The Rise Of Virtual Care - The Telemedicine Paradigm
In September, the Ministry of Health and Family Welfare (MoHFW) announced that eSanjeevani, the Government of India’s national teleconsultation service, completed over 1.2 crore OPD consultations, making it the country’s most popular and the largest telemedicine service. It has been lauded for being able to tackle the shortage of doctors and specialists, particularly in rural and remote areas.
In a pre-COVID world, such a gigantic number of online consultations would be unthinkable. But the pandemic has led to major shifts in healthcare, with technology being leveraged in several innovative ways to improve the penetration, delivery, and safety of healthcare services. Telemedicine is but one of these radical alterations to the healthcare landscape. The public appetite for options that offer a safer way to seek healthcare has increased and telemedicine has become an obvious alternative.
The Pre-COVID Scenario
Before the pandemic, telemedicine was seen more as a novelty, and its use in India was comparatively limited. A National Telemedicine Taskforce was established back in 2005 to encourage and study the use of telemedicine in India. While government entities such as the Department of Information Technology (DIT), ISRO, etc., and private hospitals initiated the use of telemedicine services, its uptake remained low due to an uncertain regulatory landscape and the lack of requisite infrastructure across much of the country.
COVID-19 and the rise of Telemedicine
The COVID-19 pandemic and subsequent lockdowns led to a curtailment of out-patient services at many healthcare facilities. In addition, resources and professionals were stretched thin, and there was the threat of transmission of COVID at in-person facilities. All of this increased the need for remote facilities exponentially. Latest projections indicate that the telemedicine market in India is projected to touch $5.4 billion by 2025.
With internet infrastructure and the use of video-conferencing and other telecommunication software becoming mainstream, telemedicine has become accessible to a much wider section of the populace very quickly. At the peak of the COVID wave, inexpensive video-conferencing tools helped doctors attend to non-urgent matters with ease, and enabled specialists to connect with remote areas, offering care to patients who would have otherwise faced major financial and logistical difficulties. Telemedicine also enabled doctors to treat low-risk patients at home, thus opening valuable hospital bed vacancies for high-risk patients.
The improved uptake of technology played a major role in capacity building and upskilling healthcare workers during the pandemic and many private organizations used telemedicine to incredible effect. An example is Project StepOne, a non-profit startup of technology and healthcare professionals on a mission to augment government resources with technology, people, and processes to effectively fight against Covid, has been using Zoom to train an extensive network of 12000+ doctors, 15000+ medics/paramedics, and 5000+ non-medical volunteers on the clinical treatment protocol for doctors and triaging protocol for medics and non-medical volunteers.
Changing Regulations, Improving Access
Digital health has already become a major part of the government’s push towards accessible healthcare. In addition to putting its weight being eSanjeevani, the government has been actively pushing for the development of a robust ecosystem to facilitate digital delivery of healthcare services. The launch of the Ayushman Bharat Digital Mission (ABDM) in September is a case in point. Through ABDM, the government is looking to enable easy access to and sharing of one’s medical records through a Unique Health ID that is created with the patient’s consent. This is likely to give a strong boost to the uptake of telemedicine in India.
Regulations are seeing changes too – in March 2020, the MoHFW along with the Medical Council of India and NITI Aayog, released the “Telemedicine Practice Guidelines” for registered medical practitioners (RMPs). These guidelines lay down standards for identification of the RMP and patient, mode of communication, type of consultation, consent and patient management. This is a major step forward in resolving a confusing regulatory landscape and laying down standards for a nascent sector.
Agenda for the future: Addressing the challenges that remain
While technological infrastructure in India has improved by leaps and bounds, there is much that remains to be addressed. The NITI Aayog’s Sustainable Development Goals (SDGs) India Index 2020-21 report shows that of every 100 Indians, only 55 have an internet subscription at this time. Of these 55, many are likely to have internet connections that are active but not very stable for video services. This leaves a major chunk of people who might not be able to readily access telemedicine facilities.
The need of the hour is to create an ecosystem that incentivizes innovation for low bandwidth video conferencing software, while also developing software that is interoperable and can be easily integrated with existing digital health solutions. Another area of focus needs to be intermediation at the last mile to improve access for people who either don’t have the required access to technology or are not well versed with operating it. A recent study by Aapti Institute into vaccine delivery shows the potential of ‘tech intermediaries’ in bridging the gap at the last mile. Strengthening infrastructure and building the capacity of personnel at local health centres, Anganwadis, and Common Service Centres (CSCs), and possibly even setting up designated medical kiosks, could be a promising way of improving the uptake of telemedicine services.
Telemedicine alone cannot be a panacea to the problems of India’s healthcare infrastructure. But what it does offer, is a potent tool to address major inequalities and improve access with significant ease. With the government taking notice of the new paradigm, the Indian healthcare sector can finally join hands with the telecommunications industry to address the long-standing problems in India’s healthcare, head-on.
