Using telemedicine to get critical medical advice in times of the lockdown

All you need is a smart phone to start consulting health specialists over video call, phone call, whatsapp, and other applications. And it does not burn a hole in your pocket

So, you're stuck at home with elevated sugar levels. You may not want to visit your diabetologist even if he is a few kilometres away, because you simply don't want to expose yourself to the dreaded Covid-19 infection. What do you do?
 

Don't fret. You can get quality advice right within the confines of your home, through a mechanism called telemedicine. All you need is a smart phone to start consulting health specialists over video call, phone call, whatsapp, and other applications.
 

Telemedicine has been around for quite a while in India, but it is only recently -- on March 25, in fact -- that the health ministry issued guidelines on its practice in the country. The Covid-19 pandemic and the consequent lockdown have also provided an impetus to the form of medical consultation.
 

The fear of contracting infections in the wake of Covid-19 pandemic has kept people from visiting hospitals physically and has prompted them instead top consult their doctors on video, phone and internet-based platforms like web, chat and apps. Little wonder then, that telemedicine has got a shot in the arm with the likes of Medicity in Gurugram, which has seen a ten-fold surge in average daily remote consultations while Practo has registered a 100 per cent increase week-on-week, and Portea Medical has been receiving 100 Covid-19 related queries a day.
 

Medicity has been offering telemedicine to domestic and international patients for the past five years through its Medanta e-clinic app and telemedicine portal. Says Pankaj Sahni, CEO, Medanta: “I have been a strong proponent of telemedicine. But just recently, several things have come together to make it happen on such a scale. The guidelines issued by the Health Ministry, the Covid-19 pandemic, smart phone penetration and the presence of sophisticated technology such as 3G, 4G and even 5G with high definition cameras have all improved the whole experience of communication over a video call exponentially.

The public has been ready for this for quite some time and those who were hesitant -- doctors and patients alike -- are being forced to take the plunge because of the pandemic.”
 

Where telemedicine is useful
 

Teleconsult is especially popular for lifestyle diseases such as diabetes, hypertension, and chronic endocrinological disorders like hypothyroidism, which need regular check-ups. This can be done remotely as quite often there is some dosage adjustment based on reports and telemedicine can be a great tool for time management for both, doctor and patient. Mental health is another big area, what with the social stigma associated with “seeing” a psychiatrist.
 

There is high demand for 'second opinions' in telemedicine, especially for ailments such as cancer. For hospitals that have super specialists, there is a huge emerging doctor-to-doctor consult where, say, a general physician is able to take advise from an oncologist or nephrologist.
 

Telemedicine also works well for patients who return to their homes in smaller towns or villages after taking treatment in larger cities like Mumbai or Delhi, as subsequent follow up can be done remotely. Says Sahni of Medanta, “If you take a few cities away from the country, you don’t have enough doctors and definitely not many super specialists. Telemedicine enables people to reach out to the doctors much easily, saving the collateral cost of travel, stay, commute, time, taking leave from work for both, the patient and the caregiver.”
 

Forty per cent of the teleconsults on the Practo platform are currently happening from tier-2 and tier-3 cities. It has had several queries on fever, cough, cold, sore throat and body ache, which have gone up three-fold, apart from specific areas such as mental health, paediatrics, gynaecology and dermatology. “Most of these come from people in the 25-40-year age group, with 35 per cent of the consultations being from women,” says Alexander Kuruvilla, Chief health strategy officer, Practo. “We’ve increased our doctor base by close to 50 per cent during the past 4-5 weeks so that access is not a concern for Indians. We’re continuing to help get more doctors onboard our teleconsult platform.”

 

 

The fear of touching contaminated surfaces or getting infected through another person is high and people are wary of visiting medical facilities and clinics for examination or regular treatments. According to Meena Ganesh, MD and CEO, Portea Medical, “We have seen a sudden increase in the number of calls and chats we are responding to. The chatbot that we launched in association with the Goa Government has received more than 1.5 million queries on Covid-19. Awareness is definitely on the rise and the Central Government also recently recognised this and released guidelines on telemedicine.” She believes telemedicine will play a major role in supporting the conventional healthcare system in India and “we will see the segment grow in the next couple of years”.
 

