Expanding Healthcare : Vanam Jwala Narasimha Rao

Expanding Healthcare

Vanam Jwala Narasimha Rao

Millennium Post (26-06-2020)

At a time when in-person visits to healthcare facilities are becoming risky and difficult, the versatility and reach of telemedicine is a much-needed supplement-Editor

We are in the midst of coronavirus pandemic crisis bogged down under lockdown thanks to government dictum or in the personal interest. People are seldom out from their residences unless otherwise seriously warranted. Even for acute medical problems there is a scare among people to reach a hospital or even their family physician. How long this state of affairs continues is anybody’s guess. In all probabilities thousands of patients might be left untreated everyday owing to the inaccessibility of a doctor. Providing In-person healthcare has become challenging.

This demands systematic focus on augmenting public health delivery systems by leveraging the synergy between information and communication technologies and modern management practices. This could be either a government controlled and monitored system in place or one in a public private partnership mode. It should ultimately be able to reach out across urban and rural areas to ensure health for all. The goal should be to create a technology enabled, comprehensive offering, that provides a range of health services to one and all filling the gap arising out of absence of personal contact.  

The disease pattern in most of the people, typically includes among others, conditions like acute minor ailments, chronic diseases (diabetes, hypertension, renal disease, and COPD), pregnancy and related conditions and pediatric illnesses besides seasonal viral and bacterial infections. Due to the difficulty of personal contact, there is a dire need for an ‘all in one’ comprehensive low-cost point of care tele-med service which fills this gap.

The objective of Tele Health service is to design a point of care, user friendly, cost effective, integrated multi-functional service for rural as well as urban telemedicine applications with emphasis on general physician services. As and when needed specialist services may also be obtained and commissioned. Hospitalization is the last resort and that too when it is indispensable like acute surgical or medical emergencies.   

Its aim is to reach the populations irrespective of whether they are in urban or rural areas, through virtual physical examination modules. Many applications in telemedicine have emerged in the past decade with various levels of sophistication, such as tele-ENT, tele-dermatology, tele-medical and surgical consult, tele-cardiology, tele-ophthalmology, tele diagnostics including ultra-sonography. Primarily Telemedicine facilitates video-conferencing among health care experts for better treatment and care. It also can be leveraged to provide opportunities for continuing education of health care personnel.

The process is as simple as a personal contact. Text, sounds, pictures and videos can be merged and interconnected to an engaging environment. Use of live video to examine patients, through Tele-med enabled devices to electronically transmit patient’s record, X-ray and recording of ECG data over long distance. Wherever these are not required simple consultancy will do the needful.

On March 25, 2020, Board of Governors in supersession of the Medical Council of India in partnership with NITI Aayog have prepared guidelines to practice telemedicine enabling Registered Medical Practitioner (a person who is enrolled in the State Medical Register or the Indian Medical Register under the IMC Act 1956) to Provide Healthcare. Telemedicine has been defined as ‘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.’   

NITI Aayog guidelines among others mention that: “pandemics pose unique challenges to providing health care. Though telemedicine will not solve them all, it is well suited for scenarios in which medical practitioners can evaluate and manage patients. A telemedicine visit can be conducted without exposing staff to viruses or infections in the times of such outbreaks. Telemedicine practice can prevent the transmission of infectious diseases reducing the risks to both health care workers and patients”.

“Unnecessary and avoidable exposure of the people involved in delivery of healthcare can to be avoided using telemedicine and patients can be screened remotely. It can provide rapid access to medical practitioners who may not be immediately available in person. In addition, it makes available extra working hands to provide physical care at the respective health institutions. Thus, health systems that are invested in telemedicine are well positioned to ensure that patients with Covid-19 kind of issues receive the care they need”.

“Digital health is a critical enabler for the overall transformation of the health system. Hence, mainstreaming telemedicine in health systems will minimize inequity and barriers to access. India’s digital health policy advocates use of digital tools for improving the efficiency and outcome of the healthcare system and lays significant focus on the use of telemedicine services, especially in the Health and Wellness Centers at the grassroots level wherein a midlevel provider or health worker can connect the patients to the doctors through technology platforms in providing timely and best possible care”.

In India, till now there was no legislation or guidelines on the practice of telemedicine, through video, phone, Internet based platforms. These guidelines which are now issued will provide information on various aspects of telemedicine including information on technology platforms and tools available to medical practitioners and how to integrate these technologies to provide health care delivery. It also spells out how technology and transmission of voice, data, images and information should be used in conjunction with other clinical standards, protocols, policies and procedures for the provision of care. Where clinically appropriate, telemedicine is a safe, effective and a valuable modality to support patient care.

The guidelines stipulate that a Registered Medical Practitioner is entitled to provide telemedicine consultation to patients from any part of India. Doctors using telemedicine shall uphold the same professional and ethical norms and standards as applicable to traditional in-person care, within the intrinsic limitations of telemedicine.

In case alternative care is not present, tele-consultation might be the only way to provide timely care. In such situations, doctors may provide consultation to their best judgement. Telemedicine services should however be avoided for emergency care when alternative in-person care is available, and telemedicine consultation should be limited to first aid, life-saving measure, counseling and advice on referral. In all cases of emergency, the patient must be advised for an in-person interaction with an RMP at the earliest. Doctor should exercise his professional judgment to decide whether a telemedicine consultation is appropriate in a given situation or an in-person consultation is needed in the interest of the patient emphasize the guidelines.

World Health Organization has also framed guidelines on Telemedicine opportunities. Against this background, it is desirable that every state including Telangana works a state-specific model to introduce Telemedicine services as early as possible.