By Dharna Singh(3rd Sem)
The World Health Organization defines teleconsultation as, “the interactions that happen between a clinician and a patient for the purpose of providing diagnostic or therapeutic advice through electronic means”. Teleconsultation has always been a quick and simple way to reach your doctor. Most individuals can recount consulting their doctor on a phone, or using a network or video link like Facetime, WhatsApp or Zoom at some point. In India, Apollo Telemedicine Networking Foundation (ATNF) is the oldest and largest multispecialty telemedicine network.
Teleconsultation during the pandemic: The new normal
We are confronted with an unprecedented crisis of Covid-19 pandemic that is dramatically changing the consumer behaviour. With social distancing becoming the norm, “contactless” has become the “new normal” buzzword. Most patients have refrained from getting in-person doctor consultations for acute ailments due to the lockdown and risk of infection. However, with the pandemic extending beyond a few months, patients were forced to explore new channels for reliable acute care.
Teleconsultation and e–pharmacy platforms have showed a steep growth in adoption by both, doctors as well as patients. For e.g., Fortis Healthcare has witnessed the shift in the outpatient department (OPD) consultation with 10% of the pre–COVID-19 consultations moving to the teleconsultation platform.
The COVID-19 pandemic has brought out the need for integrating all the steps in the clinical pathway digitally. Hence, the value lies in creating an ecosystem that can integrating all the stakeholders from doctors, caregivers, diagnostic labs and pharmacies to patients and insurance companies to enable an end-to- end customer journey.
Features of teleconsultation
- Data generation: data will get generated if patients adopt these platforms and are confident about the privacy of the data they share on these platforms.
- Data storage and handling: potential use of data will require it to be stored in a central location to maintain the complete medical history of an individual.
- Data usage: it is imperative to use the magnitude of data generated by the ecosystem to enable personalized and quality healthcare for the patient– consumer.
The teleconsultation platform can fulfil the entire patient journey from consultation to wellness and can digitally connect the steps which can be completed in-person or offline as per the need. Avoiding overcrowding, long waiting times in hospitals, Accessibility to doctor at your convenience, Avoidance of travel/ transportation and Availability in remote areas.
A teleconsultation ecosystem will require adequate technology, infrastructure and policy support. India is witnessing increased use of smartphones and wireless or mobile data.
The Niti Aayog has recommended building National Health Stack, a nationally shared digital infrastructure to support the healthcare ecosystem. Aarogya Setu app, a COVID–19 contact tracing mobile app, has instigated creation of a digital ecosystem around healthcare. Swasth Stack aims to build trust and transparency by the Open Health Services Network (OHSN) layer and by an auditable money settlement system. Pharmaceutical companies should lead the path to set up the teleconsultation ecosystem, hence, serving the government’s vision for Atmanirbhar Bharat
Tele consultation: potential to support the healthcare industry
In India, there is acute shortage of doctors with one doctor for every 1,456 people compared to WHO recommendation of 1:1000. This coupled with the fact that the density of doctors is much higher in urban areas than in rural areas, accounts for the great demand and potential of teleconsultation in India.
Teleconsultation technology platforms adoption post COVID- 19 pandemic
A huge surge in teleconsulting is witnessed across hospitals and technology platforms around the globe with the health systems reporting a massive growth in teleconsulting post-COVID-19. Globally, virtual primary care consultations have grown from 5% to 95% in last five months since January 2020. In India, Practo reported five crore Indians accessed healthcare services online during the first phase of lockdown between March 2020 to May 2020. Fifty-one percent of the overall teleconsultations are from three specialties viz., general physician, gynecology and dermatology. Amongst the telemedicine users, 80% are the first-time users and 44% are from non-metro cities. Leading healthcare chains in India are doing 200-500 tele-consults per day with a few star doctors doing 8-10 consultations per day since COVID-19 pandemic. Major teleconsultation platforms have seen up to a 500% increase in the number of online consultations post-COVID-19.
