Telemedicine simply put, refers to the practice of patient-care done remotely without the doctor and the patient being physically present with each other. All with the help of modern technology, doctors are now able to consult patients by using video conferencing tools that comply with the HIPAA standards. The term “Telemedicine” first made its debut in the 1950s. Physicians and patients are able to share information in real time from one computer screen to another. This includes capturing of readings from medical devices, using telemedicine software and diagnosing patients virtually without the hassle of waiting for an appointment.
Note: Not to confuse with the term “Telehealth”, which is the utilization of electronic information to support long-distance clinical health care. Think of telehealth as a term that encompasses telemedicine and other relevant terms under its umbrella.
Rise due to COVID-19
As our country’s health infrastructure which includes beds, protective gear and ventilators is getting ramped up in order to treat patients affected by the pandemic, the shortage of specialists in critical care is becoming acute with the rise in the number of cases across the country. The healthcare professionals along with state governments have acknowledged this problem and have come up with the strategy of addressing this issue by training doctors to become intensivists and adopting the path of telemedicine.
According to the report by Ficci-NatHealth on telemedicine, about 1.7 million COVID positive cases are forecasted to seek tele-support within the next 100 days. Also, the other primary care needs will need around 33 million hours of consultation from doctors. The study also adds that if 15 to 20 percent of doctors adopt telemedicine within the next 100 days then 25 million hours of consultation could be delivered. Prior to the pandemic, India would be getting around 500,000 ICU admissions every year having roughly 70,000 ICU beds in the country.
But the number of specialists in critical care needed to treat these patients is around 11,000. Such a ratio in normal times is unfavorable and appears worse-off in case of a pandemic that we face. Telemedicine in India is getting a complete makeover- it is not only confining itself to video consultations between doctors and patients but also becoming the tool to handle critically ill patients from remote locations. On e specialist in ICU can handle 60 beds when he is monitoring remotely compared to a handful of beds on-site. Also in tele-ICUs infection rate for these specialists is negligible compared to otherwise 8-14 percent. Thus making it not only cheaper for the patients but safer for the doctors as well. Converting a general non-ICU ward into a remotely monitored ward is even cheaper and requires temperature monitoring and oxygen saturation monitoring for the affected patients which is being done currently at government-run facility centers that house the affected patients.
How will Telemedicine support in resource-poor regions?
The skewed distribution of healthcare delivery infrastructure in resource-constrained settings is a key challenge. Telemedicine plays the role of bridging the overcoming challenges in infrastructure. While a large amount of population lives in rural areas, establishments of healthcare are located in urban settings. Also, restricted resources lead to frugal implementations such as facilitated teleconsultation by community workers who follow a checklist based initial assessment and then contact with a clinician to help provide real time consultation to the patients.
Thus, the challenges around the ownership of mobile phones and functional literacy are overcome. A successful telemedicine ecosystem requires multi-disciplinary approaches and multi-sectoral coordination, and, therefore, mandates a whole-of-government approach. Strong commitments by governments would reflect in the budgetary allocations towards establishing such an ecosystem.
How to ensure data security in Telemedicine?
The question becomes relevant especially now when having access to large amounts of data is vital enough to understand the spread and growth rate of the virus. Those countries that have a very robust infrastructure for health data can leverage real-time data for informing key strategies and public health response.
Several countries including India, have launched mobile applications for citizens to provide real-time information updates and contact tracing, most of these have incorporated data security by default ensuring end-to-end encryption. In the context of telemedicine, remote patient monitors and remote-care devices are particularly vulnerable as they often lack embedded security that would ensure the decoupling of personal health information in such settings. That is one specific approach to be considered. Every telemedicine network should consider a rapid data security audit even as they are scaling up to meet the demands posed by COVID-19.
The Corona Virus Pandemic demonstrates the potential that telemedicine has to offer in augmentation of health systems capacity in India. Even as the health systems transformation envisaged through establishing primary care networks and health and wellness centers under Ayushman Bharat are being established, the Telemedicine Guidelines 2020 provides the opportunity to leapfrog and invert the healthcare delivery paradigm. In the long term, health-seeking behavior is likely going to improve whereby citizens have an enhanced user-experience in healthcare delivery. Like all technological innovations, telemedicine will be as best at the hands of the human experts who leverage it to their advantage