Impact of Coronavirus on the Growing Popularity of Telemedicine in India

Corona Virus Impact On Telemedicine

The first case of COVID-19 in India was registered on 30 January, and the Government imposed a nationwide lockdown since March 25. Unfortunately, the country was woefully unprepared for the coronavirus crisis.

factors contributed to a spike in the number of positive cases, including:

  • Dense population of 1.38 billion
  • Abysmal doctor and hospital bed per 1,000 people ratio
  • Lack of basic hand-washing facilities, especially in rural areas
  • Expenses associated with contracting a major disease
  • Poor infection control
  • Shortage of PPEs and testing kits
  • Asymptomatic people

The official count of the infected crossed the grim milestone of 50,000 by the first week of May 2020.

As the strained Indian medical system tries to break the tide of the coronavirus epidemic, the cost for this fight is borne by non-COVID-19 patients. Non-emergency and OPD services have been halted in various hospitals and all resources are diverted for emergency care and combating the virus.

The outcome? India may soon find itself in the grips of an acute health crisis. According to the National Health Mission (NHM), hundreds of thousands of children and adults have missed out on potentially life-saving medical treatments due to curtailed immunization schedules, decreased laboratory investigations, restricted outpatient/inpatient/emergency treatment for non-communicable and infectious diseases, and reduced access to mental health treatment.

The silver lining amidst the crisis is the ingenuity and expertise displayed by medical professionals to rise up to the challenge. Take, for instance, Dr. Raktimava Sarkar, an Internal Medicine specialist in the state of West Bengal. Like the rest of India, the lockdown prevented him from directly treating patients confined at home. But he still found a way to deliver uninterrupted care to his patients. Dr. Sarkar began doing “house calls” again - but this time in the form of telemedicine visits. Partnering with a digital healthcare platform, he started offering remote care through calls, real-time video and app-based visits. And he is not alone.

Telemedicine Prospects During Coronavirus

Medical professionals across India are recognizing telemedicine as a “potential solution to rein in costs while effectively performing vital public health functions”. According to Journal of Global Health by The University of Edinburgh, telehealth applications not only improve healthcare systems but also “create an interconnected global health network” that responds to humanitarian crises like COVID-19.

The question is, what does telemedicine involve? It is an umbrella term for providing virtual, remote healthcare services by healthcare providers to patients in different physical locations. Thanks to the spread of information and communication technology in India - approximately 688 million Internet users - doctors can communicate diagnosis to patients electronically along with specific medical advice, including prescriptions.

Outlook

The national media actively touts telemedicine’s value as a means to triage possible coronavirus patients. However, healthcare experts consider telemedicine more than just a temporary stopgap. This useful medium enables doctors to consult patients with various problems and improve care delivery. The best part? Doctors and healthcare providers with a taste for telemedicine are unlikely to stop.

E-consultations increase access to primary and specialty healthcare. With the Government discouraging non-emergency in-person visits, teleconsultations help physicians step up and meet obstacles and challenges in real-time. Think of it as a transformational stage - a game changer that allows India to restructure the existing healthcare setup permanently, for the better.

Telemedicine promises to resolve problems associated with equity and accessibility in Indian healthcare. However, that will happen only through bettering of infrastructure, training of medical professionals and pooling them, clarity on privacy and data protection laws, and in assessing these programs periodically.

Telemedicine promises to resolve problems associated with equity and accessibility in Indian healthcare. However, that will happen only through bettering of infrastructure, training of medical professionals and pooling them, clarity on privacy and data protection laws, and in assessing these programs periodically.

Industry players and analysts have arrived at the conclusion that traditional healthcare in India is suffering from numerous pain points, both for service providers and consumers. Telemedicine is capable of introducing a sea change across several aspects of healthcare in India, from overcrowding in facilities to slow service levels to insufficient supply of medicines/doctors.

Perspective

Aside from streamlining access and reducing patients’ economic and travel burden, telemedicine improves care in comparison to in-person medical visits. Real-time video consultations provide doctors a more intimate, and eventually more comprehensive view of patients. Medication management also becomes simpler as healthcare professionals can peer directly into patients’ medicine cabinets.

Thanks to remote access and improved awareness, telemedicine services address the issue of quackery - the Indian Government officially confirmed in 2019 that nearly 57.3 percent of practicing allopaths lack any medical qualifications. By digitally bridging the gap between healthcare providers and patients, telehealth introduces quality care to a large section of the population. Due to multiple positive externalities, a resource-poor nation like India can reap benefits by investing in telemedicine.

Limitations

Technology is merely an enabler, not the final goal. Doctors have the last word on the decision to limit the use of online consultations and focus instead on face-to-face appointments. They should take the context, patients’ interests, and professional judgment into consideration.

For example, a doctor may be satisfied with an ultrasound image indicating a mass in the pelvic region; another may wish to perform a rectal examination. Some patients may feel uncomfortable not seeing the doctor face-to-face, at least during the initial visit. Moreover, online consultations require basic literacy, and both patients and doctors may miss nonverbal cues like physical or facial expressions while texting.

