Establishing a Routine Teleconsultation Follow-Up Clinic in a Tertiary Care Hospital of a Low-Middle-Income Country: An Operational Blueprint and Implementation Experience.

Literature on teleconsultation is rich in outcome data, and only a smaller body of work has described the operational setup of specific teleconsultation services, mainly from the COVID-era. However, publications on a routine, non-pandemic, low-cost, and asynchronous departmental teleconsultation model built on a widely available messaging application remain scarce. No structured replicable blueprint exists for establishing such a model for follow-up clinics at the departmental level in a government tertiary care hospital. We describe a step-by-step operational framework implemented in the Department of Endocrine and Breast Surgery since May 2025, which has now served 587 teleconsultations (post-thyroidectomy, post-parathyroidectomy, breast carcinoma, and pheochromocytoma) over 13 months. The model requires no dedicated funding, no institutional IT infrastructure, and no proprietary telemedicine platform. It uses a dedicated departmental smartphone, WhatsApp, a structured asynchronous review schedule, and a documentation proforma aligned with India's Digital Personal Data Protection (DPDP) Act, 2023, and the Ministry of Health and Family Welfare (MoHFW) Telemedicine Practice Guidelines, 2020. WhatsApp was selected over e-Sanjeevani for its asynchronous capability, universal patient accessibility, and zero registration burden. The average clinician time per teleconsultation is 5-10 minutes; the entire daily review session is completed within 30 minutes. The underlying principles are specialty-agnostic and potentially adaptable to cardiology, neurology, hematology, and oncology, though each specialty would require its own eligibility criteria and escalation thresholds.