The Coronavirus pandemic has surely impacted many aspects of our lifestyle and it will continue to redefine the way we interact with our surroundings.
One such change that we have observed during the coronavirus pandemic is the rapid increase in demand for Telemedicine in India.
A healthcare field that was dormant until June 2019 saw a sudden rise in demand during the coronavirus lockdown in India.
Telemedicine and Telehealth in India are definitely going to bring a big change in the way we look at our health consultations in India.
So let’s dig deep into telemedicine in India and understand all about it
Telemedicine in India
If a topic catches your eye feel free to skip
- What is Telemedicine? Meaning of Telemedicine in India
- Difference between Telemedicine and Telehealth in India
- History of Telemedicine
- Benefits and Advantages of Telemedicine
- Shortcoming and Disadvantages of Telemedicine
- Which medical specialties can use Telemedicine
- Laws and Regulations of Telemedicine in India
- Companies and Startups in India working on Telemedicine
What is Telemedicine?
The Medical Council of India defines Telemedicine in India as
The delivery of healthcare services by medical professionals using information and communication technologies to people who can not come for a personal consultation at the clinical facility.
Giving consultations for
- Health Education
- Research and Evaluation
- Prevention of injuries and diseases
In the interest of promoting the health of individuals and communities.
Telemedicine can be applied in
- Chronic Disease Management
- Medication Management
- Sharing Medical Information
- Disaster Relief
- Ambulatory Support
- Operating Remote Clinics in rural areas
- Health Education
- Emergency Room (ER) Diversion
- Taking 2nd Opinions
MCI acknowledges 4 types of Telemedicine applications in India, Based on the
- Mode of communication
- Time of the information transfer
- Purpose of consultation
- Individuals Involved
Mode of communication
- Video Consultation with a registered medical practitioner (RMP) using telemedicine software or apps like Skype and Facetime
- Audio Consultation on a regular call or voice chatting apps.
- Written Consultation on text chats, WhatsApp communications, Emails or Fax and online chat-based application
Time of the information transfer
Based on the timing of information shared between the patient and the doctor the Telemedicine can be a
- Live on Real-time using video, audio and textual means for diagnosis, education, and treatment purposes.
- A long thread of communication, Patients can tell about their problems, lab reports, images, over a period of regular communication at different point of time.
Purpose of consultation
Based on the emergency of the health situation
- For Non-Emergency Consultation patients can go for the first and follow up consultations with the doctor.
- Emergency Consultations. Telemedicine in case of an emergency should be avoided and it should only be provided if the patient requires immediate aid and can not go for an in-person consultation
Telemedicine does not only involve a relationship between doctor and patient it can be
- Patient to Doctor (Registered Medical Practitioner)
- Caregiver to the Doctor
- Doctor to Doctor
- Doctor to Health worker
Caregivers can be a family member or a person authorized by the patient to represent him, This authorization needs to be present in a written format to establish the relationship formally.
Difference between Telemedicine and Telehealth
You might have come across the word Telehealth while reading about Telemedicine, While both words are closely related, They are not the same.
NEJM Catalyst (A Reputed Healthcare Journal) defines Telehealth as
“The delivery and facilitation of health and health-related services including medical care, provider and patient education, health information services, and selfcare via telecommunications and digital communication technologies.”
Yeah, it might sound the same as Telemedicine but,
The basic difference between Telemedicine and Telehealth is that Telemedicine represents the delivery of clinical service by a Doctor (Registered Medical Practitioner)
Telehealth is a broader term which apart from clinical services also includes delivery of non-clinical services like Physician training or continuing medical education (CME) for future doctors for academic purposes.
Let’s understand this difference with some examples
- Consulting your doctors in the coronavirus pandemic using chatting and video calling apps like Whatsapp.
- Regular follow up of cancer patients with their doctors by sharing regular radiology reports. This phenomenon became really popular in The United States in 2018, It is termed by some as Teleradiology.
- Medical Tourism, Perhaps the biggest application of telemedicine has been in medical tourism. People from across the globe reach out to medical practitioners for consultations for treatments like plastic surgery, IVF, cancer treatments, etc.
- One of the biggest examples of Telehealth would be online pharmacy. You share your prescription documents with the provider and get medicine delivered to your doorstep.
- Telenursing is one of the latest trends in India, It allows providing nursing care remotely to caregivers of patients at home
- The technology providers like Practo and Lybrate that connect medical practitioners with patients are examples of Telehealth.
