Telemedicine has been mooted to be the upcoming tool in the healthcare armamentarium. Its capability to deliver complex data across large geographic boundaries instantaneously is hoped to play a vital role in ensuring quality healthcare. The rapid rise in high quality digital connectivity and the ready access to digital payments across the nation have already paved the way for these transformations. Various health tech options have emerged since the past decade which cater to various aspects and angles of healthcare.
It is obvious that any product must provide adequate utility, ease for use and cost benefit for tractionable acceptability.
Healthcare is a complex process and there are various facets where technology has been able to help streamline the processes or substitute the processes and at places offer alternative pathways which can change the outcomes of healthcare.
The process of healthcare can be split up into broad pillars:
- Preventive
- Therapeutic
The field of preventive healthcare consists of a combination of myths, beliefs, and verifiable information. In the therapeutic segment, the processes can be further be split into tasks which maybe concurrent or exclusive:
- Tasks performing increased health Awareness
- Tasks offering diagnostic support:
- Helping timely diagnosis
- Enhancing diagnostic capabilities
- Facilitating the performance or Investigations
- Improving Interpretations
- Enabling Documentation
- Identification of accessible and dependable investigative options
- Tasks offering Therapeutic support:
- Tele-consultations
- Deliverance of reliable medicines
- Facilitation of hospitalization when needed.
- Follow-up care
- Home-care
- Guidance for surgery
- Facilitation of financial support for the therapeutic management:
- Simplifying insurance finance/ re-imbursement of treatment.
- Facilitation of non-insurance financial support for treatment.
- Government schemes
- NGO support
- Crowd-funding support, etc.
In any of the above tasks, technology can contribute to improving healthcare by Improving the efficiency of well-established pathways or substituting the same by creating new channels:
- Automating certain repetitive functions- documentation procedures, medicine reminders, follow-up reminders etc.
- Simplify/ optimize database access:
- Contact patients for follow-ups etc.
- Sort medicine options
- Facilitate dosing regimes
- Anticipate or identify adverse reactions
- Use of AI:
- To extrapolate possible diagnostic options based on clinical symptom profile
- Extrapolate possible diagnoses from imaging/ investigative info
- To suggest therapeutic options
Tele-consultations:
Tele-consultations are an aspect of telemedicine wherein a patient connects with a doctor on a platform and gets professional advice. They can be a very important tool to ensure access to reliable medical opinion for patients who are logistically challenged to access the same.
In its simplest form, tele-consultations use popular chat platforms and messaging platforms:
- Benefits:
- Easy availability across the spectrum of population.
- Requires very little training since these platforms are being widely used for personal chats even outside the tele-consultation function.
- In practice, these have been good for short clarifications or review of previous physical consultations.
- Shortcomings:
- Data confidentiality.
- Inability to physically examine the patient.
- Limitation of proper documentation – leading to medico-legal vulnerability and incapability of creating a transferable record.
- Difficulty to collect charges by doctors.
- Doctors are dissatisfied with the quality of communication and patients often miss the physical connect with the clinician.
These shortcomings have led to the evolution of multiple customized tele-consultation platforms:
- Benefits:
- Patient demographics and data is captured and stored.
- Symptom documentation is simplified using ready-made templates.
- Possible to upload investigation records and store the same.
- Possible to generate customized prescriptions.
- Some of them facilitate medicine delivery and other ancillary services including investigation facilitations.
- Payment platforms are often integrated into the app.
- Shortcomings:
- Need for patient to understand and use the application:
- Multiplicity of apps leads to confusion for the patient because the patients need to know different apps to communicate with different doctors.
- Patients are often uncomfortable using these apps.
- Communication between patient and specialist across a virtual platform is often not satisfactory.
- Uploading images, investigations, information can be a challenge.
- Inability to physically examine the patient- Physical signs as perceived by the patient can be very inaccurate.
- There is often a need to individually train the patients for its use and the resultant communication lacunae have been exasperating for the doctor and dissatisfying for the patients.
There is thus a need to create a model which genuinely reaches out to bridge the gaps in medical care.
The need:
A comprehensive model which:
- Creates a significant disease awareness across geography.
- Offers simple, implementable, and reliable consultation solutions. Minimizes the need to train all patients to use the same.
- Ensures a concise, accurate, reproducible, and transferable EMR.
- Manages support systems for reliable and accessible investigations
- Facilitates reliable medicine deliveries to these areas.
- Streamlines easy processes for hospital admission in those patients where there is a need.
- Organizes processes for medical finance for those needing the same (through insurance companies, government support systems, NGO finances, crowd funding etc.).
- Incorporates a mechanism for follow-ups and persistent compliance.
Many existing telemedicine tools are targeting the savvy, elite urban patient who is using the tool more to flaunt his healthcare accessibility rather than utilize the same for a purposeful outcome. The optimum utility of this powerful communication tool will be achieved when telemedicine evolves for the ensuring access to quality healthcare to the vast majority of the non-metro population who are suffering from the lack of access to quality healthcare due to basic logistic shortcomings.
About the Author
Dr. Ketan Parikh is the Director of Pyramed Telemedicine, based in Mumbai. He is a paediatric surgeon, who has taken complex surgical and neonatal surgical procedures into easily accessible environment of smaller surgical centers. He is passionate about healthcare quality and healthcare reforms that are directed towards patient safety and protocol-based practises.
