Telemedicine services have existed for decades, but the rate at which it was scaled during the pandemic is unthinkable. As people were confined to their homes and social distancing measures were implemented, patients had to seek care remotely. This trend will not die out with time as remote healthcare allows efficient care of patients, taking the strain and burden off healthcare facilities while reducing operational costs and healthcare-related infections. This may just be a tipping point in the much wider adoption of telemedicine services, especially at the primary level. Other than that, telemedicine services also support value-based care and result in a bigger emphasis on preventive care which ultimately leads to a reduction in unsustainable healthcare costs.
Technology leapfrogging the industry
There are two aspects to this- the first is the technological advances to improve diagnosis and treatment. The second component is the improvement in healthcare delivery due to advances in technology and communication. Humankind has come a long way in terms of improving communication and recording facilities in healthcare which has made the doctors’ lives a lot easier. It has enabled healthcare providers to gather more clear information and provide the right interventions.
“The advent of telemedicine and instant messaging platforms like WhatsApp has helped doctors diagnose, transmit the images and take a considered opinion in every case. It has helped the patients also, especially during the COVID-19 pandemic who needed routine follow-ups, to communicate with the doctor and get examined. The healthcare fraternity too realised that a large part of medical interventions can be done remotely. It has further helped save a tremendous amount of expenditure, and time and made lives so much easier for patients as well, said Dr VP Singh, Chairman, Institute of Neurosciences, Medanta Hospital.
One of the biggest gains from the pandemic has undoubtedly been telemedicine, it can also become a crucial tool in the management of chronic diseases. Not only does it address the issues of accessibility but allows patients to be in touch with their care providers making it easier for patients to get the care they need.
Sharing his views, Vikram Thaploo, CEO, Apollo Telehealth commented, “For telemedicine to serve as an effective tool to treat patients, it is important that the rural populace have access to proper connectivity, equipment and also possess the functional literacy to initiate the teleconsultation. The lack of proper telecom infrastructure is also a major hindrance in this regard, as telemedicine requires better networks and faster internet speeds. It is also imperative that the healthcare providers are trained properly, in order to adopt this new technology.”
The COVID-19 pandemic is far from over and telemedicine is an effective and sustainable solution for precaution, prevention and treatment not only for COVID-19 but for various other ailments that may not require human intervention.
“Telemedicine is bridging the gap between people, physicians and health systems, enabling everyone, especially mildly symptomatic patients, to stay at home and communicate with doctors through virtual channels, helping to reduce the spread of the virus to mass populations and the medical staff on the frontlines. It also aids to convey the red flags to the people,” stated Dr Sunil Jain, Head, Emergency Medical Services, Jaslok Hospital & Research Centre, Mumbai.
Telemedicine has assisted doctors and healthcare workers in reducing patient travel time and costs, upgrading diagnosis, dealing with emergencies and predicting critical cases at an early stage by utilising communication and electronic information technology. “Patients in remote areas can describe their symptoms to doctors via email or video call, participate in a series of self-tests, and sign up for step-by-step medical services tailored to their specific condition. Telemedicine has shown a renewed potential in the COVID era and can become an important medium or a fundamental part of providing quality healthcare services in remote areas where healthcare is both scarce and of suspect quality,” shared Dr Preet Pal Thakur, Co-founder, Glamyo Health.
Technology and its advancement are also synonymous with cancer care. Be it surgical oncology, radiation or medical oncology. Dr Suvadip Chakrabarti, Surgical Oncologist, Apollo Cancer Centre, Kolkata shared, “Advent of social media and Google is considered a bane by a lot of people. I beg to differ, specifically, it has helped me. During COVID times it helped me with more interaction with prospective patients and a more personal touch. Also, WhatsApp has been a boon as I have site-specific cancer support groups which help in confidence-building.”
Sharing his views, Dr Ameet Mandot, Senior Consultant and Clinical Lead – Adult Hepatology and Liver Transplant Unit, Global Hospital, Parel, Mumbai said, “Technology is going to make a lot of inroads even in healthcare. But there is a word of caution. In medicine there is always a human element, there is always a clinical diagnosis. At times just taking a good look at the medical history or speaking to the patient one-to-one with eye contact may help the patient a lot. So overuse of technology may be detrimental if there is a loss of human touch and also each human body would differ in the form of the clinical reports. Each human body has a different effect on medicine and a clinician when examining and when they speak to the patient may be able to judge that.”