Thankfully, users can choose from other channels of communication like phone and video calls promoting timely, secure, and affordable care. In the end, automated and advanced technology allow doctors to do what they actually wish to do - devote more time to patients instead of commuting, going to their offices. Telemedicine also eliminates overheads connected to establishing a posh office.

Novel Approach to Healthcare

Telemedicine has been available in India for years, but did not gain mainstream acceptance. The reason? Many patients were not aware of this option, while doctors and healthcare systems were resistant to the idea of change. After all, a hands-on approach was at the crux of every doctor-patient relationship for millennia. Feeling lumps, taking the pulse, and listening to the chest - considerable value was assigned to the human touch of the carer. Telemedicine, on the other hand, defies the time-honored tradition of the physical visit. Common barriers to telemedicine adoption in the Indian subcontinent include:

  • Cost
  • Liability
  • Security
  • Lack of computer literacy

The technology must overcome commercial and regulatory hurdles, and rely on a digital infrastructure that facilitates secure connections between caregivers and patients.

However, the COVID-19 pandemic shone the spotlight on the shortcomings of the previous healthcare model. In the spirit of social distancing, the citizens of India are seeking new answers to routine tasks, including medical consultations. And the transition to a system that embraces the advantages of data and digital technologies is not merely a solution to the current crisis, but one of its long-term consequences too.

In the words of Nicole Corbett, the director of Nielsen, “Consumers’ uptake of technologies, to stay informed or safeguard their health, can instill confidence in a stressful period, and this may be the unforeseen catalyst to assert broader, longer-term adoption of technology platforms and solutions.” That is precisely the scenario in India with healthcare startups experiencing a huge bump in traffic as panicked Indians consult doctors over the mildest of symptoms.

Many new doctors and clinics are being onboarded to deal with the massive increase in demand for fever and flu online consultations. Patients want to keep a social distance from hospital waiting rooms and nursing homes so the COVID-19 virus cannot transmit. Apart from coronavirus concerns, people are connecting with doctors via phone, video, and chats for other issues.

Use Cases for Telemedicine in India

Common best practices for telemedicine include:

  • Telemedicine in India is a great way to direct customers for first aid or pointing them towards the closest emergency care facility.
  • In non-emergency situations, telemedicine is useful for diagnosis and treatment alike, together with follow-ups and monitoring.
  • Patients can register for teleconsultation services, select their preferred specialist, pay online, and settle upon a mutually convenient date and time.
  • Interactions organized via third-party healthcare provider platforms or custom-made software integrated into the hospital PMS, or through mobile apps.
  • Built-in data security and patient confidentiality ensure the patient’s rights of information and transparency, correction/deletion of outdated/false information, and secure data processing.

No wonder a McKinsey report found that implementing telehealth can save India upto $10 billion in 2025 if the technology replaces 30 to 40 percent of in-person outpatient consultations along with greater digitization of India’s overall healthcare industry.

Indian Government’s Position on Telemedicine

According to Randeep Guleria, the New Delhi director of AIIMS, the Indian Government is increasingly using telehealth services to minimize contact and exposure between doctors on COVID-19 duty and patients. The technology ensures the safety of medical professionals since they no longer need to be in the patient’s physical vicinity.

Telemedicine is now officially recognized as a safe way to screen and treat patients during infectious outbreaks. In fact, the Ministry of Health and Family Welfare has acknowledged the significance of telemedicine by formulating and drafting the Telemedicine Practice Guidelines, 2020 in partnership with policy think tank NITI Aayog.

The Guidelines provision suitable preface and purpose of telemedicine practice in the country.

  • The focus is the provisioning of medical care to Indian patients alongside the need for legal compliance and recordkeeping.
  • In the face of rising coronavirus cases, these Guidelines stress the need to preserve and protect the efficiency and functionality of healthcare practitioners.
  • While discussing the important, emerging role of telemedicine, the outlined purpose takes the security and privacy of patient records into account while highlighting reimbursement schemes.

As evidenced from the COVID-19 pandemic, the delivery and facilitation of uninterrupted healthcare is possible through digital mediums during national disasters. The policy will not only lower the possibility of transmission but also decrease the burden on health professionals. Telemedicine can tackle fear and panic among the general populace, dissemination of fake news, educate the masses on symptoms, and continue regular OPD for other chronic conditions like asthma, diabetes.

Apart from outbreak settings, telehealth can also be useful where healthcare facilities are not easily accessible or available. The system saves patients the time taken to visit the clinic in-person for minor ailments.

Growth of Indian Telemedicine Sector

The Government’s recognition of telemedicine has been met with great enthusiasm by the medical fraternity and inspired innovations. E-consultations also enjoy legal sanctity, having been endorsed by the Supreme Court in India. Investments are expected to ramp up from 48 crores annually by the Government to a legitimate multi-billion dollar industry within the next three to five years. New models will emerge, indigenous to the Indian landscape. This will change the country’s healthcare segment drastically as far as reach, quality, access and affordability are concerned. In fact, the telemedicine industry in India is projected to hit $32 million this year.

