How emergent telemedicine practices have been evolving in India to address the challenges of multi-stakeholders?
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Telemedicine enhances healthcare delivery in India

How emergent telemedicine practices have been evolving in India to address the challenges of multi-stakeholders?

The modern Indian healthcare system today is adaptable to make significant changes, including elevating the status of telemedicine. Clinical or medical services delivered via the Internet are known as telemedicine. Telehealth has a wider platform than telemedicine, although both can be used interchangeably. Telehealth as a platform facilitates interactions between patients and healthcare providers by enabling a broader range of clinical workflow tasks and remote monitoring to improve ongoing health issues, including lab test results, therapy, counselling, and medication management.

The World Health Organisation classifies telemedicine into four broad categories. Firstly, communication-based (email/fax, Skype, video apps, audiophone, etc.). Secondly, the timing of information transformation-based (real-time video/audio/text telemedicine, diagnosis, administration of medicine, simultaneous information transfer), and store-and-forward telemedicine (images, laboratory reports, etc.). Thirdly, classification is based on interaction among the stakeholders (interaction between the patient/caregiver and the registered medical practitioner (RMP), RMP and the health worker, and health worker to RMP). Fourthly, non-emergency consultation based on their purpose (including life-saving techniques, first aid, referrals, and follow-up with the same RMP).

The Indian government introduced telemedicine guidelines to overcome the difficulties of enabling policy, regulatory framework, and medical liability. It has taken action to solve the issues with patient privacy and confidentiality, data storage, data correctness, data privacy, data security.

G. Jabarethina

Why does Indian health care need telemedicine?

There are three key reasons for considering telemedicine: a low doctor-to-population ratio, chronic poverty, and a fragile healthcare infrastructure. Technology helps to solve various problems in every industry; why can’t the same technology be utilised to ensure equitable healthcare? Should being born in a remote or rural region be a barrier to accessing quality healthcare?

Many patients in rural locations must travel many miles to receive basic and special medical care, and many are forced to take a day off due to inevitable waiting times. Every year, India’s population falls into poverty due to high out-of-pocket expenses. India’s rural areas have a significant shortage of healthcare facilities. COVID-19 also exposed the fragile Indian healthcare infrastructure as well as worldwide. Telemedicine initiatives have the potential to fundamentally alter how the rural healthcare system functions. The National Health Policy will benefit from telemedicine since it is a low-resource modality.

India requires telemedicine because of its potential benefits, which include the capacity to increase access to specialty treatment, lower costs, and maybe aid in reducing the future physician shortage.

Initiatives taken by the government to enhance telemedicine services

The development of telemedicine services in India has been aided by the Indian Space Research Organization (ISRO), the Department of Information Technology (DIT), the Ministry of Health and Family Welfare (MoHFW), the Government of India, state governments, and medical research institutions.  These organisations contribute to improving healthcare in rural areas through various telemedicine projects and also help in addressing the challenges of telemedicine. It includes a lack of technological resources, poor connectivity in some remote locations, and challenges in carrying out conventional patient assessments.

The COVID-19 pandemic accelerated a rapid transformation in India’s healthcare system, even though telemedicine experiments had begun in the late 1990s. Healthcare providers hesitate to practice telemedicine due to medical and legal challenges, as well as a lack of guidelines. The Indian government issued guidelines for telemedicine in March 2020 to registered medical practitioners by MoHFW and NITI Aayog. The Central Council of Indian Medicine and the Central Council of Homoeopathy published telemedicine practice guidelines for Ayurveda, Siddha, and Unani practitioners, as well as licensed homeopathic practitioners, to administer telemedicine. The Indian government released guidelines for telemedicine that enabled practitioners to have comprehensive processes for first consultations, follow-up consultations, and teleconsultations with licensed medical practitioners.

The National Telemedicine Service of India’s eSanjeevaniOPD, which offers quick and easy access to doctors and medical professionals via smartphones, is an important step towards universal Universal Health Coverage. Those who do not have access to facilities can visit their nearest Ayushman Bharat Health & Wellness Centre and receive quality healthcare remotely through eSanjeevani.

Some of the private sector hospitals’ telemedicine projects

In 2000, Apollo Chennai established the first telemedicine centre in the Andhra Pradesh village of Angora. The Apollo Telemedicine Networking Foundation links over 100,000 common service centres with its Rural Connect programme. The Narayana Health Group in Bengaluru—CISCO Virtual has implemented state-of-the-art telemedicine systems at three locations: National Health City in Bengaluru, RAJARHAT in Bengal, and SIRSI and BELLARY in Karnataka. FORTIS Network in India provides telemedicine consultations to twenty-three hospitals. Corporate hospitals use call centres to set up online consultations and appointments. Following the consultation, the prescription is emailed to the patient’s email address and put on the site. Through SMS, the patient receives the e-appointment and the payment link.

