TELEMEDICINE TO THE RESCUE

With a lockdown in force, many doctors are diagnosing patients remotely via audio/video calls and electronic platforms, reports Sai Ishwar

For seventy-year old Shanta, and Kailasam, who is in his late 50s, the nationwide lockdown announced on March 24 felt like a calamity. Shanta, a Chennai resident, has been under treatment for insomnia for many years, but the medicines are no longer effective, requiring her to be under regular medical supervision.

Kailasam, also from Chennai, suffers from sleep apnea — a form of sleep disorder, for which he needs to undergo continuous positive airway pressure (CPAP) treatment. (CPAP is a type of ventilator that increases air pressure in one’s throat so that the airway doesn’t collapse when the person breathes.) Kailasam was unsure about whether he should continue with CPAP during the Covid-19 pandemic.

But the lockdown prevented both Kailasam and Shanta from travelling to the doctor’s clinic. Then, much to their relief, they heard that their doctor was available for tele-consultation over voice calls and Skype.

Shanta and Kailasam are among the 50-odd patients whom Nagarajan Ramakrishnan, a sleep medicine specialist, has attended to remotely over the last few days. “Hospitals and clinics may be open as they are an essential service, but how will patients reach them? Telemedicine is the best option for providing continued access and care to those with chronic medical problems,” says Dr Ramakrishnan, who is also the director at the Chennai-based Nithra Institute of Sleep Sciences.

With the entire country having been put under a lockdown to check the spread of the coronavirus, telemedicine, or the remote diagnosis of patients through electronic communication, has come as a boon to people seeking treatment for non-critical ailments.

Telemedicine has three levels: Diagnosis through voice calls, videocalls, and through electronic mediums after monitoring real-time data received through equipments like a glucometer or a blood pressure monitor.

Take the case of seven-year-old Aman, who was stuck in a remote village in Bihar with his father. His mother, who was away in Delhi on work, could not return home, owing to the lockdown. The child had been suffering from throat pain, fever and body ache for two days, symptoms that showed no sign of improving after primary treatment. That’s when his mother contacted Star Telehealth app to seek a tele-consultation.

Says Aleemullah MF, one of the doctors at Star, “There was no question of the boy travelling as then we would expose the child and others to risk if he had Covid-19. You would be initiating a huge epidemiological load and the risk of transmitting to others.”

Aleemullah checked him out over the app, and using his symptoms and his medical history, was able to diagnose him for acute tonsillitis. He reviewed the child’s condition every six hours. After 36 hours the boy responded to the antibiotics and was doing well.

The Telehealth app, which was initially meant only for customers of Star Health and Allied Insurance, has now been made available to everyone as a goodwill gesture. Built by the health insurance company, the app is now handling 200-250 cases a day through chat, audio and video calling. Around 20 doctors and specialists are on hand to help the patients.

The app, which is compliant with the Health Insurance Portability and Accountability Act (HIPAA Act) in the US, can be used to upload medical records that can be accessed by the doctor only through the patient’s OTPS. The doctor can also issue authenticated e-prescriptions through the app. In the wake of the Covid-19 pandemic, hospitals are now scrambling to set up facilities for telemedicine consultations. Several doctor booking apps that offer tele-consultations as an option, are also seeing a huge spike in their usage. Lybrate, a health and wellness app, says it has witnessed a sharp increase in video consultations with doctors on its platform. And a significant part of this demand is coming from tier-ii cities.

Telemedicine can also play a major role in addressing the shortage of qualified doctors in certain medical fields. According to a parliamentary reply in November last year, India has one doctor for every 1,445 people, which is much lower than the World Health Organisation’s prescribed norm of one doctor for 1,000 people.

According to a Mckinsey Digital India report released last year, telemedicine models possess the capability of handling up to half of the in-person outpatient consultations in India. “Telemedicine trials have demonstrated that remote consultations cost about 30 per cent less than equivalent in-person visits.” Use of digital technology in healthcare may also save $4 billion to $5 billion by 2025, the report added.

To address certain legal hurdles for this mode of medical practice, the ministry of health and family welfare, along with NITI Aayog, issued some guidelines last week to allow registered medical practitioners to provide telemedicine consultation. However, experts say that the guidelines are unlikely to be of help to doctors in the current situation.

“The guidelines seem broadly fine, except that they will take months to prepare the course and will not be useful during this (Covid-19) pandemic,” says Sumanth C Raman, a healthcare domain consultant with a leading IT services firm.

Guidelines or not, hospitals are going all out to ramp up their efforts to provide telemedicine platforms to their patients. “It (telemedicine) is a good initiative for a follow-up patient to whom medicines have to be prescribed, and also for someone who urgently needs medical advice,” says Somesh Mittal, CEO of Bengaluru-based Vikram Hospital. The 225-bed hospital will roll out its own app for online consultation by the end of this week.

Telemedicine in eye-care

Madurai-based Aravind Eye Care Systems set up a makeshift tele-consultation option on its website in just two days. The day after the Janata curfew on March 22, Aravind had 18 doctors ready to take patient calls from six different locations across south India. The move was in anticipation of a bigger lockdown that was announced days later. The traffic was so heavy right from the outset that three parallel windows had to be set up in each of the eight branches on the Google Hangout.

“We are now attending to about 30 cases in a day. Because of the lockdown, this is the only way patients can access us,” says Thusaliraj Ravilla, director (operations) at Aravind Eye Care.

Ravilla points out that in the case of an old patient, the advice would be reasonably accurate as the hospital would already have their medical history. “But in the case of a new patient, the consultation would offer some professional guidance that would be better than self-medication,” he adds.