History of Telemedicine
Technically the history of Telemedicine around the world can be traced side by side to the history of communications and technology
Before we start with the history of modern Telemedicine here are some fun facts
- Telemedicine through mediums of fire, smoke signals, horns, drums can be dated back to ancient Greece and Rome (500 BC) where smoke signals were used to communicate medical information
- The smoke signals would help to alert people of outbreaks like the plague or used to denote birth of a nobility
- The America tribes would use the smoke signal to imply medical tragedy and death
History of Modern Telemedicine
Telemedicine dates back to the mid 20th century when radios were used to provide medical advice on ships.
In hospitals, the first usage was in the 1950s through a closed-circuit television link for psychiatric consultations.
But, One of the biggest users of Telemedicine was the military, In the civil war, they would use the telegraph to order medical supplies and communicate medical injuries and deaths.
Radio started being used widely in the mid 20th Century by the government for health education that would cover even the far fetched rural areas.
The invention of the telephone was revolutionary and it transformed Telemedicine drastically,
People started taking medical advice over the phone from a doctor, People would report emergencies to hospitals,
Perhaps the national helpline number 108 for medical emergencies that started on 15th August 20005 was a big step in telemedicine,
In the late 1990s with the internet blast, Medical education became easily available over the web that started the base of telemedicine as we see today.
People started to look for information about diseases, download images about human anatomy, get references for medications and drugs online, etc.
Now people could get information for first aid over the phone to deal with emergencies buy just dialing a number.
In the last 30 years, telemedicine treatment has expanded to mental health, stroke, and patients with chronic diseases like asthma, diabetes, or heart failure.
A number of research studies have found it to be an effective alternative and satisfying for both the patient and the provider.
Telehealth proponents have sold it as a solution for patients in rural areas. Now they advocate it as a low cost and convenient option for tech-savvy millennials and busy parents as well.
History of Telemedicine in India
Up until 2018, there were government guidelines for practicing telemedicine, through video, phone, and Internet-based platforms.
Even though the National Digital Health Authority of India (NDHAI) set parameters for digital health record in 2016, No specific laws were given for telemedicine as service
The provisions of telemedicine prior to this could be scarcely traced under the
- Indian Medical Council Act, 1956,
- Drugs &Cosmetics Act, 1940 and Rules 1945,
- Clinical Establishment (Registration and Regulation) Act, 2010,
- Information Technology Act, 2000
- Information Technology Rules 2011
In 2018 in reference to the case Deepa Sanjeev Pawaskar And Anr vs The State Of Maharashtra on 25 July 2018
The Highcourt stated that there should be strict frameworks and guidelines for administering telemedicine in India,
In the case, Dr.Deepa Sanjeeva Pawaskar was charged with medical negligence for administering treatment over the phone without proper diagnosis which may have led to the death of a woman.
The official guidelines for telemedicine in India were released on 25th March 2020.
Perhaps the first big project on telemedicine in India can be traced back to Telemedicine Pilot Project in 2001 conducted by ISRO,
The project linked Chennai’s Apollo Hospital with the Apollo Rural Hospital at Aragonda village in the Chittoor district of Andhra Pradesh.
Benefits and Advantages of Telemedicine
- Telemedicine provides equal access to quality care:
One of the biggest benefits of telemedicine lies in providing quality healthcare to rural areas where doctors are not easily available.
One other benefit for rural areas is that often people in rural areas require doctors of certain specialty
which are unavailable in rural areas, With telemedicine they can reach out to a wider database of doctors with every specialty.
Also with telemedicine people can access preventive medication in practices that will improve the quality of health of the whole community.
As an added advantage people will also become more tech-savvy.
- Telemedicine reduces healthcare costs:
Telemedicine saves the travel cost for patients, Yes this might be looking at a small cost but for many this cost is huge,
Imagine a person living in a village traveling to the city just for a consultation from a highly reputed doctor.
Also, the cost of Telemedicine in India is less as compared the that of in-person consultation,
If an in-person appointment costs 500 Rs, The teleconsultation might just cost you 150-200 Rs
Research suggests that people who use telemedicine spend less time in the hospital which can save up to 19% of the cost.
Also, doctors can save a lot of money from Telemedicine.
- Maintains Social Distancing and Help Spread of Infections:
With pandemic situations like coronavirus, Telemedicine is a key step in maintaining social distance and avoiding infection from people in the hospital or clinic
This also prevents healthcare workers, doctors, and medical staff from getting infected and helps treat more and more patients.
