Teleconsultation – The future or COVID fad?- Raghav Gupta

By Raghav Gupta(1st Sem)

“In an age where an average customer manages nearly all aspects of life online, it’s a no brainer that healthcare should be just as convenient, accessible and safe as online banking.” 

Jonathan Linkous, former CEO of the American Telemedicine Association.

Abstract

In these challenging times of a pandemic, people are overwhelmed with ailments as well as feelings of anxiety and uncertainty.  Globally the health systems are struggling to cope with exponential demand for medical services for both physical and mental illnesses.  Health services can be at the risk of collapse caused by sheer volumes of caseload and require appropriate planning and creative solutions.

To tackle this, 21st century provides us with an affordable, accessible and flexible solution: Technology.

There is no denying that now with a stroke of finger, a simple screen can connect people across the globe.  So why should health care (which is the most important) not take that step?  Most of healthcare can be serviced by virtual means, which enables key clinical services to operate regularly and uninterrupted, during a public health emergency like Covid.  Teleconsultation can provide essential and effective health services, with full safety and protection for both healthcare providers and receivers.

Introduction

Telemedicine

 ‘The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities’ -Telemedicine Practice Guidelines, Medical Council of India, 25 March 2020

According to MCI, there are three primary technologies that can be used to deliver teleconsultation:

  • Video
  • Audio
  • Text (chat, messaging, email, fax etc.)

Each of the technology have their strengths, weaknesses and contexts, in which they may be appropriate or inadequate to deliver medical services.

Since February 2020, telemedicine grew from less than 1% of primary care visits to 43.5% in April 2020 worldwide.  Perhaps this is the largest growth in any sector during the slow economy – an indication of need for creative solutions and growing demand of digital healthcare services.

Strength and Opportunities

  • Increased accessibility- Leave no one behind.
    • 75% of doctors are in cities, whereas 68.84% of India’s population is in rural areas. Teleconsultation helps cross geographical barriers by reaching remote areas and servicing marginalised communities.
    • Teleconsultation can be lifesaving in emergency and critical care situations where moving a patient is undesirable or not feasible.
  • Affordability -Significantly reduces costs to both doctors and patients, and a big relief on out-of-pocket medical expenses.
  • Easier documentation and potential for research – Technology enables auto record keeping which is important for patient history and this data can be used for medical research too.
  • Enhanced reach of tertiary care – new technology has allowed specialist to read scans of x-rays/CT etc online.

ISRO’s Telemedicine projects has successfully linked hospitals and healthcare centres in remote rural areas with specialty hospitals in cities through INSAT satellite.           

Source: ISRO Telemedicine Initiative: Healing touch through space 

  • Improve efficiency and safety –
    • reduced crowding, helps in social distancing.
    •  avoiding long waiting time for ailing patients and their caregivers.
  • Increase potential for second opinion between doctors, helps in reducing disease burden by avoiding complications and averting deaths.
  • Preventive Communication and Medical Education:  Teleconsultation can be used for giving information on prevention.  Also, online distance learning means are being used for medical students, which is interactive too.

Weakness and Risks

1. Misinterpretation – This can be due to lack of credibility of the medical practitioner or incorrect understanding of the diagnosis/treatment by the client.

“Strong verification process is crucial to understand if they are genuine doctors, every detail of the doctor including identity, degree of both MBBS and speciality is a mandate. This is the best way to avoid quackery and make sure only the right people are available on the platform.”

-Dr Alexander Kuruvilla, Chief Strategy Officer, Practomedicine Association.

2.  Privacy and data protection – Providers need to adhere to regulatory guidelines to mitigate potential risks of privacy and date protection.  Also important for cross-border teleconsultation where the patient and doctor are from different countries.

3. Training of medical staff – Doctors, paramedics and technicians will require training on hardware (equipment, privacy etc.) and “soft” issues e.g., how to handle patients as “human factor” is critical to make the digital interactions effective.  Both are time and capital intensive.

4. Tech Infrastructure are essential for effective delivery, though often a challenge for most of the Indian population.

  • Secure, high-speed internet connection
  • Smart device (phone or laptop) with appropriate software (e.g., Webex, Skype, Zoom, MS Teams, FaceTime)
  • IT Services for problem solving and maintenance.

Most of the above weaknesses and risks can be addressed through careful planning, medical policy guidelines and availability of infrastructure and training.

Future Awaits

Even before COVID there were significant developments in digital healthcare services, but predominantly limited to developed countries.  The dire urgency to meet the humongous medical needs during the pandemic has accelerated teleconsultation leading to an unparallel boom in developing countries as well.   This trend is likely to continue with scope for evolution and learning as we go along.

“With patients becoming accustomed to the level of access telemedicine provides, I don’t think we’re ever going to be able to go back. The box is now open.”

Dr. Jeffrey English, Atlanta Neurologist

Emerging future applications of telecommunication

1. Follow ups:  E-communication between patients and providers is gaining momentum e.g.  update messages, appointment scheduling, sharing laboratory reports.

2. Web-based/multi-media health records: Electronic medical records (EMRs) will have text and numbers but also other medically relevant data, including still images, video recordings e.g.  echocardiograms, endoscopies and patient interviews. This will allow specialists, local providers and students located at multiple sites to review archived studies, visualize the course of a patient’s disease and get rich educational experience.

3. Specialist consultations and second opinions: Cancer patients routinely seek Internet-based second opinions to ensure that they are doing everything possible to battle their disease.  It can also be used for overseas consultations.

“Continued growth in telehealth will be sustained for years to come. The common thread will be easier access to healthcare, which will generate confidence and drive growth.”

-Jack Williams, President of VirtualMed Staff

Conclusion

The growth and integration of technology with traditional healthcare services holds a great potential for all – patients, providers and the buyers of health services of the future.  Overall, the advantages of telemedicine supersede its downsides.   Policy frameworks for implementation and monitoring, provision of infrastructure and upskilling of medical fraternity can make teleconsultation a big success.

Perhaps the most difficult question is: ‘Will telemedicine meet the required standards of medical care and treatment?’  Though this is a tough question, I strongly think it is upon all of us to make this work.  Our actions today and in future will determine the robustness of the standards for teleconsultation. We have made significant headway in this new direction and if we all put our best efforts, there is no stopping to this “new world” where digital technology strengthens (not replaces) medical science.  As rightly stated by Alan kay, a visionary in the field of computer science, ‘The best way to predict the future is to invent it.’

Reference Links

Reference Articles

  • Agarwal N, Jain P, Pathak R, Gupta R. Telemedicine in India: A tool for transforming health care in the era of COVID-19 pandemic. J Edu Health Promot 2020;9:190
  • [Mehta KG, Chavda P. Telemedicine: A boon and the promise to rural India. J Rev Prog 2013;1:1-3.]
  • ISRO Telemedicine Initiative. [Internet]. Televital.com. Available from: http://www.televital.com/downloads/ISRO-Telemedicine-Initiative.pdf. [Last accessed on 2020 May 06]. 
  • Predicting the Future Role of Telemedicine, October 27, 2020.  modernheath.com
  • Saner H. eHealth and telemedicine: current situation and future challenges. Eur J Prev Cardiol. 2013 Jun;20(2 Suppl):1-2. doi: 10.1177/2047487313487483. PMID: 23702982.
  • Heinzelmann, P. J., Lugn, N. E., & Kvedar, J. C. (2005). Telemedicine in the future. Journal of Telemedicine and Telecare11(8), 384–390. https://doi.org/10.1177/1357633X0501100802

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