All you need to know about Telemedicine

In the digital world, where literally everything is at the tip of our fingers, medical consultation has also taken the digital route. Telemedicine, or telehealth, involves communicating with medical professionals through audio calls, video calls, emails or text.

 
The World Health Organization (WHO) defines telemedicine, as “the delivery of healthcare services, where distance is a critical factor, by all healthcare 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 healthcare providers, all in the interests of advancing the health of individuals and their communities.”

Historically, telemedicine can be traced back to the late 19th and early 20th century, when electrocardiograph data was transmitted over telephone wires. However, the inception of modern telemedicine took place in the 1960s, predominantly driven by the military and space technology sectors, and a few individuals using readily available commercial equipment.


India’s journey with telemedicine started around two decades back in 2001, with a pilot project by the Indian Space Research Organisation (ISRO). The advent of this pilot project - SatCom, combined with Information technology, aims to boost up advanced medical sciences, to reach even the remotest and most inaccessible corners of our country.

Telemedicine has been one of ISRO's continuous endeavours to apply space technology for the benefit of the masses. Moreover, there has been a visible rise in this sector in the last decade.


Telemedicine - key to the pandemic

The basic purpose of introducing the concept of telemedicine, was to cut down the ‘distance’ factor, which has been labelled as critical in the WHO definition.


Representation image of a teleconsultation session in progress (Image credit: Forbes Img)


In general, the prime target group for whom telemedicine has been devised, is to provide special healthcare services and catering to the patients living in rural and remote locations in the country. For these patients for whom accessibility is extremely tough, telemedicine is the optimal solution, providing a timely and faster access, thereby cutting down on travel and related ancillary costs.


For a largely populated country like India, with limited resources, often doctors and healthcare professionals are burdened due to the large number of in-person consultations. What telemedicine does is not only remove the waiting time for the patients, it also allows doctors to treat more patients, and also as per their comfort and convenience, considering the patients are non-critical.


In cases, where an infection can be contagious, like the COVID-19 virus, telemedicine guarantees safety for the treating medical professionals. During the COVID-19 pandemic, the subsequent lockdown measures and the resultant social distancing protocols, gave a boost to the adoption of telemedicine in India.


Sashmita Sahu, a Pharmaceutical analyst at GlobalData, comments on the fresh impetus the telemedicine segment received during the first wave of the pandemic in 2020.

Sahu says, “Without proper guidelines in place, doctors and patients alike were somewhat apprehensive about using this medium of healthcare consultations. But still with a high number of COVID-19 infections, telemedicine became the preferred option.”

Sahu also explains that telemedicine will have a promising future in India considering the emergence of digital schemes.

Sahu says, “While telemedicine cannot replace the traditional medical consultations and hospital visits for emergency conditions and medical procedures, it will certainly reduce the pressure on the healthcare system in a vast and populous country like India with disproportionate healthcare facilities.”

In addition, with the digitalization through telemedicine, there is a higher likelihood of proper online documentation and maintenance of records. This not just minimizes the chances of missing out on advice from the medical professionals, it also increases the legal protection of both parties, in unforeseen circumstances.


Challenges faced in telemedicine

However, while the advantages might be plenty there are certain disadvantages too. There may be instances of miscommunication of symptoms by patients or misinterpretation of symptoms by the physicians.


On the other hand, while a country like India, still grapples with electricity woes, consultation through video conferencing or emails is still a very optimistic option in certain regions. Adding to it, many elderly people and people in rural India are still technologically challenged. Also, while medical consultations always demand confidentiality between the patient and the medical professional, ensuring privacy in video consultations is extremely critical.


However, telemedicine is a viable option only when the patient is non-critical. There are many instances where patients require thorough examination. Imagine someone develops a stone in the gallbladder or has a ruptured appendix or has a dislocated shoulder, it is impossible to treat through telemedicine, and needs immediate in-person treatment.


