by Sruthi Jayakumar and Pranav Veepanattu
Image Courtesy: CGTN
Technological transitions have reshaped the future of health care across the globe. Traditional healthcare delivery and existing models in health care often fail to serve people's needs in a densely populated country like India. It's high time for India to utilize the tremendous scope of digital health to assure the health coverage for its citizens’. Universal Health Coverage is defined as ensuring equal access to health services (including prevention, promotion, treatment, rehabilitation, and palliative) of sufficient quality to be effective while ensuring that the use of these services does not expose the user to financial hardship. The existence and functioning of health care services and health care systems differ across districts, states, and countries.
According to the World Health Organization, the health system's ultimate goal is to deliver effective, preventive, and curative health services to the population equitably and efficiently. Inadequate public health funding, shortage of skilled health professionals, gaps in the health infrastructure, and varying rural and urban geographies are significant challenges in India's healthcare delivery system.
The strategy for better application of digital health could be one potential solution to address some of these challenges. In the 13th General Programme of Work (GPW13), the World Health Organization highlighted the Triple Billion Targets of achieving the Universal Health Coverage target for 2023. Digital health provides unique opportunities to accelerate our progress in attaining health and well-being, incorporating the UN's Sustainable Development Goals (SDGs), especially SDG-3.
What is Digital Health?
Digital Health has emerged as a field of practice to address the community's health care needs by exploring and enhancing the scope of Information and Communication Technology (ICT). The term digital health evolved from e-health, which can be defined as the use of information technology for supporting health and health-related activities. It has broadened its horizons and has also included other forms of data sciences such as Big Data, Genomics, and Artificial Intelligence for promoting high quality and evidence-based digital interventions.
Digital healthcare in India
Albeit being the second-most populous country in the world, India spends only 1.13% of its GDP on health. More than 60% of the Indian population resides in rural areas, where they have the least access to health care services. Overwhelming financial burden due to the high, out of pocket expenditure has driven more than half of the households into poverty. Existing urban-rural disparities have a severe impact on health care coverage and quality of care. Digital health alone may not be an ideal solution to address the rural-urban health divide, but it will help to narrow the gaps in the healthcare delivery system. The Ministry of Health and Family Welfare released "National Digital Health Blueprint'' (NDHB) in November 2019, which acts as a framework for health care digitisation in India. It provides systematic guidelines to integrate IT components in the health ecosystem for enhancing the quality of care, while ensuring the confidentiality and privacy of the health information. India has a booming digital economy with more than 560 million internet users and above 12.3 billion mobile applications. Effective utilization of digital platforms for health care delivery can help leapfrog towards achieving the UHC goal. Reproductive and Child Health Care portal (RCH), NIKSHAY (online TB- patient monitoring application), Health Information Management System (HMIS), Electronic Vaccine Intelligence Network (eVIN), Ayushman Bharat, National Program for Control of Blindness (NPCB), Mera Aspatal (Patient Feedback System), e–sushrut are some of the government-managed digital data-based platforms already in place which aids the monitoring of health care services in India. The massive data collected through the information management system can be utilized to track the health status of the individuals, perform research in health care, enhance decision making at the policy level, forecast community outbreaks, pandemics, and offer real-time solutions during the times of crisis.
Virtual health in the era of pandemic
Over the past few months, the world has been witnessing one of the worst crises in human history triggered by the COVID-19 pandemic. The public health emergency brought by the pandemic has imposed several challenges in health care delivery across the globe. A huge number of healthcare providers have been exposed to this dreadful virus due to direct exposure and shortage of personal protective equipment (PPE). Even the developed countries with adequate resources and highly sophisticated technologies are finding it hard to offer services to their patients. In India, the public sector is in the front line against the COVID-19 pandemic. The private sector of India, which accounts for two-third of its hospital beds and ventilator facilities have been reluctant to handle the current workload; which in turn has overburdened the public healthcare system and calls for the need to have a public- private partnership model to improve the functioning of the existing health care system. On the one side when the hospitals are overwhelmed with COVID-19 cases, the non-COVID services too are disrupted and have made the individuals and communities more vulnerable to communicable and non-communicable diseases. Continuous lockdowns and inaccessibility to healthcare, restricted individual access to avail health services which include immunization, delivery, treatment for various co-morbidities such as heart diseases, diabetes, tuberculosis, cancer and mental health conditions. The need of hour is to ensure that all individuals receive equitable access to health care services, amidst the prevailing pandemic and telehealth can be a robust way to meet the future health care demands.
Is telehealth a boon to the health care system in times of COVID-19?
