“The burden of chronic diseases is steadily rising in the country and in reality many patients’ chronic diseases are not well controlled with only 50% of patients evidently taking their medications as prescribed. In situations like this and many more, telemedicine has a life-saving potential,” says Dr Sudip Roy, Senior Director – Primary Care, Practo

We are living in a world that is constantly changing and evolving to tackle adversities. The last two years are a testament to that. The progress of telemedicine in the last two decades witnessed a surge during the recent global pandemic, which pushed humankind to innovate and evolve, accelerating the adoption of digitisation, especially in healthcare. 

Today, any patient from anywhere in India, when in need of healthcare support can effortlessly use a digital health platform to avail of an array of healthcare services – from virtual consultations with the right doctor for the concerned ailment to getting diagnostics done and even medicine delivery. 

In today’s world telemedicine has emerged as a game-changer owing to its improved affordability and convenience in accessing quality healthcare delivery. However, the impact of telemedicine supersedes convenience, accessibility and affordability, and Dr Sudip Roy, Senior Director- Primary Care, Practo sheds light into this discussion elaborating on the present impact and the potential of transformation it has in the near future.

Dr Roy has over 21 years of experience spanning clinical microbiology, quality assurance – laboratory & hospital, healthcare setup commissioning, infection control, and clinical research. He was associated with HJ Hospital, Kinshasa, Democratic Republic of Congo (DRC) as a Consultant Clinical Microbiologist & in-charge of Microbiology, Serology, and Molecular Biology (including COVID Lab & Africa-CDC Lab for HIV). 

Is pandemic the only reason for accelerating adoption of telemedicine?

Not really. Telemedicine has been making significant strides since the last 2 decades. While it is true that the pandemic pushed for its mass adoption and telemedicine users in India grew by 35% (monthly active users) from 2019 to 2020, but it slowly evolved. What started as a need, has quickly become a choice, especially in case of emergencies as it makes the process of receiving quality healthcare, seamless and transparent. It addresses the inefficiencies that come with traditional care delivery while keeping the patient at the centre. Owing to this, telemedicine has become the starting point for delivering standardised quality healthcare. 

What are the advantages and scope of growth for telemedicine in the present situation post-pandemic?

One of the biggest advantages of telemedicine is its flexibility and that allows its scope to grow and evolve with time. It no longer matters where a patient is located or what language they speak. This is especially impactful in remote areas. Patients there have access to the most relevant doctors when they need it, and all this with the same quality of care that one would receive in any metro city. Telemedicine offers the potential to scale, reaching tier 2 and tier 3 markets, especially with access to doctors who speak the same language as the patients, improving efficiency and delivery of care.

With telemedicine, patients’ medical records are also digitally stored, which is of high importance, especially for chronic ailments such as diabetes, hypertension etc. After the consultation, the doctor can upload the case history and prescription under the patient’s account on the platform. This helps patients to always have easy access to their medical history, or a prescription when required. These electronic medical records can also be easily accessed if needed by other specialists relevant to a patient’s case.

This reduces discrepancies that may arise due to a lack of access to medical history ensuring the quality of care is not compromised. And a patient can also seek multiple follow-ups with limited wait time ensuring a continuum of care. 

How can telemedicine impact public health in India?

One of India’s biggest problems in healthcare is that rural India is not entirely connected to the healthcare system. While a lot has been done by the government to bring them under the health system such as the Primary Health Care centres, Accredited Social Health Activist (ASHA), National Rural Health Mission etc, a lot more needs to be done. And telemedicine can bridge these gaps in public health. 

Imagine India’s TB program with telemedicine, while the primary health centres help supply medicines to patients, the availability of doctors in rural areas is scarce. Here, with the help of digital platforms the supply of doctors can be solved. It can also be used to inform, influence and motivate individuals and the population on health, health-related issues and the adoption of healthy lifestyles. It can simplify communication between healthcare providers and individuals regarding the prevention, diagnosis or management of a health condition. 

Can you cite an example to highlight telemedicine’s impact especially in rural or underserved communities?

Telemedicine has been quite impactful especially in the social sector, with NGOs using technology to improve the quality of life for many underserved communities. For example, Wheels Global Foundation has a rural telemedicine solution to provide affordable and accessible healthcare to rural India. They are working with a sort of hybrid model wherein a rural telemedicine centre (RTC) staffed by two assistants (called ‘Sahayaks’) with the necessary equipment and software, help gather key diagnostic data prior to the patients seeing the physician. Post this, a 10-minute video consultation is conducted with the physician (while the physician has device-generated diagnostics and AI/ML software sharing critical inputs for treatment), and finally, a prescription is sent to the nearest pharmacy (directly or through the Sahayak).

Is telemedicine’s scope limited to primary and secondary care? Or, can it be more?

Definitely it can be more and telemedicine is already proving to be exceptionally helpful in the treatment of chronic diseases. 

About 21% of the elderly in India reportedly have at least one chronic disease; 17% are elderly in rural areas and 29% in urban areas. Hypertension and diabetes account for about 68% of all chronic diseases. 

While the burden of chronic diseases is steadily rising in the country, patients are still not able to manage it effectively. Because the reality is that many patients’ chronic diseases are not well controlled and that only 50% of patients evidently take their medications as prescribed. As dangerous as it can be, non-adherence can stem from poor healthcare literacy, lack of involvement in the decision-making process, and confusion on patients’ and providers’ side on what medications a patient might be taking, particularly after a hospital stay. This is where telemedicine can help. 

For example, with home blood pressure monitoring, the patient can share updates with the physicians via chats and this will allow the provider to monitor the patient more closely and encourage regular checks. And the routine use of telemedicine visits in conjunction with regular home self-monitoring could remarkably improve hypertension outcomes. Similar outcomes can also be achieved with other chronic ailments such as diabetes, CVDs etc especially by improving clinical outcomes, medical adherence and dietary outcomes. 

What do you think the future for telemedicine looks like?

It’s true that the pandemic gave a boost to telemedicine and it may seem that it’s been the most effective to address challenges related to accessibility and reach. But, that’s not the whole truth and we have barely scratched the surface.

For instance, look at the potential of Teleradiology, that allows radiological images of the patients to be directly relayed to specialists through these platforms. When radiology centres in tier 2 and tier 3 cities would partner with digital health platforms, it would speed up the process of diagnosis and help in timely treatment. And primary triage of the radiological images can filter the normal ones from abnormal ones by using AI before sharing it with the specialists.

So far, telemedicine has got the ball rolling for digital health and the world is steadily catching up to tap into its true potential. Plus, with the Ministry of Health and Family Welfare issuing ‘Telemedicine Practice Guidelines – 2020’ that details the SOPs for medical professionals and healthcare companies, it is a step in the right direction. 

That said, digital healthcare companies must continue to innovate and evolve to provide healthcare that is standardised, patient-centric and quality-driven, because that’s what will help create a real and lasting impact for the people of India.