“As an oncologist, the first things that come to mind are the advent of robotics with a trained surgical oncologist at the helm has resulted in minimal blood loss, lesser time in the OR and faster recovery in the post-operative period and less time in hospital admission. The degree of precision has increased, now the dictum is ‘less is more’, so less morbid procedures help in early recovery and early resumption of daily activity. Secondly, the advent of the ICG technique has ushered a new era of sentinel lymph node biopsy with high accuracy and has resulted in lesser lymph node dissection in breast, and gynae oncology. But all this has to be backed up by a frozen section facility backed by an oncopathologist,” added Dr Chakrabarti.
India is a vast nation with a high populace and technology has the power to fundamentally alter how care can be provided in a timely and accurate manner, even in the most rural areas of the nation. With a significant doctor-to-patient ratio gap in India, healthcare delivery can be improved throughout the country with the aid of cutting-edge technologies. “The acceptance and adoption of the electronic medical record (EMR), a tool that has the potential to achieve the highest standard of healthcare delivery for the doctors, is an example of innovation in the digital healthcare ecosystem. It now only takes a few seconds to write a prescription, allowing healthcare providers to spend more time with patients and learn about their concerns. To ensure that patients receive regular health checks, mentioned Dr Manish Lashkare, Consultant Physician, HealthPlix.
Dr Lashkare added, “Such digital tools, in my opinion, are not only efficient but also a clinician’s best friend in daily practice. India is on the verge of a once-in-a-lifetime opportunity, with technology assisting the ecosystem in leapfrogging from an unstandardised/unorganised healthcare system to a protocol- and technology-driven system.
Bottlenecks in implementing technology
Despite favourable outcomes of digital tools, patients in many cases are reluctant to use new systems which may appear over-complicated given their lack of exposure. As with any new technology, people in general and more so in remote areas need training and time to adapt to a new way of delivering health care.
“There are technical challenges in the widespread implementation of telemedicine. Its ability to supplement the overall patient experience and replace traditional modalities of palpation and auscultation are still to be proven at scale. Privacy violations, disclosure of confidential information, fraud and abuse, and ineffective solutions, are some of the current obstacles in the widespread adoption of telemedicine,” added Dr Thakur.
Patients mostly consult doctors in the advanced stages of their illnesses, resulting in rapid decompensation and may require hospitalisation. “The management is history-based and examination is not possible so diagnosing other diseases is limited. The reality might be that for COVID-19, telemedicine, as it exists now, needs to be modified to help manage early testing, diagnosis and triage for those who may require in-patient care,” shared Dr Jain.
Technology beyond doubt has become the crux of healthcare delivery but there are certain aspects that only human intervention can address. “Overuse of technology may be detrimental if there is a loss of human touch and also each human body would differ in the form of the clinical reports. Each human body has a different effect on medicine and a clinician when examining and when they speak to the patient may be able to judge that. The other drawback of technology is that there is too much information available to everyone which at times can confuse a patient and make them feel that they will always think of the worst scenarios because they are patients themselves. Too much information without a proper filter can also be dangerous in healthcare, remarked Dr Mandot.
Earlier due to the lack of networking the potential of healthcare was not optimally utilised leading to duplication of work, larger steps, and bottlenecks. This has changed drastically over the years with the advent of the Internet and other digital tools available globally.
“There are some limitations that make it unable for us to fully leverage the technological advances in healthcare. The ability to see and check the patient in person becomes very important in some cases in case to check the minor weakness and sensations which can not be checked digitally, however, technological advances are being done in the space to constantly improve patient experience in healthcare,” noted Dr Singh.
Dr Sandeep De, Consultant, Radiation Oncology, Apollo Cancer Centre, Navi Mumbai added, “Bottlenecks in incorporating technology for delivering healthcare are education as well as the training regarding the new technology. To address this, proper education and training are required as without this, the technology will be misused. The key challenges would be validation (any technology that is developed should be governed through trials), ongoing education of medical professionals, and implementation. Any technology has some advantages and disadvantages. We need to weigh both and decide on when the advantages are multiple times higher than disadvantages for the benefit of the doctor fraternity as well as the patients.”
