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Telemedicine Use Cases

Implementation Note: Telemedicine workflows comply with Telemedicine Practice Guidelines 2020 (India). Supports video consultations, e-prescriptions, remote monitoring, and follow-up care with ABDM integration.

UC-TM-001: [Moved to Appointments]

Note: Telemedicine scheduling is now handled under UC-APPT-009: Schedule Telemedicine Appointment to centralize all scheduling workflows.

UC-TM-002: Conduct Video Consultation

Purpose: Facilitate real-time video consultation between patient and doctor.

Property Value
Actor Doctor / Patient
Trigger Scheduled consultation time
Priority P0

Main Success Scenario: 

1. Patient joins consultation:
   - Click meeting link
   - Grant camera/microphone access
   - Waiting room (until doctor admits)
2. Doctor starts session:
   - Review patient's pre-consultation info
   - Admit patient from waiting room
3. Video consultation:
   - Establish audio/video connection
   - Greeting and identity verification
   - History taking
   - Examination guidance (show affected area)
4. During session tools:
   - Screen share (reports, images)
   - Patient document viewer
   - Prescription writing interface
5. If technical issues:
   - Switch to audio-only
   - Callback option
   - Reschedule if unresolved
6. End consultation:
   - Summarize findings
   - Share prescription
   - Schedule follow-up if needed
7. Post-consultation:
   - Session recording (if consented)
   - Notes saved to EMR
   - Feedback request

Acceptance Criteria:

  1. [ ] Stable video/audio connection
  2. [ ] Screen sharing capability
  3. [ ] In-session prescription
  4. [ ] Session duration tracking
  5. [ ] Technical fallback options

UC-TM-003: E-Prescription Generation

Purpose: Generate legally valid electronic prescription during/after teleconsultation.

Property Value
Actor Doctor
Trigger Consultation completed
Priority P0

Main Success Scenario: 

1. Doctor creates prescription:
   - Select medications from drug master
   - Dosage, frequency, duration
   - Special instructions
2. Add diagnosis:
   - ICD-10 coded diagnosis
   - Clinical notes
3. Validate prescription:
   - Drug-drug interactions
   - Allergy check
   - Age/weight appropriateness
4. Apply digital signature:
   - Doctor's digital signature
   - Registration number
   - Timestamp
5. Generate prescription document:
   - Hospital/Clinic letterhead
   - QR code for verification
   - Unique prescription ID
6. Share with patient:
   - Mobile app push
   - WhatsApp/SMS link
   - Email attachment
7. Store in patient record
8. Share with pharmacy (patient consent):
   - Nearby pharmacy location
   - Medication availability check

Acceptance Criteria:

  1. [ ] Digital signature integration (DSC/Aadhaar-based)
  2. [ ] QR-verified prescription
  3. [ ] Multi-channel delivery
  4. [ ] Pharmacy integration (optional)
  5. [ ] ABDM health locker push

India-Specific:

  • NMC e-prescription guidelines
  • Schedule H/H1/X drug restrictions
  • Generic drug name mandate

UC-TM-004: Remote Vitals Monitoring

Purpose: Capture and review patient vitals remotely using connected devices.

Property Value
Actor Patient / Remote Monitoring Team
Trigger Scheduled monitoring or device reading
Priority P1

Main Success Scenario: 

1. Patient setup:
   - Register connected devices
   - Pair with patient account
   - Configure monitoring schedule
2. Vital capture:
   - Blood pressure monitor
   - Glucometer
   - Pulse oximeter
   - Weight scale
   - Temperature
3. Data transmission:
   - Automatic sync (Bluetooth/WiFi)
   - Manual entry fallback
4. Data processing:
   - Validate readings
   - Flag abnormal values
   - Trend analysis
5. Alert generation:
   - Critical values: Immediate alert to care team
   - Trending concern: Weekly review flag
6. Doctor review:
   - Dashboard view of patient vitals
   - Trend charts
   - Intervention notes
7. Patient feedback:
   - Acknowledge readings
   - Medication adherence prompt
   - Lifestyle recommendations

Acceptance Criteria:

  1. [ ] Multi-device integration
  2. [ ] Automated data sync
  3. [ ] Abnormal value alerts
  4. [ ] Trend visualization
  5. [ ] Care team escalation

UC-TM-005: Asynchronous Consultation (Store-and-Forward)

Purpose: Enable consultation via uploaded documents/images without live session.

