|Year : 2022 | Volume
| Issue : 3 | Page : 209-210
Telemedicine: A case of turning adversity into opportunity
Meenu Singh1, Ketan Kumar2
1 Editor, Journal of Medical Evidence; Department of Telemedicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
2 Department of Pediatrics, PGIMER, Chandigarh, India
|Date of Submission||14-Nov-2022|
|Date of Decision||15-Nov-2022|
|Date of Acceptance||15-Nov-2022|
|Date of Web Publication||28-Dec-2022|
Prof. Meenu Singh
Editor, Journal of Medical Evidence, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh M, Kumar K. Telemedicine: A case of turning adversity into opportunity. J Med Evid 2022;3:209-10
According to Douglas Engelbart, an American engineer, 'The digital revolution is far more significant than the invention of writing and even of printing'. While the quote might not sit well with history buffs, there is no denying the force that technology is fast becoming. Health and wellness is one of the major aspects of human life, undergoing a major revamp with the use of technology. The use of telemedicine or as the World Health Organization defines it 'the delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies…', is probably the most significant recent development in this area, which has gained further momentum during the COVID-19 pandemic.
It won't be an exaggeration to say that telemedicine has protected essential healthcare services from crashing, especially during the period of strict lockdowns in multiple countries of the world. The ability to use audio-visual tools for providing healthcare turned out to be an absolute boon in settings with mandated physical distancing. However, health delivery systems are fast realising that the advantages of telemedicine are not limited to the pandemic. In developing nations like ours, where access to quality healthcare might be a luxury in far-flung areas, web-based tools are being used to bridge this gap. Telemedicine can further be used as a way to consult specialists in various fields even if primary healthcare is available physically to the patient, obviating the need for actual travel. Communication between healthcare providers in complicated cases and taking second opinions can be made much easier. Systems can also be adapted to remotely monitor the status of patients, once discharged from a healthcare facility after the initial period of recovery. Apart from patient care, telemedicine can also be used for medical education and research.
Thankfully, India was quick enough to rise to the challenge thrown by the pandemic. On 25 March 2020, Telemedicine Practice Guidelines were prepared and released by the Ministry of Health and Family Welfare, in partnership with the NITI Aayog. These guidelines enabled registered medical practitioners to provide healthcare using telemedicine and now constitute Appendix V of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002. Moving forward, the free telemedicine service eSanjeevani was launched on 9 August 2020, which has now been successfully integrated with Ayushman Bharat Digital Mission. The web-based service is available in two variants, the eSanjeevani Ayushman Bharat-Health and Wellness Centre, supposed to be utilised by a local healthcare centre or spoke visited by the patient to connect to a specialist at a remote tertiary care facility or hub, and the eSanjeevani outpatient department, which can be used by patients to connect directly with doctors. Another example of such an initiative specifically for mental healthcare is e-Manas, an internet platform developed under the Karnataka Government as a National Health Mission initiative.
At the time of writing this article, the eSanjeevani system has operationalized more than 104,000 centres or spokes, served by approximately 12,400 hubs and has been used by more than 68 million patients. A successful instance where a state government has formalised the use of eSanjeevani to reach out to sub-centres and primary health centres is presented by the Haryana Government, which also collaborates with the Department of Telemedicine at Post Graduate Institute of Medical Education and Research, Chandigarh. The latter has been providing consultations in medicine, paediatrics, obstetrics and gynaecology, ophthalmology and otorhinolaryngology since March 2021.
Despite these rapid and welcome advances, the use of telemedicine is not without its unique challenges. The need for infrastructure in terms of both hardware and software and access to internet capability fast enough to support high-quality audio-video communication might be the most evident hurdle. Unfortunately, the rural and remote regions of our country lacking these capabilities are the same ones which stand to benefit the most from efficient use of telemedicine. More widespread application of telemedicine without upscaling infrastructure might therefore even endanger health equity. Traditionally, healthcare personnel in India are not attuned to using telehealth systems and it is high time that the medical education curriculum starts formal training for the same. Acceptance for new technology might also be a concern amongst healthcare users, as has been shown by a few studies and it requires creating awareness about the utility and non-invasiveness of the new models. Our country has already started making strides in this area, and the 2020 Guidelines will go a long way in resolving some of these challenges, however, there is still scope for significant refinement in the same. Furthermore, we would do well to remember that howsoever convenient and efficient it might be, technology cannot be a replacement for real interpersonal interaction between healthcare providers and beneficiaries.
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NITI Aayog. Telemedicine Practice Guidelines Enabling Registered Medical Practitioners to Provide Healthcare Using Telemedicine; 2020. Available form: https://www.mohfw.gov.in/pdf/Telemedicine.pdf
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