Similar trends were observed in the US where health systems have reported 50-170 times increase in the number of virtual healthcare visits as compared to the pre-COVID-19 scenario.
- Willing to adopt teleconsulting due to convenience and safety but lack of trust on the virtual care remains the major concern
- Lack of doctors’ personal touch causes mistrust among patients while they are diagnosed online
- Data privacy concerns and reservations about sharing health data online to affect future health seeking behavior.
- Don’t want to be on multiple platforms, need patients’ consolidation with digital backbone and structured health data
- Remote diagnostic tools required for effective examination
- Unethical practices adopted by the platforms around ratings and uberization of doctors is a major disinclination factor
- Doctors are not comfortable maintaining the patients’ data privacy and confidentiality.
Way Forward: Strategic interventions required
- Bring the national medical and industry bodies together to validate the protocols and ensure data privacy and protection standards
- Work with the government in progressively reviewing and upgrading the laws to suit the teleconsultation and e-pharmacy platform operations
- All three bodies viz., MCI, IMA, ICMR should be brought together to seek clarity and to frame common guidelines for a nationwide neutral teleconsulting platform.
COVID-19 has provided the much-needed fillip towards teleconsultation adoption across the globe with the required policy support globally and in India. Teleconsultation is here to stay with about 15%-20% of consultations expected to happen on teleconsultation platforms in India. Though the adoption faces trust issues, new technology wave, policy changes and consumer behaviour in healthcare is expected to shift towards phygital (physical along with digital) in new normal. Doctors look forward to a comprehensive virtual solution with intermediary diagnostic support and patients’ consolidation across platforms supported by digital backbone and structured data system. With all the requisites for success and growth of tele- consultation platforms existing, it becomes imperative to address the concerns and barriers faced by both, the patients and the doctors. A technological evolution, digital ecosystem partnerships and policy interventions have the potential to address concerns from key stakeholders in the healthcare sector for teleconsultation to drive large-scale healthcare benefits.
- https://www.paho.org/ish/images/docs/covid-19-teleconsultations-en.pdf?ua=1 2
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455413/ 3
- https://www.apollohospitals.com/news/government-s-new-health-initiative-sehat-launched-in- association-with-apollo
- 12https://niti.gov.in/writereaddata/files/document_publication/NHS-Strategy-and-Approach-Document- for-consultation.pdf
- https://www.livemint.com/science/health/coronavirus-impact-lybrate-sees-60-jump-in-online-doctor- consultations-11585652263774.html
- https://hitconsultant.net/2020/05/14/COVID-19-global-impact-primary-care-virtual- consultations/#.XvZLqXduI2x
- https://www.healthcareitnews.com/news/europe/uae-opens-access-new-telemedicine-applications-and- facilitators
- https://health.economictimes.indiatimes.com/news/health-it/nabh-to-set-digital-health-standards- telemedicine-accreditation-in-focus-too/75500238
- https://economictimes.indiatimes.com/news/politics-and-nation/share-of-population-over-age-of-60-in- india-projected-to-increase-to-20-in-2050-un/article show/68919318.cms?from=mdr
- https://www.thehindu.com/sci-tech/health/india-has-second-largest-number-of-people-with diabetes/article29975027.ece#:~:text=One%20in%20six%20peo ple%20with,with%20over%20116%20mi
- Systematic review and meta-analysis. Eye (Lond) 2014;28:788–96. – PMC – PubMed
- Saleem SM, Pasquale LR, Sidoti PA, Tsai JC. Virtual ophthalmology: Telemedicine in a Covid-19 era. Am J Ophthalmol. 2020 doi: 10.1016/j.ajo. 2020.04.029. – PMC – PubMed
- Telemedicine Practice Guidelines by BOARD OF GOVERNORS In supersession of the Medical Council of India constitutes, Appendix 5 of the Indian Medical Council