Property Value
Actor Patient / Doctor
Trigger Patient uploads query
Priority P1

Main Success Scenario: 

1. Patient submits query:
   - Describe symptoms/concern
   - Upload relevant documents:
     - Photos (skin condition, wound)
     - Lab reports
     - Previous prescriptions
   - Indicate urgency
2. Queue for doctor review:
   - Route to appropriate specialty
   - Priority based on urgency
3. Doctor reviews (within SLA):
   - Review all submitted materials
   - Request additional info if needed
4. Doctor responds:
   - Written diagnosis/advice
   - Prescription if appropriate
   - Recommend in-person visit if needed
5. Patient notified:
   - Response available notification
   - View in app/portal
6. Follow-up handling:
   - Patient can ask clarifying questions
   - Convert to video consult if needed

Acceptance Criteria:

  1. [ ] Multi-format document upload
  2. [ ] Specialty-based routing
  3. [ ] Response SLA tracking
  4. [ ] Follow-up query handling
  5. [ ] Escalation to video consult

UC-TM-006: Specialist Referral (Tele-Referral)

Purpose: Enable primary care doctor to refer patient to specialist via telemedicine.

Property Value
Actor Primary Care Doctor
Trigger Need for specialist opinion
Priority P1

Main Success Scenario: 

1. Initiate referral:
   - Select specialty
   - Attach clinical summary
   - Specific questions for specialist
2. Find specialist:
   - Available specialists
   - Filter by expertise, language
   - Availability check
3. Schedule options:
   - Joint consult (3-way video)
   - Sequential consult (patient alone)
   - Async opinion request
4. Joint consultation:
   - Primary doctor presents case
   - Specialist examines (via video)
   - Discussion and plan
5. Document referral:
   - Specialist recommendations
   - Follow-up plan
   - Prescription additions
6. Care coordination:
   - Primary doctor receives summary
   - Patient gets unified plan
   - Follow-up responsibilities clear

Acceptance Criteria:

  1. [ ] Specialist directory with availability
  2. [ ] 3-way video call capability
  3. [ ] Referral note template
  4. [ ] Care plan documentation
  5. [ ] Follow-up assignment

UC-TM-007: Post-Discharge Telemedicine Follow-Up

Purpose: Conduct follow-up consultations for discharged patients via telemedicine.

Property Value
Actor Patient / Treating Doctor
Trigger Scheduled follow-up or patient request
Priority P1

Main Success Scenario: 

1. Schedule follow-up:
   - Auto-suggested based on discharge plan
   - Patient confirms preferred slot
2. Pre-visit preparation:
   - System pulls discharge summary
   - Current medications
   - Pending investigations
3. Conduct follow-up:
   - Review recovery progress
   - Symptom check
   - Wound/surgical site review (camera)
4. Assessment:
   - Recovery on track / Concern identified
   - Medication adjustments
   - Additional tests ordered
5. Documentation:
   - Follow-up note linked to admission
   - Updated care plan
6. Next steps:
   - Schedule next follow-up
   - Transition to in-person if needed
   - Discharge from follow-up care

Acceptance Criteria:

  1. [ ] Discharge-linked follow-up scheduling
  2. [ ] Auto-pull admission context
  3. [ ] Recovery milestone tracking
  4. [ ] Medication reconciliation
  5. [ ] Care plan updates

Purpose: Capture telemedicine-specific consent and maintain compliant documentation.

Property Value
Actor System / Patient
Trigger Telemedicine session initiation
Priority P0

Main Success Scenario: 

1. Display telemedicine consent:
   - Nature of teleconsultation
   - Limitations of remote examination
   - Privacy and recording notice
   - Emergency protocol
   - Right to in-person visit
2. Patient acknowledgment:
   - Digital acceptance (checkbox)
   - OTP verification (India)
   - Timestamp captured
3. During session documentation:
   - Session start/end time
   - Participants
   - Technical quality notes
4. Post-session record:
   - Consultation summary
   - Prescription (if any)
   - Follow-up plan
5. Consent record storage:
   - Linked to patient record
   - Accessible for audit
6. ABDM integration:
   - Push records to ABHA
   - Health locker update

Acceptance Criteria:

  1. [ ] Consent mandatory before session
  2. [ ] OTP-based verification
  3. [ ] Session recording consent (separate)
  4. [ ] Complete documentation trail
  5. [ ] ABDM consent compliance

Document Owner: Telemedicine Lead / IT Lead
Last Updated: 2024-12-09
Related: Appointments | Document Generation | Consent