Science And Health: What Is Telemedicine And Is India Ready For It?

New Delhi: “I vividly remember, it was March 28, 2020, and the first nationwide lockdown was in full swing. At 8pm, a patient with a history of chest uneasiness consulted me over a call and I suspected that it could be a heart attack. Our emergency was full of COVID patients so, I advised him to go to a nearby nursing home and get an ECG (electrocardiogram) done to check heart’s rhythm. After going through the reports on WhatsApp, I found chances of acute heart attack and advised him to come immediately. We created a corridor and the patient was shifted straight to catheterization lab where the artery was opened and a life was saved”, recalled Dr Balbir Singh, Chairman, Cardiology, Pan Max Healthcare, in a conversation with NDTV.

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When the COVID-19 pandemic hit the country, healthcare infrastructure was diverted towards containing the spread of the highly infectious disease and saving lives. All the other medical emergencies including scheduled surgeries and follow-ups were postponed. Along with this, the fear of contracting COVID-19 made services inaccessible. However, telemedicine – the remote diagnosis and treatment of patients through telecommunications technology – came to the rescue. Not only people with non-communicable or chronic diseases availed treatment online, but even COVID-19 patients also opted for online consultation.

Telemedicine To Rescue During COVID-19

According to a survey of 155 countries carried out by the World Health Organisation (WHO) and released on June 1, 2020, the health services were partially or completely disrupted in many countries. More than half (53 per cent) of the countries surveyed reported partial or complete disruption of services for hypertension treatment; 49 per cent for treatment for diabetes and diabetes-related complications; 42 per cent for cancer treatment, and 31 per cent for cardiovascular emergencies.

In the majority (94 per cent) of countries responding, the ministry of health staff working in the area of non-communicable diseases (NCDs) was partially or fully reassigned to support COVID-19.

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Among the countries reporting service disruptions, globally 58 per cent of countries were using telemedicine (advice by telephone or online means) to replace in-person consultations; in low-income countries this figure is 42 per cent, reported WHO.

During the second wave, telemedicine served as a lifeboat for many patients of COVID-19 and beyond. It supported patients with mild to moderate infection to connect with a physician and get access to medical care. It helped us to move towards a more patient-centric healthcare model and immensely supported patients across the country, said Sudarshan Jain, Secretary General, Indian Pharmaceutical Alliance.

For instance, in India, Practo (a mobile application that provides video consultation with doctors) reported five crore Indians accessed healthcare services online during the first phase of lockdown between March 2020 to May 2020. On average, a typical user consulted a doctor online twice a month which led to a drop of 67 per cent in in-person visits, as per Practo’s analysis.

All About Telemedicine Service In India

WHO defines telemedicine as,

The delivery of health-care services, where distance is a critical factor, by all healthcare professionals using information and communications technologies for the exchange of valid information for the diagnosis, treatment and prevention of disease and injuries, research and evaluation, and the continuing education of healthcare workers, with the aim of advancing the health of individuals and communities.

In India, to give a boost to telemedicine, the Ministry of Health and Family Welfare in partnership with NITI Aayog released ‘Telemedicine Practice Guidelines’ on March 25, 2020. As per the said guidelines, patients may consult with a registered medical practitioner (RMP) for diagnosis and treatment of their condition or for health education and counseling. A patient can also use telemedicine service for follow-up consultation on their ongoing treatment with the same RMP who prescribed the treatment in an earlier in-person consult.

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In case of an emergency, if alternative care is not present, the guidelines recommend tele-consultation to provide timely care. However, telemedicine consultation should be limited to first aid, life-saving measure, counseling and advice on referral.

In September 2020, EY (Ernst & Young), a global organisation, released a report titled ‘Healthcare goes mobile: Evolution of teleconsultation and e-pharmacy in new Normal’, based on a study conducted in collaboration with the Indian Pharmaceutical Alliance (IPA). The analysis states that the telemedicine market in India is expected to grow at a compound annual growth rate (CAGR) of 31 per cent for the period 2020–25 and reach $5.5 billion.

The telemedicine market in India has already grown from $85 million in 2010 to $829 million in 2019, as per the EY analysis.

Telemedicine In India: Advantages And Limitations

Some of the key advantages of telemedicine are:

1. Multifold Benefits Of Telemedicine

Khushboo Aggarwal, Founder and CEO, Zyla Health, a health start-up, based out of Gurugram, founded in 2017 with a focus on providing access to personalised and real-time care, says,

The biggest power of telemedicine lies in its ability to track vitals, check on symptoms and assess parameters in real-time. The ability to predict and prevent complications gives it an edge over conventional methods. Besides, it also saves time and money for the patients, while they can stay safe at home and access it with ease. Also, it offers services across the value chain from consultation and treatments to diagnostics, medicine and product purchases.

