The COVID-19 pandemic has prompted a surge in global demand for remote care. With the Indian government’s recent notification of guidelines for telemedicine, empowering doctors to consult patients via audio-video and chat applications, will virtual care become the mainstream of healthcare?

“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 the 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.”

That’s the definition of telemedicine, as per the recent notification of the Telemedicine Practice Guide by the Ministry of Health and Family Welfare in India.

In the wake of COVID-19, there has been a global surge in demand for telemedicine. When the outbreak was first announced in China, virtual healthcare platforms such as Ping An Good Doctor and Alibaba Health Information Technology were flooded with appointment requests and customer queries.

Over the last three months, countries like Australia, Japan, Thailand, Indonesia, Hong Kong, and the Philippines have been ramping up virtual healthcare on a war footing, while the US government has earmarked USD 500 million exclusively for the use of telemedicine in the fight against the pandemic.

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Pandemic push

When India announced its nationwide lockdown starting 25th March 2020, the panic among expectant mothers, parents of infants, and couples seeking infertility treatment urged Dr. Kishore Kumar, founder chairman, and neonatologist at Cloudnine Group of Hospitals, Bengaluru, to kick-start teleconsultation services. “It took us about two weeks to get the technology and doctors on board as well as to sort out teething troubles of the new system. We have been able to connect virtually with patients across the country…I’m certain telemedicine will revolutionise care in India,” he says.

Having witnessed the reach and quality of remote care while practising in Australia way back in 2000, the doctor explains that medico-legal concerns in the absence of clear government regulations were the only deterrent in adopting the model earlier. However, with the recently notified Telemedicine Practice Guidelines, prepared in partnership with the Medical Council of India (MCI) and NITI Aayog, the government’s premier thinks tank, the industry is no longer in a regulatory grey area.

With over 560 million internet users, India is the second-largest online market in the world, ranked only behind China. Doctors consulting patients via audio-video and chat applications can make it feasible to reach under-served populations in remote areas, with hitherto limited healthcare access.

Data shows that only nine among India’s 28 states meet the World Health Organization (WHO) recommendation of a 1:1000 doctor-population ratio. For a country that spends a little over one percent of its GDP on healthcare, virtual care has the potential to significantly change the narrative, in terms of affordability, quality, and access to healthcare. Telemedicine can bridge the yawning gap, marking the dawn of a new era in Indian healthcare.

New opportunities

“It is not a question of either in-patient or teleconsultation. Both complement each other to create a complete and more progressive healthcare system,” notes Madhusudan Chauhan, director of Jiva Ayurveda, touted as the ‘world’s largest Ayurveda telemedicine centre’ with over 450 Ayurvedic doctors employed across India. Started in 1992, the company has catered to over 17 lakh patients to date, with 35-40 percent teleconsultations happening in metros and tier-1 Indian cities. “The outcome results are similar when we compare in-patient and teleconsultation,” he maintains.

At the time of an outbreak like COVID-19 when healthcare resources are scarce and social distancing the norm, teleconsultations with doctors have proved to be a boon. Routine follow-ups, non-emergency treatments, monitoring, report evaluation, prescribing medicines, are being done over voice, video, or text consultations. And with digital payment options, the process is fairly simple.

“The biggest challenge is our mental block,” admits Sneha Raut, a marketing executive from Mumbai, who recently opted for home physiotherapy via video conferencing. Though apprehensive, she signed up for the physiotherapy session on her surgeon’s recommendation. “I had a surgery for shoulder dislocation last month and needed physiotherapy to restore range of motion and strength. The online sessions have been very effective. Also, they save so much time and energy. I plan to continue with the virtual sessions even after the lockdown is eased,” she says.

Old challenges

While most private healthcare centres in India are adopting the virtual care model in the current scenario, the Indian government has also launched an app – eSanjeevani – to digitally connect patients with doctors in the public healthcare sector. The real challenge, though, will be to expand the telemedicine network across tier-II towns and rural areas to address healthcare needs beyond those posed by the current pandemic.

The Telemedicine Practice Guidelines place the onus on the doctor to decide whether teleconsultation will suffice, or if an in-person review is needed, based on factors pertinent to each case. “The guidelines state that technology platforms based on artificial intelligence (AI) and machine learning (ML) cannot replace the doctor. However, they will need to be further refined to address concerns regarding data privacy, insurance coverage, and the like,” contends Dr. Vinita Sharma, a general practitioner, who is unsure about undergoing the online training for doctors on the telemedicine guidelines.

“It is not easy to convince doctors. You have to give them time,” admits Dr. Kishore Kumar of Cloudnine Group of Hospitals. Also, it’s a myth, he says, that the technology is unaffordable. “Once you establish the backend operation, the technology pays for itself in the long run. It’s a worthwhile investment,” he affirms.
In time, data analytics can help improve care from super-specialised tertiary care centers to secondary and primary health centres. Telemedicine can make valuable insights available at the point of care, leading to accurate diagnosis, enabling timely, preventive actions, and improved clinical outcomes.

“In India, we have been discussing telemedicine guidelines since 2005, but only now has the procedure been fast-tracked. This is only the beginning…the guidelines must evolve to help garner more public trust and pave the way for personalised treatment based on data analytics,” says Madhusudan Chauhan of Jiva Ayurveda.

The way forward

According to industry reports, Asia Pacific will account for nearly 30 percent share of the global telemedicine market by 2025. This prediction is primarily driven by the expectation of a reduction in the cost of primary care and improvement in the delivery of quality healthcare to the last mile in China and India.

China has already made good progress in terms of ramping up telemedicine infrastructure and setting up dedicated chat and video healthcare services to help its citizens recover from the effects of the pandemic. In India though, the process has been off to a slow start.

However, with the government planning to expand the scope of its telemedicine app beyond the urban and semi-urban areas, there’s immense scope for a healthcare revolution. The key will be to establish telemedicine centres or IT-enabled healthcare kiosks with video consultation facilities in under-served areas and train local people in operating these centres.

According to a 2019 study by McKinsey Global, India could save USD 10 billion by 2025 if telemedicine replaced between 30 percent and 40 percent of in-person outpatient consultations. Given the growth of 4G and 5G spectrum as well as the rise of health-tech startups, telemedicine is well poised to move from the fringes to the mainstream of Indian healthcare.

The only question is: Will the stop-gap solution in the crisis become an accelerant for change and shape the ‘new normal’?