· India becomes latest country to legalize telemedicine as COVID-19 stretches hospital resources
· In China, online health platforms see surge in new users during peak of outbreak
For Dr. Sunita Maheshwari, a cardiologist in Bengaluru, March 25, 2020, will go down as “a red letter day in the history of telemedicine in India.”
It was on this day that the Indian government legalized teleconsulting in India. Previously, a doctor would pick up the phone to speak to a patient only if the latter was a relative or was referred by someone close. Even then, such calls are usually handled with reluctance and apprehension.
“As recently as May 2019, the Karnataka medical council advised doctors against engaging in online teleconsults,” said Masheshwari, “and even threatened to have them struck off the council rolls if they were found to have done a teleconsultation.”
“It took a virus, and the central government of India, to get the council to take a U-turn on their stand and legalize telemedicine,” she added.
India joins many other countries where the medical community has embraced teleconsulting, some even before measures put in place to stop the spread of the coronavirus forced people to stay home. It is also one of many examples of COVID-19 accelerating — and in some cases, forcing — digital transformation in some of the last holdouts in industry and services.
In the UK, the National Health Service (NHS), a free public healthcare system, has been pushing telemedicine as a way to manage overcrowding in hospitals. The coronavirus pandemic only helped popularize it further.
“Face to face takes a lot of time and many people have to wait couple of weeks to see the doctor,” said Dr. Nandita Shrisalkar, an ophthalmologist who also practices internal medicine in London. “Now, all emergencies are allocated to the duty doctor who triages the patient after taking the proper history on phone or video, and asks them to come over only if it is required. Children are normally seen the same day.”
E-consulting has become mandatory in the UK, said Shrisalkar, and there are three ways recommended for doctors to approach patients. The first is via email where history and details are sent with attached pictures; the second is when a patient communicates with the doctor via phone; and the third is when a patient is put on triage and the concerned specialist doctor does a video consultation.
In the U.S., 76 percent of hospitals connect with patients and consulting practitioners at a distance through the use of video and other technology, according to the American Hospital Association (AHA), a national organization of hospitals, healthcare networks and patients.
“Monitoring and screening patients virtually for symptoms can keep vulnerable and senior populations safer by reducing their need to leave their homes for medical visits,” according to the AHA website, which updates patients about how hospitals and health systems are using digital tools and technology to handle the rapid influx of COVID-19 patients in the U.S.
Other benefits include cost savings for both patients, as it cuts travel expense, and doctors, who can consult more patients per day. It also makes it easier for the disabled and elderly to access doctors from the comfort of their homes, and helps to slow the spread of infections, including the coronavirus.
In China, the lack of a mature system of family doctors or general practitioners has meant that medical needs are concentrated on hospitals, where people flock to treat everything from runny noses to heart attacks. This has resulted in lengthy waits at hospitals.
Remote consultations also help ease the burden on rural residents, who often make long trips to big cities for medical attention. This demand for timely healthcare has driven the creation of online health platforms that connect doctors with patients.
The largest of them, Ping An Good Doctor, provided free online and teleconsulting to people concerned about the coronavirus. The platform saw the number of new registered users surge 10 times on average between January 22 and February 6, when the virus outbreak was at its peak in China. Its daily online consultations too grew nine times on average over the same period.
“I hope telemedicine grows more in the coming days and helps in overcoming the barrier of stigma in seeking mental health services,” said Dr. PKN Choudary, a Psychiatrist in Chetna Hospital in Hyderabad, India.
Most psychiatrists and clinical psychologists in Choudary’s hospital are now teleconsulting via Skype or WhatsApp. He said prescriptions are sent to patients from hospital cellphones so pharmacists can authenticate them, and payments are made through portals such as Gpay, PayTM and BHIM app.
“The video clarity allows us to see the previous medicines, including prescriptions that are written in the illegible handwriting of doctors, and patients’ expressions and movements, and we can reach a proper clinical judgment,” said Choudary.
Maheshwari, who also runs a teleradiology clinic in India that analyses chest X-rays and CT scans of patients in the U.S. to check for the coronavirus, agrees that the benefits of telemedicine “in today’s Covid world” are obvious.
“Doctors can see their patients without the risk of getting corona, patients can see their doctors even during a lockdown and without the risk of being in a crowded clinic or hospital, and it also allows for social distancing,” she said.
Interestingly, even veterinary doctors have been e-consulting these days as governments ease rules, allowing them to see emergency cases.
“It’s not ideal but we manage,” said a doctor at Town Vets in Singapore who dispenses medicines for pets through a glass window after teleconsulting with pet-owners about their dog or cat’s problem.
For most doctors, the coronavirus pandemic is both a challenge and an opportunity to rethink healthcare.
“Especially in this climate, the tele and video consultation is just amazing,” said Shrisalkar, who responds to 40 calls a day sometimes as “health anxiety has gone through the roof” during the COVID-19 period.
“I just find it (teleconsulting) so useful and hope that it continues when all this is over.”