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2. Affordability And Accessibility

As per Ravi Kunduru, Founder & CEO, QurHealth, a healthcare data management company that also provides teleconsultation, the most challenging issues for India’s healthcare system are affordability and accessibility. But, with telemedicine, geographical boundaries are no longer a concern.

More patients can remain connected with providers with video conferencing, and smartphone apps. Moreover, remote analysis and monitoring services and electronic data storage dramatically lower healthcare service costs and benefit both providers and patients, he added.

3. Taking Healthcare To Rural India

Through telemedicine, individuals living in rural and remote locations can avail services that are limited to urban areas, while saving on indirect expenses such as loss of daily wages and transportation, say experts.

4. Enabling Continuity Of Care

Since the data is saved digitally and can be accessed by the patient anytime, anywhere through their health ID, telemedicine platforms allow continuity of care between different levels of the health system.

Though telemedicine has been a boon for India especially during the pandemic, it has a fair share of limitations as well. For instance, very often, telemedicine services are developed keeping the digitally literate and educated population in mind. As a result, patients face considerable challenges with regards to language, literacy and technology in using telemedicine. Additionally, incorrect selection of specialisation by patients can lead to wasteful visits.

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Dr Singh is of the opinion that judgement errors can happen from doctors’ point by underestimating or overestimating the symptoms. Also, the legal implications of prescribing medications are still not clear. He added,

Legally we, medical health professionals, are not clear on how much we can treat or consult online. There have been instances when medicines were advised and the patient did adversely and filed a case against the medical practitioner. For example, if a new patient consults me for chest pain. Without diagnosis I cannot underline the cause behind the pain – whether it is because of gastric issue or a heart attack or probably some other reason. We need reports in such a case to advice the treatment. Hence, in my opinion, physicians should be conservative during teleconsultation.

The Future Of Telemedicine In India

According to experts, India is now witnessing a paradigm shift as telemedicine has proved to be a safe and convenient method that saves time and money. But, Mr Jain is of the opinion that complete acceptance of telemedicine may take time. He explains,

The Indian pharmaceutical sector is a highly regulated sector with an aim to protect patients. While it is true that, technology disruptions such as telemedicine are important and have achieved some success in North America, Europe and Japan because of the regulatory framework in place. Various checks and balances built in their regulatory framework do not compromise a patient’s health and his/her interest is adequately protected. In India, we lack a robust regulatory framework for e-pharmacies/tele-medicines to operate. Several vital concerns such as privacy and security issues, are required to be addressed.

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The industry experts believe that in India, the National Digital Health mission and the e-Sanjeevani platform have played a crucial role in improving the access to and availability of telemedicine services. National Digital Health Mission (NDHM) was formulated with the aim to provide the necessary support for the integration of digital health infrastructure in the country. Under NDHM, citizens can create and obtain a unique ‘health ID’ which will have all health records of an individual. Similarly, ‘digi-doctor’, a repository of doctors practising or teaching medicine is created.

e-Sanjeevani is a doctor-to-patient telemedicine system by the Ministry of Health & Family Welfare under the Ayushman Bharat Scheme of the Government of India. The free service can be accessed through a toll-free number 1075. An individual needs to verify the mobile number, register themselves for online consultation and at the end, download an e-prescription.

Talking about the role of the government in promoting telemedicine, Ms Aggarwal said,

Regulating authorities such as Insurance Regulatory and Development Authority (IRDAI) are relentlessly working for digital health through initiatives such as Sandbox, where they are encouraging Life Insurance companies to bundle innovative digital health products for the well-being of the members.

Importantly, going forward, improving digital literacy and internet connectivity in rural areas are required to accentuate the reach.While signing off, Mr Kunduru emphasised on adopting the right digital policies like the National Digital Health Mission and boosting private entities to create collaborative digital platforms for the promotion.

The government needs to make an attempt to improve patient confidence and reliability in virtual consultation with transparent standard operating procedures (SOPs), compliance, and strict data privacy. Also, by developing consumer awareness and making them understand the ways to use telemedicine services.

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NDTV – Dettol have been working towards a clean and healthy India since 2014 via Banega Swachh India initiative, which is helmed by Campaign Ambassador Amitabh Bachchan. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – the LGBTQ population, indigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fight malnutrition, mental wellbeing, self care, science and health, adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity,  that is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and the country can become a Swasth or healthy India.