre at Trivandrum⁴⁵

• PGI, Chandigarh³⁸

• National Rural AYUSH Telemedicines⁴⁶

• AROGYASHREE⁴¹

CONCLUSION:

The communication technologies have really revolutionized the heathcare field. The telemedicine is such technology which has the potential of turning healthcare facilities and services to be in the reach of general public.The infrastructure development in such fields can really serve the mankind in the real sense.

ACKNOWLEDGEMENT:

The authors are grateful to the authorities of Department of Pharmacy, MJP Rohilkhand University Bareilly, U.P., India and Institute of Pharmaceutical Research, GLA University, Chaumuhan- 281406, District-Mathura, U.P., India for providing necessary facilities for completing this paper.

CONFLICT OF INTEREST:

The authors has no conflict of interest.

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Received on 17.03.2021 Modified on 13.06.2021

Research J. Pharm. and Tech 2022; 15(12):5909-5918.

DOI: 10.52711/0974-360X.2022.00996

Communication medium	Advantages	Disadvantages
Video communication	• Closest approach, live discussion • Patient recognition is convenient • Doctor can visualize the patient and interact with caretaker • Image Perception • Inspection of patient can be done	• High quality internet dependency with high speed and bandwidth. Latency limitation must be overcome. • Since there is risk of person privacy. The authentication is therefore very important before the consultation process and this can lead to successful telemedicine implementation
Audio communication	• Convenient, Rapid • Maximum reachability • emergency cases handled • Minimum requirement of Infrastructure facility • There is assurance of Privacy • Image to Image interaction	• The nonverbal interaction not possible • Not suitable where visual inspection is required • Patient identification is important task
Text basedcommunication	• Faster and reliable • Documentation and Identification • Reliable for emergency requirement, or follow-ups, other opinions selection	• Missed authentication of call • No rapport