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COVID-19: Telemedicine Is a Good Idea – but Not Without Access

COVID-19: Telemedicine Is a Good Idea – but Not Without Access

Since India commenced, and subsequently extended, its nationwide lockdown from March 24, healthcare in the country has been adversely – and ironically – affected. Coupled with the curtailment or shutting down of outpatient consultations, drawn largely from the Italian experience where hospitals became sites of ‘superspreading’, routine healthcare services have been drastically reduced.

To address this and to minimise the risk to healthcare workers, a plethora of digital health technologies have surfaced. These efforts, which are attempting to mitigate the circumstances, are laudable and should be mainstreamed even after the crisis is over, but after addressing concerns surrounding infrastructure, lack of training, data use, privacy and evaluation.

Telemedicine was initiated in India with the Indian Space Research Organisation starting a Telemedicine Pilot Project in 2001. A National Telemedicine Taskforce by the health ministry was established in 2005, and its jurisdiction lies with the Ministry of Health and Family Welfare (MoHFW). The experience until now has been mixed, but telemedicine has not been as successful as it was envisaged to be.

The COVID-19 pandemic provided the need for MoHFW to roll out for the first time telemedicine guidelines on March 25, 2020. The guidelines make for a good primer and list video, audio and texting as three broad modes of communication for telemedicine consultation.

The guidelines outline the limitations of these modes effectively and also delineate the types of medications that can be prescribed. But it lacks clarity while addressing privacy concerns and data usage. Use of third-party apps to transmit personal information and the recent example of the newly popular ‘Zoom’ leaking data should make all users of telemedicine wary.

Also read: Before You Dial a Doctor, Check If Telemedicine Is Really for You

The guidelines, putting the onus entirely on doctors to maintain the record of all exchange of communication between her and the patient and them to be aware of Data Protection and Privacy laws, in not coming clear on storage duration and further use of that data, in asking for details like address and any other ‘reasonable’ identification, in not providing a grievance redressing mechanism, are incomplete. It will be in the best interest of both doctors and patients, if the MoHFW comes with revisions and makes the guideline more comprehensive.

In this light, news of the National Accreditation Board for Hospitals and Healthcare Providers (NABH) taking the initiative to establish a Digital Health Standards which would aim to protect privacy and confidentiality, legality, communication standards and other concerns, while developing SOPs and guidelines for every process, is a welcome development.

The success of telemedicine rests largely on infrastructure. As of March 2019, there were 385 million active internet users in India above the age of 12, according to IAMAI (Internet and Mobile Association of India). But internet penetration was a modest 36% with, worryingly, only 28% of females having access to it in rural India and with huge geographical disparity. With about two-thirds of Indians still without access to good-quality internet, access to telemedicine continues to remain a point of concern. Poor spectrum resources, inadequate fibre facilities and unflattering internet speed are infrastructural hurdles in the success of telemedicine.

Effectiveness of telemedicine depends on competencies that Indian doctors largely lack. In 2016, the American Medical Association encouraged its UG and PG accrediting bodies to include core competencies for telemedicine in their programs. Digital communication, ‘webside’ manners, remote examination, group interactions, emergent situation handling, troubleshooting are some competencies that require training. One can only hope that this experience during the COVID-19 pandemic brings about mandarins of medical education in India to include such competencies in their regular programs.

Also read: Connectivity Is Imperative in the Battle Against Coronavirus

Since a focus on COVID-19 neglects non-communicable diseases that cause more than 60% of natural deaths in Indians, telemedicine offers few solutions. In providing remote access and with more awareness about it, telemedicine programs can address the problem of widespread quackery. In bringing specialists to a smartphone, telemedicine can bring quality care to a large population. Since the positive externalities are plenty, investing in telemedicine would reap benefits for a resource-poor country like India.

The Indian experience of ‘too few too far in between’ telemedicine has seen a boost during this pandemic. Issues like access, equity and quality in Indian healthcare can see improvement through telemedicine. But for that to happen there has to be bettering of infrastructure, training of doctors and pooling more of them, clarity on data protection and privacy laws, and in evaluating these programs regularly.

Sambit Dash teaches in Melaka Manipal Medical College, Manipal Academy of Higher Education (MAHE), Manipal. He comments on public policy, healthcare, science and issues of social interest and tweets at @sambit_dash. Aarthy Ramasamy is a doctor and research fellow at the Madras Diabetes Research Foundation, Chennai.

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