- Telemedicine can improve quality of care delivery
Telemedicine can improve the quality of healthcare for people with mental and medical health issues.
A remote behavioral health study showed that 63% more likely to spend fewer days in the hospital,38% fewer hospital admissions and 31% fewer hospital readmissions
- Reduce the burden on hospitals
Hospitals get visited by a lot of patients every day for routine checkups and primary healthcare services,
If more people go for telemedicine the burden on hospitals will decrease and the hospital can channelize more of their workforce towards treating patients with severe medical conditions.
This is especially beneficial in a country like India where we have less than 1 bed for 1000 people.
- Maintenance of records and documentation
Medical history and documentation are key factors in the diagnosis process of a doctor. It can be really insightful for a doctor you are visiting for the first time.
Telemedicine will require you to save these medical records for future references, We do not have a habit of maintaining our health records which many times lead to the wrong diagnosis.
A way to ensure that your documents are well maintained is by having a softcopy of the reports on your laptop, computer, phone, cloud storage, etc.
Which has become a common practice in many urban areas in India
- Increases the legal protection of doctors and patients
Every day there are a lot of medical negligence cases being filed on a practitioner,
some can be right, some can be wrong but a way to arrive at the right decision in such cases can be with the help of Telemedicine.
You can record each consultation with your doctor while using telemedicine, Giving you and the doctor the required evidence needed in the court to prove your case.
- Timely and faster access to doctors who may not be immediately available in person
- Can help patients to stick to their medication regimens and manage their diseases better
Telemedcine allows doctors to do regular follow up of their patients and instruct caretakers of the patients about intrinsic details of the treatment regime for better results.
- Convenience and enhanced patient experience
You don’t need to wait in a clinic waiting room for your consultation and also avoid exposure to various illnesses.
Some people face social anxiety and do not like going to clinics in person, for them telemedicine is really convenient.
Shortcoming and Disadvantages of Telemedicine
- Protection of your medical data
This is a problem with every technology these days. Your data and personal information have become vulnerable and with the right skill, someone can hack into this data.
The problem becomes more alarming when it involves health data, People can hack into your reports and share it with people online.
- Technological Issues
Apart from the fact that not everyone is tech-savvy which makes this experience difficult for many, The infrastructural cost associated with it is high both for doctors and patients.
The effective and stable internet connectivity required for telemedicine is not available to everyone in India.
But with the internet revolution unfolding in India, we might soon be able to provide quality internet to everyone in urban and rural areas
- Continuity of medical care from one practitioner
Many platforms available online connect you to a random doctor, while he may have all the medical records required to help you,
Treatment form the same doctor can prove continued and better care
- Increase in online frauds
While there are strict laws regarding telemedicine, It still allows a lot of frauds to get their way online
There can be possible medical quacks that offer you cheap consultation and give you the wrong health advice and may also defraud you into buying unnecessary medicine and health supplements.
- Many insurances may not cover Telemedicine
Even though it might seem implied that telemedicine will be covered under insurance as in-person consultation, It might not be the case with your health insurance provider.
Health insurers may not have acknowledged telemedicine as a consultation in your healthcare insurance
which means that you might end up paying for the telemedicine consultation out of your pocket even while having health insurance.
Which medical specialties can use Telemedicine
While every specialty at some level can use telemedicine to provide care using telemedicine the most effective use of telemedicine can be seen in these fields
- Obstetrics/Gynecology, It’s a tough thing for first-time parents to deal with pregnancy and you might have a lot of questions during this whole journey, Telemedicine is just the right way of getting all these answers.
Regular checkups during pregnancy can be really inconvenient especially during a period like a coronavirus pandemic, this can be easily tackled with telemedicine.
- Dermatology, With the availability of HD cameras and excellent display, Dermatological conditions can be easily treated remotely using Telemedicine.
- Cardiology, You can easily share all your reports with your doctor and get regular checkups. This is really beneficial for old patients with heart conditions
- Pediatrics, children are more prone to infectious diseases than adults so it’s better to go for telemedicine and avoid possible infection in clinics.
- Endocrinology, Treatments like diabetes require regular monitoring and adjustment in hormones which can be more effectively monitored and maintained using telemedicine
- Psychiatry, You can easily monitor medications and perform cognitive behavioral therapy using telemedicine.
