The COVID-19 pandemic managed to open a “can of worms” in India. Like the gaping cracks in an unsteady but seemingly efficient health-care system, a tumultuous economy, and dangerous political propaganda to name a few.[1] But amid the chaos, the coronavirus pandemic was the harbinger of a wave of telemedicine. Although telemedicine is not a fable tale to many in India, the real taste of its potential was never felt so strongly before.
With a majority of health-care facilities being concentrated in the big cities, rural dwellers found themselves ill-disposed to quality care. The heat of this disparity was felt so strongly during the pandemic when even these sparse health-care vantage points found themselves overwhelmed. In towns and villages, with limited health-care workers falling prey to COVID infection, the growing demands of patients went unaddressed. Amid this struggle, many patients turned to telemedicine. Unexpectedly, telemedicine was able to cement the great divide in Indian health care and lack of accessibility to good health-care facilities in rural areas. Not only among underprivileged society, but even city dwellers took to reaping the benefits of teleconsultations.
India’s early attempts at teleconsultations were largely unambitious and lackluster. However, with the onset of the COVID-19 predicament, the Ministry of Health and Family Welfare launched a national teleconsultation service named eSanjeevani. Although the project made headway in offering OPD services at home, a majority of its objectives remain on paper. Be that as it may, the pandemic marked the touchstone of legalizing and regulating telemedicine in India when new guidelines were issued regarding the same by the Government of India.[2] This propelled a number of private telehealth platforms to parlay at providing health care.
Telemedicine during the COVID-19 pandemic was impactful in scaling down the fear and paranoia people felt during these uncertain times. It also helped prevent overcrowding of hospitals and overburdening the frontline health-care workers. Another successful pursuit has been in maintaining a high follow-up rate. Indian patients have been identified to be defaulters to follow-up. Especially in identifying and treating diseases such as tuberculosis, which relies on the patient making the first move to get initial diagnosis and treatment. This may lead to massive delay in life-threatening illnesses and loss in follow-up.[3] When many patients took to telehealth platforms for mild COVID infection, keeping track of their symptoms and marking their progress became an achievable feat. This makes one wonder if similar accolades may be accomplished in following up other communicable and noncommunicable diseases in the future, now that a telemedicine trend has been set.
Having witnessed the success of telemedicine in monitoring mild health conditions distributed over a wide geographic expansion with good follow-up rates, made us envision telemedicine as an emerging health force. An aid that could elevate the workings of Indian health care.[4] In a country where the internet is more accessible than quality health care, telemedicine can uplift screening, monitoring, and reporting systems remarkably.
In a study published in JAMA including a cohort of over 11 lakh patients, prescription of drugs and ordering investigations were lower in self-scheduled primary care telemedicine visits compared to conventional in person clinic visits.[5] The rate of follow-up was also observed to be better with telemedicine patients. These findings can pave the way for a pilot program in low-resource settings and help in follow-up of patients who travel long distances to reach tertiary care medical centers in most parts of the country.
Diagnosing and treating mental health illnesses can be improved drastically with telemedicine. According to the National Crime Records Bureau, deaths due to suicide in 2020 rose to an all time high of over 1.5 lakhs in number. The COVID-19 pandemic has also managed to accentuate the need for improvement in mental health-care facilities for the common person. The modest success of telemedicine has encouraged the government to set up 23 telemental health centers for excellence, under the expertise of the National Institute for Mental Health and Neurosciences. The move may prove hugely beneficial to people trying to seek help for psychiatric illnesses.
However, clinical practise on telehealth platforms come with their own pitfalls. Inability to respond to emergencies effectively and diagnostic limitations do exist on a phone-based consultation. It may throw health-care workers into an ethical dilemma as there is no solidarity in guidelines enforcing rightful telemanagement. It may also prove to be challenging for physicians who are used to being surrounded by full-fledged multidisciplinary teams to provide all round care for their patients.[6] Adjusting to the new system and getting adequately trained in this new venture may add to the number of reasons causing physician burnout. To a large extent, this venture remains to be a hazy yet potential goldmine for proving accessible and equitable health care for all.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
1. Saha K. Can India's COVID-19 emergency be fixed without politics?. Lancet 2021;397:2465–6.
2. Dash S, Aarthy R, Mohan V. Telemedicine during COVID-19 in India – A new policy and its challenges. J Public Health Policy 2021;42:501–9.
3. Garg T, Gupta V, Sen D, Verma M, Brouwer M, Mishra R, et al. Prediagnostic loss to follow-up in an active case finding tuberculosis programme: A mixed-methods study from rural Bihar, India. BMJ Open 2020;10:e033706.
4. Das P, Sharma A. Deployment of telemedicine as another mitigation tool during the COVID-19 pandemic in India. Public Health Pract (Oxf) 2021;2:100167.
5. Reed M, Huang J, Graetz I, Muelly E, Millman A, Lee C. Treatment and follow-up care associated with patient-scheduled primary care telemedicine and in-person visits in a large integrated health system. JAMA Netw Open 2021;4:e2132793.
6. Kichloo A, Albosta M, Dettloff K, Wani F, El-Amir Z, Singh J, et al. Telemedicine, the current COVID-19 pandemic and the future: A narrative review and perspectives moving forward in the USA. Fam Med Community Health 2020;8:e000530.