Also, there are some instances when a patient requires a visual inspection, like a skin, eye or tongue examination. In those cases, while audio calls are futile, video calls also might not provide the highest video quality for examination.


The multi-fold rise in teleconsultations in 2020

As per a report titled ‘Rise of Telemedicine - 2020’, which was a collaborative research by the Telemedicine Society of India and Practo, the statistics related to the online consultations between March and November 2020 have been recorded.


Shashank ND, the CEO and Co-founder of Practo, expects this report to be a positive step towards the growth of telemedicine in the future.

He says, “Our aim with this report is to ignite meaningful discussions around telemedicine as a critical first step towards establishing more collaborations among stakeholders, tied by a common commitment to one industry.”

This report states that, while there was a 32 percent dip in the physical consultations understandably due to the lockdowns, the teleconsultations zoomed up with a staggering 300 percent increase.


Another positive statistic highlighted in this report was the penetration of teleconsultation in the non-metro cities.

The report states that, “Non-metros saw a seven fold growth in online consultations in the surveyed period, as compared to the same period in 2019.”

Also, with telemedicine, there has been a reported increase in the number of women following this route. While there is a growing social stigma related to mental health, telemedicine has been successful to an extent in overcoming that. As per this survey, there has been a 302 percent rise in overall mental health related queries and consultations.


Popular telemedicine apps in India now

Presently there are multiple telemedicine apps operating across India. While some of these apps have a pan-India coverage, others are regional and based out from smaller cities.


One of the largest telemedicine facilities in the country is Apollo Telehealth, with around 700 healthcare centers across the country operating in PPP (public-private partnership) mode, touching more than 11 million lives. Practo, is another successful telemedicine service, which in addition to providing consultations from specialist doctors, also has a medicine ordering facility which delivers medicines to the patients’ doorstep.


In addition to these popular services, there is an emergence of newer telemedicine apps, which are growing in the urban centres across the country. These include - MFine, DocsApp and Lybrate. MFine is one of the only apps that has the added feature of a self-check. Through a chat-based question answer session which is created and certified by doctors, the patient can report all the symptoms and get a detailed report free of charge.


Other start-ups like Meddo and Navia Lifecare, have also implemented teleconsultation services, through audio and video calls.


On the other hand many regional based startups have also jumped onto the telemedicine bandwagon. These include the Vadodara based startup ‘I Online Doctor’ aiming to connect patients with Certified Medical Professionals via Secure Video Call, utilizing a portable application.


Rajasthan based telemedicine service MedCords, has received funding from the Rajasthan Government’s start-up activity iStart in late 2018.


Future of telemedicine in India

In August 2020, the government of India introduced its telemedicine service, eSanjeevani also labelled as the National Telemedicine Service , as part of the ‘Digital India’ scheme. This platform currently permits two types of telemedicine service - eSanjeevani (doctor to doctor) and eSanjeevani OPD (patient to doctor).


The consultation procedure for eSanjeevani OPD (Image credit: eSanjeevani OPD)


The main purpose of this was to serve both the purposes - consultation for patients in geographically diverse locations in rural and urban India.


However, the efforts of the government towards promoting this eSanjeevani experience and the efforts made by the private sector, aim to digitize and improve the healthcare situation in the country. However, the overall aim should be to expand telemedicine services even after the pandemic subsides.


Achieving this will primarily require a stronger and well-developed internet infrastructure, not just in the populated urban centres, but also in the remotest rural corners. In addition, for a hugely populated country like India, with a heavily skewed doctor patient ratio of 1:1,511, it is imperative to train a higher number of junior doctors, nurse practitioners or physician assistants, and involve them in telemedicine. This will not only provide them much needed experience, but will also reduce the already overburdened medical professionals, who are involved with critical patients or COVID-19 related commitments.

 

Edited by Aparna Chandrashekhar

 

Some resources and links to help you learn more on telemedicine -

  1. Telemedicine is the answer, but who will plug its gaps?

  2. Telemedicine in India: Where do we stand?