Telehealth refers to the delivery and facilitation of health and health-related services through the use of information and communication technologies. With the advent of telemedicine, health care has become accessible even to remote areas by reducing the cost and efforts associated with it. Telehealth has emerged as an innovative and sustainable solution to bridge the gap between individuals, physicians, and health systems. The current crisis imposed by the pandemic has coerced more hospitals to adopt telehealth technologies to limit viral exposure to frontline workers and patients. Recognizing the importance of telehealth during this pandemic, governments across the globe have revised regulations and recommendations to implement this model of care. The decentralized research approach, by enhancing the scope of newer technologies, is the latest trend in clinical research. Clinical Trial Transforming Initiative (CTTI), a public-private partnership, has launched multi-stakeholder decentralized clinical trials to improve clinical trials' quality and efficiency. These trials make use of the smart application of telemedicine and mobile health to overcome barriers to trial execution and data sharing across organizations. It also reduces the potential risk of microorganism exposure to study participants while accelerating the development of drugs and vaccines in these challenging times.
“Telehealth can directly influence flattening the curve of demand on health systems worldwide, slowing transmission and spreading incidence over a longer period," said Raviganesh Venkataraman, Chief Executive Officer, Cloudnine Group of Hospitals, India
In the Indian context, there were no legislative guidelines regarding the practice of telemedicine so far. But as a result of the emergency induced by the COVID-19 outbreak in the country, the Medical Council of India in partnership with NITI Aayog issued telemedicine practice guidelines on March 25, 2020. As per the guidelines, a Registered Medical Practitioner (RMP) has the authority to provide consultation from any part of India using a suitable telemedicine tool such as telephone, video, devices connected over LAN, WAN, internet, mobile or landline phones, chat platforms like WhatsApp, Facebook messenger as well as mobile applications or internet-based digital platforms for telemedicine or data transmission systems like Skype/email/fax, etc. These services are made available to individuals by following the principles of medical ethics and maintaining patient privacy and confidentiality. In response to the government notification regulating telemedicine practices in India, many hospitals and health startups have come forward with innovative ideas to function effectively during pandemic.
What are the pros and cons of adopting telehealth in the current scenario?
Non-emergency or routine consultation services such as inpatient and outpatient services can be provided through telehealth, which may be difficult to access otherwise.
Access to virtual health care services considerably reduces the footfalls to outpatient settings, clinics, and hospitals. This will also reduce the exposure for individuals at high risk (elderly, children, pregnant women, individuals living with other comorbidities or pre-existing conditions).
Consultation services can be provided to patients who are undergoing home quarantine/have milder symptoms of COVID-19. This is useful even if the doctor is quarantined.
Human resources availability for providing emergency care at hospitals/clinics can be maximized.
Stigma, anxiety, and fear in society can be alleviated by imparting health education through webinars, resource materials, self-diagnostic questionnaires, and help-lines.
Provide accurate and time-bound information to the community with the help of various trackers and applications using artificial intelligence techniques.
Reduces the need for PPEs, which can be utilized in an emergency/COVID-19 setting.
Prescription records and lab records can be maintained digitally and can be easily accessed by the patients and health care providers.
Cons and Recommendations
Even though digital health is rapidly evolving, it has numerous challenges in its way forward.
India is a country with wide geographical diversity; it is essential to ensure that essential infrastructure for adopting digital health is distributed equally across the country. Still, many parts of the country (rural and urban areas) have no access to electricity and other necessary facilities. The gaps in the infrastructure should be bridged to provide need-based health care to the citizens.
Society has lots of misunderstanding and chaos regarding the digital health concept, due to which they mistrust the technology. Adequate technology literacy must be imparted in to create awareness.
Half of the Indian population cannot afford the cost of accessing digital health care services. Considering these factors, individuals should have access to low-cost and affordable digital health technology.
Accuracy of the information generated through the digital platforms can be misleading if it is not correctly handled by the experts. So it is essential to provide adequate training to health care staff for better outputs.
Lack of practical guidelines for functioning can hamper the quality of services provided. Government organizations and institutions should make sure that there are enough guidelines in place to function effectively.
Real-time interaction is not possible in virtual platforms, so patient satisfaction can be compromised. It is crucial to support individuals to adapt to the digital environment.
Continuity in care may be decreased if the same physician does not attend the patient, which results in compromised quality of care. Efforts should be taken to identify the problem and offer constructive solutions.
There is a remote possibility of abuse/misuse of patient privacy, especially during the video consultations. Strict legislation must be implemented to safeguard patient privacy if violated.
There is some amount of limitation in prescribing certain medicines, e.g., psychotropic drugs, narcotic drugs, etc. This is to ensure safe medication practice, and the public should be made aware of the same.
Data breach due to cyber attacks is one of the significant threats in the technological era. Improved cybersecurity strategies should be adopted to ensure better data safety.
Digital health interventions provide immense opportunities for health system strengthening and can be a vital tool in the current public health emergency. Although there are numerous challenges, a continuous urge to move towards digitisation is an eye-opener to policymakers and the higher authorities. Tele-health is an attractive, effective, and an affordable option for digitisation. The government, insurers, and health care professionals should function together and ensure that the digital spark provided by the COVID-19 endures and accelerates even after the pandemic ends.
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Ms. Jayakumar is a public health researcher and former Research Coordinator at Chest Research Foundation, Pune and Mr. Veepanattu is a public health professional, who is affiliated with Amrita Institute of Medical Sciences, Kochi, Kerala as a Research Consultant. The views expressed in the article are personal to the authors