The word telemedicine means healing from a distance. It uses existing computing devices belonging to the patient or physician. Often used as the umbrella term. It encompass health care delivery also other activities. It includes education, research, health surveillance and public health promotion. This includes inexpensive, self-owned equipment like smartphone cameras, wearable biosensors. Earliest published record of telemedicine was in the first half of the 20th century.
When transmission of ECG was over telephone lines. Its initiation in India was by the Indian Space Research Organisation in 2001. Establishment of National Telemedicine Taskforce by the health ministry took place in 2015. Its jurisdiction lies with the Ministry of Health and Family Welfare (MoHFW).
Globally telemedicine is a huge market, in India it is still at a very nascent stage. Investing in telemedicine would reap benefits for a resource-poor country like India. But industry reports suggest telemedicine has the potential to grow. Estimated to reach value of USD 5-6 billion over the next few years. Today telemedcine platforms such as DocsApp, Practo have seen rise in virtual consultations.
COVID-19 and Telemedicine
All health workers forces diverted to win the Covid-19 war. Due to Covid 19 there has been a positive shift in the mindset towards telemedicine. And also the regulators and Government have also started paying attention towards telemedicine. Hospitals and clinics have seen a decline in consultations (for any other health conditions). Lockdown, social distancing and need to access healthcare has pushed Indians to telemedicine.
Benefits of Telemedicine
During the pandemic it has saved on transportation for patients. It has allowed less time in the waiting room. And patitents gained real-time access of records. Online transaction was possible which saved time on registration and billing counter. It has kept patients out of the hospital and avoided unnecessary exposure. On 25th March 2020, Medical Council of India issued ‘Tele Medicine practice guidelines’. This was for the first time. Even Indian government has endorsed telemedicine.
This is to look it forward as a long-term solution for Indian healthcare post pandemic. Telemedicine’s attempt to mitigate the circumstances, are laudable. And it should compliment mainstream health care even after the crisis is over. But only after discussing the concerns surrounding infrastructure, lack of training and privacy.
Access and reach
It promises of bridging the healthcare gap between rural and urban India. But is telemedicine helping only the middle class? As of March 2019, there were 385 million active internet users in India above the age of 12. This was According to Internet and Mobile Association of India).
However, the internet penetration was a modest 36%. Only 28% of females having access to it in rural India and with huge geographical disparity. The success of telemedicine rests on infrastructure and access. There exists poor spectrum resources. Inadequate fibre facilities also continues to remain a point of concern. About two-thirds of Indians still without access to quality internet. These factors act as a hurdle in the success of telemedicine.
Data usage and privacy concerns
The guidelines rolled out for the first time telemedicine makes for a good primer. But it lacks clarity while addressing privacy concerns and data usage. Especially the usage of third-party apps to send personal information.
It puts the onus on doctors to maintain the record of all exchange of communication. It will be in the best interest, if the MoHFW comes with revisions. Thus making the guideline more comprehensive. Recently National Accreditation Board for Hospitals and Healthcare Providers (NABH) took the initiative. Establishing a digital Health Standards is a welcome development.
Patchy regulation, extraordinary multiplicity of branded medications
Prescriptions are often the only paperwork patients receive after consultations. Hence, they are invaluable to patients. India’s Code of Medical Ethics wants doctors prescribe as possible, use generic drugs. Audits show inadequate dosage regimes and disproportionate use of expensive drugs. It also shows excessive broad spectrum antibiotic use.
Half of medical expenses incurred in India are on unnecessary medicines and investigations. Poor prescriptions contribute to the estimated five million medical errors in India yearly. Introduction of Standardised digital prescription systems by the government as internet connectivity expands. This would enable monitoring of prescribing practices and reduce prescription errors. It could check pharmacy dispensing data and lower costs.
Training
The MoHaFW telemedicine guidelines (March 2020) endorse the WHO definition of telemedicine. These values are also highlighted in the Code of Medical Ethics Regulations (Medical Council of India, 2002). Effectiveness of telemedicine depends on doctors competencies.
In 2016, American Medical Association supported its UG & PG accrediting bodies for it. It included core competencies for telemedicine in their programs. It included digital communication, ‘webside’ manners and remote examination. Group interactions, emergent situation handling and troubleshooting are also aspects that need training.
Conclusion
A circular dated 11 June 2020 released by IRDAI. It suggested to include telemedicine as claim for insurance. Still telemedicine currently is a mere band-aid. It complements but cannot replace face-to-face clinical care in a pandemic or beyond. Though telemedicine has seen a boost in recent times.
The issues like access and quality can see improvement through telemedicine. WHO recommends a doctor-population ratio of 1:1000. But the current doctor population ratio in India is only 0.62:1000. So there are positive externalities and would help both patients and doctors. But there needs to be better infrastructure, training of doctors and pooling more of them. India needs clarity on data protection and privacy laws. And these programs should evaluated on regular basis.
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