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India warms to telehealth amid pandemic

Covid-19 has accelerated adoption of telehealth services in India as more healthcare providers look to offer medical treatment and assistance without risking infections

At the peak of the Covid-19 pandemic, India’s healthcare system was brought to its knees, with hospitals across the subcontinent running out of beds and oxygen. There was also a nationwide lockdown, and a fear of infection that deterred people from visiting hospitals.

At the same time, there was doubt and panic and often a need to consult a doctor. That’s when healthcare experts realised that telehealth was the only way for them to provide medical treatment and assistance without risking infections.

As Neeraj Lal, chief operating officer of Apollo Hospitals in Ahmedabad noted, telehealth accounted for less than 5% of India’s overall healthcare IT market before Covid-19, but this figure rose to 47% during the pandemic.

“Telehealth was always here in this country, but there was reluctance from both doctors and patients to adopt the technology,” said Lal. “The crisis left no choice and spurred people towards video-consultations and new-age platforms. It became a win-win for doctors, patients and hospitals.”

In an interview with Computer Weekly, Lal said his hospital had spent time and resources every month to send doctors to rural areas. Telehealth has eased a lot of those hassles, he said, which matters a lot for a country where tier-two and tier-three cities struggle with medical access.

Today, Apollo Hospitals operates a telehealth platform around the clock that enables patients to connect with doctors, upload reports and get prescriptions quickly. “Telehealth has changed the face of healthcare in India,” said Lal.

Raghavendra Prasad, founder of Project StepOne, a telehealth startup, is seeing similar trends. In April 2021, his firm was handling 162,000 patients a day. This number grew to 310,000 patients by May 2021, with an average of a million calls a day over two months.

“Before the pandemic, the Indian government had no guidelines on telehealth, while doctors preferred in-person meetings and hospitals largely discouraged its adoption,” said Prasad. “However, during the pandemic, everything changed. Telemedicine guidelines were released in March 2020, and doctors and hospitals adopted various technologies. Patients have always wanted telehealth, so they have been quick adopters.”

R Duraisamy, state programme officer for non-communicable diseases in Puducherry, noted that many states and cities in India have leveraged technology to help patients during the pandemic.

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“Telehealth has picked up very well in India,” he said. “Some government portals were available, but acceptance was low. The urgent and serious nature of this crisis changed everything. We used telephones, helplines and many platforms, with even people from neighbouring districts using it for routine follow-ups or primary care.”

In Puducherry, where telehealth services are available, routine calls are handled by volunteers, who filter 95% of cases, some of which are repeat consultations or requests for prescriptions. More serious and critical cases can be escalated to specialists when needed.

In fact, just one in 10 patients actually need to visit a doctor in person, said Lal, making telehealth valuable for patients and doctors. More hospitals are also delivering outpatient services through telehealth, such as e-prescriptions and e-diagnostics, with only critical cases, CT (computerised tomography) scans and MRI (magnetic resonance imaging) handled physically.

Changes in adjacent sectors, such as insurance, as well as government initiatives such as the eSanjeevani telemedicine system, have also driven demand for telehealth services in India – a market that was worth $1.3bn in 2021.

Veena Tripathi, a visiting professor at the Jaipuria Institute of Management, said telehealth could even help to improve a patient’s mental health.

“One of the main benefits of telehealth is its immediate accessibility,” she said. “Self-harm is one of the most common causes of death in India. An individual facing major mental health issues is often stuck when it comes to urgent personal interaction.

“Telehealth could serve as an ‘ambulance emergency’ in self-harm cases. It is also a phenomenal solution for an individual to get their mental health treatment independently, safely and privately.”

Threats to the telehealth pulse

As promising as it has been, there are kinks to iron out in India’s telehealth landscape. According to management consulting firm Praxis Global Alliance, the difficulty in understanding a patient’s symptoms over the phone remains a challenge.

Also, delayed payments and high service charges have caused dissatisfaction among doctors. There is also room for improving transparency, data privacy and interoperability between telehealth platforms.

People who live in tier-three cities and remote areas may face awareness issues and resistance as they continue to prefer to visit a doctor in person. Today, about 85% of queries at telemedicine service provider Practo come from metro cities.

Project StepOne’s Prasad noted that the vast majority of patients still prefer voice calls over app, web or video-based systems, adding that the lack of familiarity with mobile apps remains a challenge to most first-generation smartphone users.

Lal said he believed healthcare providers that do not adapt to telehealth will fade away, while hospitals would only be used for critical care and surgeries. He does not see this leap to telehealth making a U-turn in the coming years.

Duraisamy agreed, noting that there are multiple platforms and technologies such as machine learning that will make it easier and faster to deliver healthcare services.

“Covid has exposed a lot of gaps and possibilities,” he said. “I don’t think we will go back to old ways now. It’s going to be the future – no doubt about that.”

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