There has also been speculation that technologies could replace humans in the future but that seems to be a far cry. The human touch is unmatchable. Newer technologies will replace older technologies to make healthcare delivery more efficient and address the challenges that in today’s time and age cannot be treated. However, the challenge will be implementing it on a global stage and making it accessible and affordable to all those who need it. Technology will be crucial in delivering healthcare efficiently but the challenge will be the implementation which needs to be addressed. Doctors are always going to be crucial to healthcare delivery and the sheer necessity for them is only going to increase with newer diseases, infections and outbreaks in the future.
Doctors braving the pandemic
Healthcare workers have been instrumental in the fight against the COVID-19 pandemic, even though it was one of the most trying times that mankind has seen in the modern era. All the frontline workers displayed immense grit and courage during critical moments of the pandemic and ensured quality care for all patients.
“The COVID-19 outbreak was undoubtedly a demanding period for medical teams across hospitals. To adapt to this, a core team was set up who were able to implement strategies so that patients would not suffer, but receive the best possible support, attention, and treatment they deserve. At different levels, various teams were created to ensure that hospitals were able to enhance patient experiences and accessibility to healthcare. In the future, emphasis will be on advanced technology, remote access, and team collaboration,” Dr S Narayani, Zonal Director, Fortis Hospitals, Mumbai.
“The determination and sacrifice of COVID warriors have been inspiring, especially in the last two years. By looking at the big picture and taking each day as it comes, healthcare professionals will be able to handle all the challenges that they encounter even in the coming years,” concluded Dr Narayani.
People were anxious because of the novelty and uncertainty of the virus and add to it the role of uncontrolled social media in creating panic. There was a lot of post-traumatic stress disorder which psychologists had to see. People were not getting time to grieve the way they would want to, and the inability to say the final goodbyes were some of the most difficult situations to handle.
Sharing insights in dealing with the strenuous job of being a doctor, Dr Preeti Singh, Sr Consultant Clinical Psychology and Psychotherapy, Chief Medical Officer, Lissun advised, “Doctors are expected to set boundaries with patients and with the administration of the hospital, make sure that they take good care of themselves eat well, stay hydrated, manage good sleep whenever possible, see wherever they can delegate responsibilities, plan a way that they’d only have to repeat the same information, engage in self-compassion and practise mindful meditation wherever possible.
The devastation of the pandemic can still be felt worldwide, humans are still trying to recover from the impact and scars of the pandemic. The pandemic has taken millions of lives and it hasn’t spared the frontline warriors who sacrificed their lives to save millions from the dreaded virus.
Dr Singh shared, “In neurology specifically we depend a lot on the history, so we were able to take that over the phone and based on that we were making decisions. If the patient appears to be serious based on the symptoms, we had to reassure the patients to come to the hospital for a check-up as people were scared to come to the hospital. There were some intermediate categories of cases as well where we were not sure of the symptoms and gave medications for improvement for 24 hours and then examined them again. This, however, led to the extended treatment protocol for the doctors and the patients in a few cases.
During the peak of the COVID-19 pandemic, the major challenge was to meet the sudden high demand for services during the pandemic and keep all personnel safe and protected. “Initial challenges included lack of connectivity in certain rural areas, inability to provide a seamless continuum of care between online and offline services and consultation fee parity. Medical charts used for offline consultations and digital consultations were also being integrated to enable better continuity of care. As an increasing number of doctors consulted through these services, they realised that the teleconsultations both minimised their own risk and brought more value to patients, added Thaploo.
The medical fraternity worked round the clock to take care of all infected with the virus. Since not much was known about sars-cov-2, healthcare providers were working on guidelines issued by the World Health Organisation (WHO), the Indian Council of Medical Research (ICMR), and the Ministry of Health & Family Welfare (MoHFW), guidelines issued by the central and state government. The medical fraternity was on high alert as treatment protocols were changing rapidly as scientists and researchers learnt more about the virus. The medical fraternity made sacrifices to save millions of lives, endangering their well-being. This National Doctor’s Day, let’s pay tribute to all the doctors that have been crucial to the lives of millions of patients across the nation