COVID-19 has led to a rapid rise in adoption of telemedicine in India, but the model still faces challenges on language, trust data confidentiality, licensing, perception of impersonal care, information overload, interoperability and language barriers.
• COVID-19 has put a huge pressure on the country’s already strained healthcare ecosystem, for which telemedicine has emerged as a safety valve.
• With its clear advantages like reducing chances of infection, saving time of patients, remote patient monitoring and enabling doctors to attend to more patients, the popularity of telemedicine has surged by leaps & bounds of late.
• However, the sector is still at its nascent stages in India and faces some critical gaps.
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COVID-19 has indeed been a black swan event that has put immense pressure on our healthcare system. Consequently, India has been grappling with the dual challenges of controlling the rising number of cases while trying to bring down the mortality rates. According to a report by online consultancy platform Practo, COVID-19 continues to be India’s topmost concern. Unsurprisingly, between March 1 and May 31, 2020, queries related to COVID-19 grew by 200%, with 50% of all GP consults pertaining to Coronavirus-related symptoms.
Indubitably, the pandemic is peculiar for being a large-scale health challenge that requires urgent mobilization of resources and affects the whole population. Further, health issues related to lifestyle changes & non-communicable diseases (especially now with the work-from-home paradigm) have also aggravated the pressure on India’s healthcare system. Gynaecology, GP and dermatology emerged as the topmost consulted specialities over the last few months, collectively accounting for 51% of the overall consultations.
To contain the virus, severe lockdown restrictions are in place throughout the nation. With hospitals being seen as infection epicentres for the contagious (& sometimes nefarious) disease, there was a 500% surge in telemedicine consultation across the nation. Simultaneously, in-person doctor visits dropped by 67%. What testifies for this tectonic shift in Indian healthcare ecosystem is the fact that 80% of all telemedicine users experienced it for the first time and 44% of the tele-consultations were from non-metro cities.
Thus, the pandemic acted as a catalyst for the growth of the Indian telemedicine sector. According to an analysis by DataLabs, the country’s telemedicine market is expected to cross US$ 5.5 billion by 2025, with a CAGR of 31%.
Indian telemedicine sector: A quick sneak-peek
A major factor responsible for greater adoption of telemedicine in the country is the growth in internet usage in India over the recent few years. An analysis by market research agency Kantar IMRB states that India’s internet users are expected to register double digit growth to reach 627 million in 2019, powered by rural internet growth and usage. As per an analysis by PwC India, India’s internet users are going to rise significantly in the next few years.
On the other hand, a report by the Center for Disease Dynamics, Economics & Policy (CDDEP) in the US reveals that India has a shortage of an estimated 600,000 doctors and 2 million nurses. Further, it has one government doctor for every 10,189 people (whereas the WHO recommends a ratio of 1:1,000).
With the benefit of technology outreach, telemedicine bridges the healthcare gap between the patients and medical practitioners in cases where the access to medical facilities, specialists’ opinions and advance healthcare amenities is limited. It has become the need of the hour for a nation like India, which is seriously challenged by the dearth of medical & paramedical staff.
Telemedicine is a win-win situation for both the patient and the medical staff. It will save transportation costs involved in visiting a health clinic, save the time spent in the waiting room, save time lost at registration and billing counters & keep patients out of hospitals. At the same time, it will provide real-time patient information and assist with symptom-based diagnosis, which can save doctors’ time and enable them to consult more patients. It will also de-centralise patient health records using blockchain technology to maintain a single source.
Keeping these factors in mind, the government has taken some measures to provide a fillip to the digital healthcare framework in India. Establishing the National eHealth Authority (NeHA), creating an Integrated Health Information Program (IHIP), framing Electronic Health Record Standards for India and launching the mHealth initiative are some such steps.
However, in the light of COVID-19, the government took another major step that can catapult the sector to an accelerated growth path. It accorded legal status to telemedicine in India. The guidelines for this out of hospital contactless healthcare were issued to de-congest healthcare facilities and allow all channels of communication with the patient that leverage information technology platforms, including voice, audio, text and digital data exchange. Most importantly, they allow doctors to prescribe medicines.
Smoothening out the rough edges
While COVID-19 has proved to be the ideal breeding ground for the telemedicine industry, the sector is still in its nascent stage and has its own set of teething troubles. Owing to the country’s cultural and ethnic diversity, doctors are facing linguistic barriers while communicating with their patients. Dr Raja Indana, Lead- Doctors team, MFine comments, “There needs to be accreditation from a certified body that monitors the quality standards. With India being a country of multiple languages, it becomes difficult. Solving the language problem can help expand the telemedicine reach.”
Winning the trust of their patients and customer satisfaction is another challenge that these doctors face. This problem is exacerbated by the availability of technically-challenged staff Added to this are concerns related to data privacy and the doctor-patient confidentiality vis-à-vis data transfer and storage. Several e-health platforms have loose data policies that allow them to potentially exploit sensitive patient data for commercial gains without having to make case-by-case disclosures to patients.
There is also the possibility of vested interests, since teleconsultation may entail links to pharma companies or insurance providers. Thus, telehealth may be prescribing medicines from brand ‘A’ against brand ‘B’. There’s also a possibility that they may share the health details of patients with insurance companies. Lastly, the data may be susceptible to risks like hacking.
To sum up, telemedicine has served as a panacea in these times of crisis. However, the sector is facing some critical gaps such as data confidentiality, licensing, perception of impersonal care, information overload, interoperability and language barrier. In order to resolve these, telemedicine needs to be regulated with comprehensive guidelines that are in sync with international health standards. Finalising the draft Personal Data Protection Bill should be the government’s top most priority.
Integrating technology for real time translation of the conversation between the doctor and the patient while taking into account considerations like data security and privacy is another option to make the interaction seamless. Applications like Google AI can be leveraged to that extent.
“e-health platforms need to have Chinese walls between their businesses and should be required to disclose potential conflicts of interests to patients in an accessible form and language,” comments Ashna Ashesh from Survivors Against TB. The government should also set up a telemedicine division responsible for the governance of telemedicine and advocate for services at the local level to address pressing health concerns.
