What is telemedicine?
Telemedicine is an all-encompassing term for providing remote virtual healthcare with the healthcare provider and the beneficiary physically in different locations. Information and communication technology (predominantly the internet ) is used for history taking, reasonable relevant clinical examination and review of any investigations available. Telemedicine-enabled devices such as the thermometer, torch, stethoscope, BP apparatus, ECG, glucometers etc. convert the patient’s location to a clinic. The diagnosis (provisional or final) is communicated to the patient electronically along with specific advise including a prescription.
When did telemedicine start?
The world’s first telephone call made by Alexander Graham Bell on March 10, 1876 was actually a request for medical help. “Watson, come here I want you,” he said after acid from a Leclanche cell fell on his hand. From 1925, the radio was used on and off to make medical diagnosis. In 1970, a telemedicine link was established between Mass General Hospital Boston and the Logan Airport in Boston. In India formal telemedicine commenced on March 24, 2000 when Bill Clinton commissioned the world’s first VSAT (ISRO supplied)-enabled village hospital at Aragonda, the birth place of P.C. Reddy, chairman, Apollo Hospitals.
What are the components of telemedicine?
Technical requirements include hardware, software, connectivity,acquisition, storage,retrieval, display, while health care providers have to be oriented, trained, helped with customisations, to be cost effective, self-sustaining, and follow all the regulations in order to be future-ready.
Can prescriptions be given remotely?
Yes. The recently notified Telemedicine Practice Guidelines enables Registered Medical Practitioners to send prescriptions electronically. There are several in built safety methods to prevent abuse of the system. Pharmacists have to dispense from a digital screen with the doctor’s registration no and fascmile of the signature.
What are the different types of telemedicine
Different modalities includes a)Telephonic consultation, b)Chat mode, c) Whats App, d)SMS, e) Video consult, f) Proper full-fledged telemedicine using an approved EMR (Electronic Medical Record) where case records, images, investigations, teleconsults can be stored, retrieved and a good video camera is used for interaction. Peripheral medical devices located remotely can be controlled and results obtained in real time.
Are there any limitations in using telemedicine?
Yes ! No ! No !
Technology is only an enabler, not an end by itself. The decision when to limit use of Telemedicine and insist on a face-to-face consult is always a clinical decision. The context, professional judgement and the patient’s interest alone matter. Some doctors may be satisfied with an ultrasound image showing a mass in the pelvis. Others may want to do a rectal examination. Patients may not be comfortable without seeing the doctor face-to-face at least for the first time.
What is the future of telemedicine?
The ‘future’ of Telemedicine started in December 2019. Worldwide Covid-19 is causing millions of people to try telemedicine for the first time. Telemedicine will continue to grow rapidly. Enforced habits of today will become the new normal. Life will never again be the same in the AC (After Corona) era. Gradually obligatory preferences of today will switch to a default mode. Patients may not want to return to the BC era when face-to-face consults were the norm and telemedicine was a bystander!!
With technology becoming sophisticated and automated, doctors can do what they really want to do – spend more time with the patient – rather than spend time commuting, to go to their offices. Overheads in establishing a posh office will come down.
Patients too will now have more time, avoiding the hassles of travel, and waiting outside the doctor’s room. Virtual visits can make group care possible. Today considerable time is spent and effort has to be put in to get opinion of multiple specialists sequentially. Imagine if all the specialists discuss various options with the patient together. Transparency at its highest. Shift to virtual care has always been there in India — after all the Telemedicine Society of India was started 18 years ago! COVID-19 has only accelerated the process.
(The author is also director, Apollo Telehealth Services)