In light of the new telemedicine regulations, the right business model will expand e-consultations to rural regions, which account for over 70 percent of India’s population. Even now, many individuals in tier II and tier III cities do not use mobile apps to contact physicians since smartphone usage for such programs is still low.

Telemedicine Comparison with Neighboring Countries

Amidst the COVID-19 outbreak, India’s response to telemedicine has been overwhelmingly positive, considering the technology’s proven potential to make a sizable impact on the holy trinity of cost, quality and access to care. A quick look at how the country’s approach compares to that of its neighbors:

Bangladesh

Telemedicine began in Bangladesh back in the early 2010’s and received a boost in 2012 when the Directorate General of Health Services took some measures. The Government was keen to popularize the service on a massive scale, and launched 25 telemedicine centers in various upazila health complexes through the ICT division’s ‘Info Sarker’ project in 2015. The focus was providing healthcare to rural communities.

According to the DGHS, there are 94 facilities in the country at present with video conferencing facilities, including 9 medical colleges and government hospitals, 11 district hospitals, and over 50 upazila level hospitals.

The coronavirus has been a shot in the arm for telemedicine in Bangladesh, with the government receiving approximately 2.45 million health-related calls between late March and early April. Tertiary hospitals in the capital city of Dhaka, which lacked decent telemedicine setup, have been introduced in a more organized way to prevent the spread of the infection at hospital outpatient services and protect doctors. Many doctor’s rights forums, physicians’ associations, and even politically-motivated doctor’s associations are offering telehealth services to the people currently.

Pakistan

The country is staring down the barrel of a serious health crisis as hospitals are receiving a massive influx of COVID positive patients. As a result, even citizens who normally shy away from technology are attempting to make the switch to telemedicine. The system lends a helping hand to hospitals and provides medical services over the phone to people isolating at home.

Pakistani doctors believe telemedicine can be “utilised across a broad spectrum of diseases and has especially proven to be effective in psychiatry, dermatology, radiology, gynaecology, pediatrics as well as the management of chronic diseases.” In fact, people are slowly recognizing the impact of telemedicine in the delivery of high-quality healthcare in the country.

Prospective customers can connect via:

  • Phone-based call centers
  • Incoming messages to Facebook pages
  • Nurses deployed in telemedicine clinics
  • Frontline health workers

While several telemedicine providers in Pakistan have failed to take off, the federal government has been supportive of the medium, “especially during COVID-19.” In fact, the Centre has launched a new technology initiative known as Digital Pakistan that integrates various telemedicine partners onto the platform and continuously adds more service providers. Also noteworthy is the Federal Ministry of Health’s Yaran-e-Watan initiative that enlists overseas Pakistani doctors to help their motherland from the comfort of their home or clinic/hospital in the UK, US, UAE, and Canada.

Patients are responding well to telemedicine and the burden on hospital emergency wards in Pakistan has somewhat lessened. And although online facilities in Pakistan are closely following the standard operating procedures issued by relevant authorities, an institution is necessary to regulate them thoroughly.

China

There has been a fundamental paradigm shift to telemedicine in China, the epicenter of the deadly coronavirus. The People’s Republic has already become the third largest med tech market globally and is expanding rapidly. Multiple digital healthcare platforms have emerged across the province, providing thousands of consultations every hour. Tech firms have deployed applications that assist the Government with tracking down suspected patients and monitoring citizens as businesses slowly resume operations.

In 2014, the National Health and Family Planning Commission of China drafted a framework regulation for telemedicine, but it did not come into effect until 2018. Numerous regulations protect the personal medical data of Chinese citizens. During the COVID-19 crisis, the Government facilitated the sharing of personal health information to track suspected novel coronavirus patients and protect public health.

In future, the draft “Law on the Promotion of Basic Medical and Health Care” will come into effect from June 2020. It has already received approval from the National People’s Congress and promotes the implementation of telemedicine services. The reform and development of digital healthcare began long ago in China, but the recent outbreak expedited its rapid growth.

Conclusion

Telehealth will not only save time, but it will also reduce the urban-rural health disparity in the country. Primary health settings will become more efficient, providing referral services for individuals unable to visit better health facilities. Given India’s dismal public and out-of-pocket healthcare spending (3.6 percent of GDP) and rising health needs, it is the right time to utilize the potential of telemedicine and enhance the public health scenario.

But this does not mean telemedicine is a one-size-fits-all solution; there is a limit to its capabilities. Will the technology completely substitute in-person visits, physical examinations, deep interpersonal connections, and the transmission of trust and empathy? Never! But what remote healthcare will do is persist, even after the impact of coronavirus dissipates.

India can now harness the power of telemedicine to provide more efficient and improved care. Digital tools will keep us connected and in the era of social distancing that works in favor of patients and the health workforce.