TELEMEDICINE: the future of health care delivery

Ranging from a simple tele – conversation, to the most sophisticated robotic surgery, Telemedicine has been practiced in various form in various ages of time depending on the availability of means of communication. In its early manifestations, African villagers used smoke signals to warn people to stay away from the village in case of serious disease or epidemic. In early 1900, people living in remote areas of Australia used two-way radios, powered by a dynamo driven by a set of bicycle pedals.Later on, all the available means of telecom have been used to establish communication between the patient and medical practitioner.

Since few decades, the health care landscape has changed dramatically mostly due to advancement in technology. Rare procedures have now become routine. Many ailments are now prevented with a simple vaccination. Health care delivery has been evolved too, but what remained unchanged is the “doctor-patient relationship”

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Now, with the advent of new software modules along the Internet, patients, and their health care professionals, including physicians, nurses and dentists now have the opportunity for a virtual connection. In the past, the ability of the patient to consult his health care professional was often been limited due to issues related to transportation and mobility I, but today, they can connect with each other, online at the same time ensuring quality patient care. With a global spread of high-speed internet and the common use of personal computers, tablets, and smartphones, it simply makes a sensible option to receive health advice via virtual platforms.

Providing healthcare to billions of population of developing countries living in villages is a formidable task. Most of the doctors’ practice in urban areas and semi-urban areas. This leaves a few per cent of the qualified doctors, who serve the population living in villages. With the perfect integration of medical science and information and communication technology (ICT), it is possible to take the benefits to such remote localities where the essential Medicare is scarce.

Telemedicine or Telehealth is a good step in the right direction which will allow the medical field to fully harness the promise of new and innovative technology no matter where the patient or his/her doctor is. This has been trumpeted as the great health care hope for the rural population, but, has it been achieved? Well, may be to some extent.

World Health Organisation describes Telemedicine 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”

The terms telemedicine, Telehealth, e-health are often used interchangeably. There are four  elements which are:

  1. The purpose is to provide clinical support.
  2. Intended to eliminate difficulties due to geographical barriers.
  3. Uses various methods of ICT
  4. The goal is to improve overall health outcome.

The advantages of telemedicine are manifold; Taking medical help to patients where no medical help existed before, diagnosing a medical condition before it becomes untreatable. Some variants are: Tele pathology, Teleradiology, tele ophthalmology, Tele=Dermatology and so on.

Video Consultation is an important and very popular component of telemedicine where a doctor remotely talks to a patient, gets first-hand information about the patient and advises accordingly. It has its share of criticism; that, If a doctor can’t physically examine a patient, how can he diagnose accurately?,  can a patient and doctor who see each other on a screen actually develop the ‘Patient-Doctor Relationship’? does the patient ‘feel’ he got a right medical advice? Is the doctor at the other end legally liable?.

Several studies have been done to assess these issues. In a study conducted by NCBI, ‘between 94 and 99 % reported being “very satisfied”, one-third preferred a Telehealth visit to a traditional in-person visit.(source: ‘Patients’ Satisfaction with and Preference for Telehealth Visits’ – by NCBI) In terms of legal liability, however, this remains a grey area. The Many States have already framed their policies on Telemedicine practice, others are in the process of making one. The key point in this issue that all the patient data must be made available to the consultant by a qualified and authorized person, based on which the provider can give his opinion. However, there are still some grey areas. In spite of this, the reason for the growing trend of telemedicine can be attributed to its lucrative benefits to the end users. The advent of various tools like Digital versions of Stethoscope,  ECG, Otoscope, Thermometer, Glucometer, Blood pressure monitor etc. have raised the confidence level. These gadgets can transmit the real time patient data to the consulting physician based on which he can take a correct decision. The data so transmitted can also be saved for future reference. This has made the telemedicine consultation more scientific and based on real time data.

Similarly, a trained paramedic at the patient end can act as a moderator and can assist the consultant in by fetching the vital parameters and basic clinical data. That way the patient is indirectly examined and assessed guided by the consultant.

The biggest advantage of telemedicine is that it takes the doctor to places where no doctor has been before. And in a situation where there is a gross deficiency of health care providers, it can act as a force multiplier.

Telemedicine has potential roles:

  1. For primary care to a population living in a remote area.
  2. For seeking a specialist opinion from a specialist by primary health centres.
  3. Pre-operative and post-operative consultation.
  4. As a satellite center for large hospitals and pathological laboratories.
  5. For reporting radiology images – teleradiology.

The possibilities are many, the expectations are great, however, there is very less penetration of telemedicine into the field of medical practice. Although efforts are being made by many large groups of hospitals for its implementation, the rate of its growth is much below the desired level.

There are several reasons for this:

  1. There is a misconception that the project requires a lot of infrastructure and expertise whereas, the simple form telemedicine only requires only some basic equipment. For a village doctor and villagers, using high-end technology may be too inhibiting and radical. However, once the benefits are seen, the acceptance rate will likely be high such as has been seen with mobile telephony and rural internet services.
  2. Most of the client – server modules are not free. There are very few websites who offer easy and free access to the platform. It is not economical to develop a customized web portal due to high development costs.
  3. Some corporate hospitals have started their own telemedicine portal but they allow their own centers to use it. If such a patient requires hospital admission and further treatment, he can be taken in to the hospital. That way, the telepatients are converted in to real patients. The same platform is usually not available to small hospitals and clinics. While part of their CSR, it also has the effect of improving their bed occupancy.
  4. Some physicians also hesitate to use telemedicine and are satisfied with their traditional practice. Since these in-house specialists work in a busy hospital setting, making time for telemedicine consultation becomes an issue. The fact that if the consultations are free, it further reduces the incentive to make this a high throughput service.
  5. The biggest waste in the world is the difference between what you are and what you could be. This epitomizes telemedicine as a whole. In order to implement telemedicine, training is needed at the village end for technicians, IT staff, and local doctors. At the consulting doctor’s end, a lot of pushy administration and coordination is required.

Telemedicine in developing countries can be a game changer and can affect real change in the medical scenario of the country….if done well, using multiple hospitals/centers , and on a large scale. Technologies for telemedicine designed by innovative groups should be low cost, easy to install and use and should be able to work on low bandwidths. Public campaigns to increase awareness of the benefits of telemedicine would be of great help. A standardized training program for all telemedicine providers and users would be helpful too.

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