Women and child health care is traditionally viewed as an 'in-person' consult area. But now, at hospitals such as Nova IVF Fertility, most of the consultations happen remotely, especially the preliminary consultation for new patients or the follow-ups for existing ones. "One saves on multiple visits," says Shobhit Agarwal, CEO, Nova IVF Fertility. "Only when “the patient needs Ultrasound and some pathological testing does he have to visit the consultant at the clinic.”
 

Likewise, Motherhood Hospitals, which caters to pregnant women and children, is getting 200 consultations through video calls, and 30-40 pharmacy orders a day. "The teleconsult process is a replication of our regular process of appointment booking," says Vijayarathna Venkatraman, CEO, Motherhood Hospitals, Bengaluru. “Our mode of consultation is video consultation. Customers must log on to our website or contact our call centre to book a video consultation appointment. After the consultation, the customer receives a copy of the prescription via email. We also have offered e-payment modes payment methods of UPI like Phone Pe, Bhim UPI, Paytm, and netbanking. So, it’s a frictionless approach combining e-consult, e-prescription and e-payment.”
 

Tech infrastructure
 

All you need is a smart phone and you are good to go. According to Dheeraj Jain, Founder, Redcliffe Life Sciences, “Basic facilities like availability of high-speed internet and video conferencing through webcam or smartphone are adequate, if the doctors need to advise patients on minor ailments such as cough, cold or check their diagnostic reports to prescribe medicine."

He adds, "Before Covid-19, the telemedicine industry was growing at CAGR of 16.8 per cent and global telemedicine market was expected to cross the $56 billion mark by 2023. Now we might see it cross that figure much earlier."
 

Technological development is leading to the creation of advanced gadgets and remote monitoring healthcare devices that can help the doctor access the vitals of the patient such as blood pressure readings, ECGs, and SPO2 levels. There are plenty of plug-in devices and technologies available today, such as digital stethoscope, remote ECG and X Rays, and special medical cameras that doctors can use for a throat or ENT examination.
 

Preferred form of communication
 

Most patients opt for video calls. “Out of 100, let’s say 60 is video and 40 would be phone call. I would say that the least popular is offline consultations through email and e-clinic application but video is the most popular,” says Medanta’s Sahni.
 

Today, many technology-enabled health care platforms cater to the growing demand of telemedicine. Typically, they get a registered practitioner which the Health Ministry guidelines describe as “a person who is enrolled in the State Medical Register or the Indian Medical Register under the Indian Medical Council Act 1956.’ [IMC Act, 1956].” According to Saurabh Arora, Founder & CEO Lybrate, “We provide the bandwidth, the ability to collect payments for doctors and a way to manage patient queue with an online appointment scheduler and medico legal guidelines that protect medical fraternity. Also, the prescription is generated online.”
 

Payments in teleconsulting are made through multiple gateways such as credit and debit cards, UPI, bank transfer and e-wallets.
 

Competitive Pricing
 

Tele-consultations are 10-20 per cent cheaper than in-person, because people are still getting used to the idea. Apps and hospitals are trying to woo their customers and currently the likes of Practo have plans, starting at Rs 399 a month for unlimited online consultations with doctors across 20-plus specialities. In certain apps such as Lybrate, a premium is charged for video and audio call while consultations over text cost less. Experts however feel that over time, there will be no difference in consultation fees.
 

Age is no longer a barrier as most patients are comfortable with phone or WhatsApp calls. Even the elderly with very little technical grasp can easily use their phones and if there is an issue, they can be assisted by their tech-savvy children or grandchildren.
 

Limitations and challenges
 

According to Ganesh of Portea Medical, “The limitations pertain only to situations where treatment requires the patient and doctor to be physically present at a place. For example, medical emergencies, surgical procedures, attending to injuries or administering IV drugs, are not possible through telemedicine. In such cases, home healthcare is a great option, since it reduces the risk of hospital-acquired infections and also ensures timely treatment.”

There are several procedural and functional issues that the industry is in the process of addressing, one such being reimbursement. Says Dheeraj Jain, “Most insurance providers don’t cover telemedicine expenses as there are no clear guidelines related to it in many countries.”

The benefits of telemedicine are many and the biggest is that it allows for continuity of care. Says Sahni of Medanta, “This is a watershed moment as it allows to intervene early and decrease the severity of disease. Also, the data that it throws up can be used for analytics and predictive modelling.”