Telemedicine the New Normal By: Dr Anupa Vig (DNB OBGYN))

The Need. The COVID 19 outbreak has placed unprecedented demands on the health system in India. To combat the pandemic, the first step announced by the government was a complete lockdown on 24th March 2020. This made even essential medical services difficult to avail and access, for e.g. a small reason like lack of regular transport made it difficult to even reach a hospital. The workforce and health facilities were inundated with a plethora of activities related to controlling the pandemic. The health seeking was affected because of social/ physical distancing requirements or community reluctance, owing to perceptions that health facilities may be infected. While focusing on COVID 19 related activities, which is imperative, continuing to provide essential healthcare services is equally important. It is required not only to maintain people’s trust in the health system to deliver essential health services, but also to minimize an increase in morbidity and mortality from other health conditions. Analysis from the 2014-2015 Ebola outbreak suggests that increased number of deaths caused by measles, malaria, HIV/ AIDS and tuberculosis, attributable to health system failures, exceeded deaths from Ebola. A similar reduction in family planning use, antenatal care visits, and facility-based delivery, as seen during the Ebola epidemic, is expected due to the COVID-19 pandemic globally. Using the Lives saved Tool, it is estimated that a reduction in provision of essential RMNCAH services due to the COVID-19 pandemic in LMICs like India, Indonesia, Nigeria, and Pakistan, would result in as many as 31,980 additional maternal deaths, 395,440 additional newborn deaths, and 338,760 additional stillbirths which corresponds to a 31% increase in total mortality. [1]

Telemedicine. Telemedicine has come out to be the saviour in these times, allowing the patients to reach out to healthcare professionals and for the healthcare professionals to help triage and provide patient care. It has also brought forth an urgent need for the healthcare sector to evolve and adapt to the new requirements. The first step in this direction was the issue of the Telemedicine practice guidelines on March 25th, 2020 by MoHFW. This not only made the practice of telemedicine legal but also provided an initial framework on the legal aspects surrounding it, the different models, the protocols and procedures to be followed. Measures are being taken by the Medical Council of India (MCI), the Board of Governors and the MoHFW, like the conduct of regular orientation capsule to the Telemedicine guidelines. As a way forward following has been announced: -

· An online program will be developed and made available by the Board of Governors in supersession of Medical Council of India

· All registered medical practitioners intending to provide online consultation need to complete the mandatory online course within 3 years of its notification

· In the interim period, the principles mentioned in the guidelines need to be followed.

· Thereafter, undergoing and qualifying such a course, as prescribed, will be essential prior to practice of telemedicine2

Experience so far and the way ahead. The last few months have actually been a massive trial for telemedicine and adjustments into a new reality where everything, even education, is being provided over the internet.

I have been teleconsulting for the last one year. It is an integrated practice with an excellent EHR platform and a GNM led model in the primary healthcare sector. COVID times have changed the composition of the patients majorly, where now the percentage of patients coming are high risk as against routine patients, that one got to see earlier. We have been able to support the healthcare system in these times by triaging and referring only those patients to facilities who needed admission or emergency care, rest have been managed at our centers. Besides, have also carried out triaging for COVID 19 suspects as well.

The future for us practitioners is to accept and adapt to this new normal. Any technology is most effectively put to use in an environment that it is shaped for. It is also the case with telemedicine. Thus, telemedicine has its advantages and disadvantages. I have just highlighted a few in the succeeding paragraphs. To name a few advantages accrued by the use of telemedicine – it has enabled the provision of specialist care to the rural population and deliver the last mile in healthcare, it certainly brings down the out of pocket expenditure incurred on travelling to facilities thereby bringing down the cost of healthcare furthermore it has helped decongest the higher facilities off patients who can be managed with the help of telemedicine. However, in the times of COVID, one of the biggest advantages has been being able to protect and prevent exposure to healthcare providers, reducing the transmission to them and thus protecting this community and their patients too - the benefits of the same are well understood.

On the other hand a few disadvantage of telemedicine are - limited number of medications can be used via the telemedicine platform, there is also the inability of the older population and others who are not comfortable using technology to use it to the maximum potential and concerns with regard to the privacy issues associated with the data being generated.

The above-mentioned list of advantages and disadvantages is by no way complete, but I am sure that advantages will outnumber the disadvantages specially when it is used complimentarily with the existing modalities. Furthermore, disadvantages like data privacy can be further safeguarded by employing better technology in tandem with policy and procedures to support the functioning of telemedicine. Telemedicine would also help reduce the likely number of fatalities caused by healthcare problems not related to COVID-19 (in times of the pandemic – which I think, supported by statistics quoted earlier, will be a cause of worry in the coming times) by helping triage and offer proper consultation along with medication.

Seeing the current times and the technological advances we can say “Now is the time to merge and master the skill of use of technology with our knowledge of medicine.” For India, with our limited healthcare infrastructure, telemedicine is a force multiplier and the best way to reach out to our 1.3 billion plus population with healthcare. The PMs digital push to have a health card for each Indian would be well supported by telemedicine.

Reference:

1. http://www.healthpolicyplus.com/covid-mnh-impacts.cfm

2. https://www.mohfw.gov.in/pdf/Telemedicine.pdf