Telemedicine enhances healthcare delivery in India
Figure 2. Some of the private sector hospitals’ telemedicine projects
Credit. Open source

Challenges and responses of Telemedicine practice in India

The government of India introduced telemedicine guidelines to overcome the difficulties of enabling policy, regulatory framework, and medical liability. The Indian government has taken action to address the challenges relating to patient privacy and confidentiality, data storage, data accuracy, data privacy, and data security. The Indian government has taken action in the process of establishing a secure framework for sharing data with consent. Giving individuals authority over their data based on consent is the cornerstone of the ‘Data Empowerment and Protection Architecture’, which is a paradigm shift.

ChallengesResponse
Patient Privacy and Confidentiality
Data Storage/Achieved mechanism
Data Privacy and Security
Data Accuracy
Data Empowerment and Protection Architecture (DEPA) 
Account Aggregator (AA)
National Digital Health Mission (NDHM)
National Digital Health Blueprint (NDHB)
National Health Stack (NHS)
Enabling Policy and Regulatory Framework
Medical Liability
Telemedicine Guidelines
Healthcare Professionals Reluctance
Computer Literacy
Non-technical Challenge
Improve Cultural Responsiveness
Educate the Public about Multiple Health Care Sites
Invest in Mobile Clinics
Online and offline courses
Incentives to Healthcare professionals
Table 1. Major challenges and responses of telemedicine practice in India
Credit. Authors’ elaboration

The Reserve Bank of India has established an ‘Account Aggregators’, a new consent manager organisation, to guarantee that individuals can consent to the sharing of their data and to safeguard their right to privacy. In the same way, the Ayushman Bharat ‘National Digital Health Mission’ would provide a platform for digitising Indian citizens’ medical records and their subsequent dissemination to public and private hospitals, clinics, and pharmacies.

‘The National Health Stack’ is a digital infrastructure designed to make it easier to collect and share all medical data securely and privately. The concept of ‘The National Digital Health Blueprint’ foresees the architectural framework and infrastructure needed to connect health data across the public and private sectors. To reach all Indian villages by 2025, Bharat Broadband Network Limited plans to expand the fibre network.

Telemedicine enhances healthcare delivery in India
Figure 3. Government of India initiatives on Healthcare technology platforms and Information consideration
Credit. open access

Healthcare professionals face several challenges, including computer literacy, non-technical difficulties, and reluctance. To address these issues, efforts have been made to promote cultural responsiveness, educate the public about healthcare options, establish mobile clinics, offer online and offline courses, and provide incentives to healthcare providers.  Non-technological hurdles typically hamper the growth of technology-enabled healthcare. The widespread implementation of telemedicine-enabled healthcare pathways in India’s complex, diverse, and risk-prone environments, however, depends on the healthcare sector’s leaders resolving several interconnected issues.

Conclusion

India has extensive expertise in both the public and private healthcare sectors, with several technology-enabled telemedicine initiatives. Four key aspects need to be focused on in telemedicine: guidelines for local Indian languages, telemedicine through various pathways in Indian medicine, health infrastructure (data storage and privacy), curriculum, and skill development to support learning at the corporate and individual levels. For India’s digital health revolution to succeed, it is essential to regularly analyse and assure congruence among the policy-practice-people-technology nexus.

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Journal reference

Jabarethina, G., & John, K. C. (2023). Emergent Telemedicine Practice in India: Challenge and Response. INDAM: Indian Academy of Management at SBM-NMIMS Mumbai, 39-59. https://doi.org/10.1007/978-981-99-0197-5_3

G. Jabarethina graduated from the University of Madras with an M.Com., an M.B.A., and an M.Phil. She then pursued a Ph.D. in management sciences. Holding a UGC Management National Eligibility Test certificate, she currently serves as an Associate Professor in the Faculty of Management Sciences at the Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), India. To her credit, she has been a teacher for two decades. She has published in eighteen indexed journals. Her research mainly focuses on areas of performance management, healthcare management, strategic human resource management, and digital health.

KC John earned his Ph.D. in Management from the Indian Institute of Management Ahmedabad [IIMA]. John has balanced several successful careers in the spheres of R&D grant-making, applied research, technology innovation, entrepreneurship, and sustainable development. He raised funding and scaled start-up ventures in mobile computing, the Internet, digital communications, and healthcare technology. He successfully exited three of his ventures, which were acquired in high multiple trade sales by strategic investors. John offers MBA courses, leads a research program in Digital Health in India, and designs and implements bespoke Executive Development Programs for healthcare and high technology companies.