- Oncology, In a 2018 conducted survey the biggest beneficiary of Telemedicine were cancer patients who could easily share their radiology reports with their doctors,
This trend became so popular that it was called Teleradiology.
- Pulmonology, For people with COPD and asthma treatment with telemedicine, is a more pleasant choice compared to an in-person consultation
- Nephrology, Doctors can conveniently create an in-home treatment regimen for patients who have kidney disease or have undergone kidney replacement surgery.
Laws and Regulations of Telemedicine in India
Board of Governors In supersession of the Medical Council of India and in partnership with NITI Aayog laid down the guidelines for Telemedicine in India on 25th March 2020
The much-awaited step was taken during the coronavirus pandemic to manage the situation and ensure the smooth functioning of the much-needed telemedicine in India.
You can read the detail document of the guideline by clicking on this link
The key highlights and summary of the guidelines for telemedicine in India are
- Telemedicine consultation can not be anonymous, Both the patient and the doctor should know each other’s identity.
The doctor needs to confirm the identity of the patient, explicitly the age of the person before giving him a prescription,
In case a patient is a minor, teleconsultation can only be given in the presence of an Adult whose identity is confirmed.
The doctor needs to display his registration number issued by the Medical Council of India or State Medical Council
- Patient consent is must for teleconsultation, If a patient contacts a doctor the consent is implied without being said,
A written or explicit consent is required in case the teleconsultation is being taken by a caregiver (3rd person) in place of the patient.
- Prescribing medications, via telemedicine consultation
Doctors can prescribe medicines on telemedicine consultations at their own professional discretion,
But prescribing medicines without a proper diagnosis will amount to a medical negligence
There are certain restrictions on prescribing medicines via telemedicine consultation.
The following category of medicines can be prescribed
- List O Medicine: These medicines are used to treat common conditions, which include medicines like paracetamol, ORS solution, Cough medicine, etc.
Or medicines that are prescribed during a public health emergency
- List A Medicine: These include medicines that can be prescribed on the first consultation and are being re-prescribed or re-filled, In case of a follow-up
These are safe medicine with low potential of abuse by the patients,
For first consultation(Only after video consultation): These include eye drops, ear drops, ointments and lotions
In the case of followup: There can be hypertension meds like Atenolol or Metformin in case of diabetes.
- List B Medicine: They can only be prescribed in a followup consultation or after an in-person consultation
- List O Medicine: These medicines are used to treat common conditions, which include medicines like paracetamol, ORS solution, Cough medicine, etc.
- Medicines that can not be prescribed
Medicines listed in Schedule X of Drug and Cosmetic Act and Rules or any Narcotic and Psychotropic substance listed in the Narcotic Drugs and Psychotropic Substances, Act, 1985 can not be prescribed
- It is mandatory for doctors to maintain digital trails and documentation of consultations
- If a physical exam is required, The doctors should not proceed with telemedicine.
Companies and Startups in India working on Telemedicine
The upcoming telemedicine industry in India is expected to provide more than $5.4 Bn market opportunity by 2025
Startups in India have sensed this opportunity and are working hard to acquire a major chunk in this upcoming industry.
While we explore the list of companies and startups in India working on telemedicine let’s also look at the names of their founders and CEO
- Practo (Shashank ND)
- DocPrime (Ashish Gupta)
- Lybrate (Saurabh Arora and Rahul Narang)
- mFine (Ashutosh Lawania)
- CallHealth (Sandhya Raju)
- MedCords (Nikhil Baheti, Saida Dhanavath, and Shreyans Mehta)
- TeleHealth, Apollo Hospitals Group (Vikram Thaploo)
- Online Doctor(Deepak Patel)
- oDoc (Hesh Fernando, Sohan Dharmaraja, Janaka Wickramasinghe)
- Glocal Healthcare (Dr. Azim)
- Clinivintage (Dinesh Samudra)
Telemedicine and Telehealth are an upcoming filed in the Indian Healthcare Market and while they have great potential in solving some of the biggest problems in Indian Healthcare System,
We need to carefully unfold this technology and provide the right education behind using Telemedicine in India or things can get ugly.
Every upcoming market or development in Healthcare always comes with educational challenges which if implemented right can promote better health for individuals and their communities.
Coronavirus pandemic has changed many aspects of our life and will continue to do so, We need to be mentally prepared to accept these changes and start living in this new normal ecosystem.
Telemedicine would definitely change the way we look at our health.