Telemedicine- scaling up the Indian advantage

Telemedicine- scaling up the Indian advantage

Introduction

• In the novel coronavirus pandemic, health-care providers have been reassigned from other specialties to COVID-19, simultaneously with lockdowns and fear of transmission have dampened demand for non-emergency care.

World Health Organization (WHO) survey

• A survey conducted by the World Health Organization (WHO) in 105 countries in July 2020 showed that essential services were disrupted in the majority of countries, with immunisation, antenatal and childcare services among the most widely affected.
• About 45% of low-income countries incurred at least partial disruption of over 75% of services, relative to only 4% of high-income countries.
• Almost 60% of services were at least partially disrupted in South East Asian countries.

COVID-19 impact

• Detection of tuberculosis: In India, detection of tuberculosis cases was down by 50% in April-December of 2020 relative to the same period in 2019
• Antenatal care: antenatal care visits were down by 56% in the first half of 2020.
• Diabetics: With stoppage of routine follow ups, blood sugar control for diabetics was at risk, increasing the chances of adverse events requiring hospitalisation, including worse outcomes in the case of COVID-19 infection.
• Cancer care: Cancer care has been badly affected in many countries, as well as diagnosis and treatment of other non-communicable diseases.
• Widening inequalities: Further, the pandemic has exacerbated inequalities — people living in rural and remote areas were further disadvantaged by not being able to travel to cities to seek specialist care.
  • The pre-existing shortage of specialists in many rural areas led to care being delayed or not happening at all.

Enhance technology use

• Virtual consultations: It avoids the risk of COVID-19 transmission and are helping to bridge this socio-economic divide.
• eSanjeevani platform: The Indian government’s eSanjeevani platform offers both provider-to-patient interactions and provider-to-provider interactions, where patients visit smartphone-equipped community health officers in rural health and wellness centres; these in turn connect to general practitioners and specialist doctors through a hub-and-spoke model.
• Remote-shared medical appointments: Remote-shared medical appointments in which multiple patients with similar medical needs meet with a clinician at once, remotely, and where each receives individual attention, can greatly increase telehealth capacity by eliminating repetition of common advice.

Utilising shared appointments

• Remote shared medical appointments essentially virtualise in-person shared medical appointments (SMAs) which have been offered successfully in the United States for over 20 years.

Advantages of shared medical appointments (SMAs)

• Patients get more time with their clinician.
• SMAs enable peer support and peer-to-peer learning.
• SMAs could help tackle India’s widespread “sugar” problem.
  • Case Study: The Aravind Eye Hospital in Puducherry has successfully trialled in-person SMAs for patients with glaucoma, a disease that causes gradual, irreversible blindness.
  • Glaucoma progression can be slowed through regular follow up and taking prescribed medications.
  • The eye hospital found that in shared appointments, patients spur one another to engage more and ask more questions.
• Telehealth platforms: eSanjeevani and other telehealth platforms could consider offering virtual shared medical appointments.
  • Patients in different villages, with similar conditions can be seen at once remotely by a generalist or specialist, during the pandemic.
• Training platforms:Training platforms such as ECHO, which train primary-care providers in many States through an online platform — can accelerate adoption and should also guide implementers on how to gather data that can be used to scientifically validate this care model.

The plusses

• Relative to other nations, India is well poised to ramp up telehealth.
• Data plans are cheaper in India than anywhere.
  • It is possible to get 1.5GB of data a day for a few hundred rupees a month, and Indians from all socioeconomic groups regularly enjoy group video chats with friends and relatives.
• WHO’s Global Strategy on Digital Health, adopted by the World Health Assembly, is a call to action providing a road map for nations to rapidly expand digital health services.

Way ahead

• With innovation in systems thinking, learning and adaptation, new digital tools bring an opportunity to leapfrog into a reality of ‘Health for All’.

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