Telemedicine is termed as the remote diagnosis and treatment of patients by means of telecommunications technology, thereby providing significant healthcare to low income regions. Earliest published record of telemedicine is in the first half of the 20th century when ECG was transferred over telephone lines. Since then, telemedicine has come a long way in terms of both healthcare delivery and technology. A major part in this was played by NASA and ISRO. The setting up of the National Telemedicine Taskforce by the Health Ministry of India, in 2005, paved way for the attainment of various projects like the ICMR-AROGYASREE, NeHA and VRCs. Telemedicine also helps family physicians by giving them easy access to speciality doctors and helping them in close observance of patients. Different types of telemedicine services like store and forward, real-time and remote or self-monitoring provides various educational, healthcare delivery and administration, disease screening and disaster management facilities all over the globe. Even though telemedicine cannot be an answer to all the problems, it can surely help reduce the burden of the healthcare system to a large extent.
Introduction
World Health Organization (WHO) has well-defined telemedicine as, “the delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities.” Telemedicine is often used as an overall term to include health care delivery in addition to other activities such as education, research, health surveillance, and public health promotion.
Over the past several decades, as the use of wireless broadband technology has become more cutting-edge and cell phone and internet use has become nearly omnipresent, Patient education with pictures and videos, transmission of medical images like X-rays and scans, and real-time audio and video consultations became a reality. Development in internet infrastructure such as bandwidth communication speeds, information storage databanks, web service backups, standard formats for data transmission, encryption, password protection, HIPAA (Health Insurance Portability and Accountability Act of 1996) guidelines, digitalizing information and establishment of EMRs (electronic medical records) made e-health and telemedicine stress-free and cost effective.
Telemedicine in India
India is a large nation with a population of more than 121 crores of diverse people. Due to this statistic, the impartial distribution of healthcare services has been recognized to be a major goal in public health organization time and again. Adding to this is the recent trend of concentration of healthcare facilities to the cities and towns (including 75% of the population of doctors), away from rural India, where 68.84% of the national population live.
ISRO (Indian Space Research Organization) made a humble foundation in telemedicine in India with a Telemedicine Pilot Project in 2001, networking Chennai’s Apollo Hospital with the Apollo Rural Hospital at Aragonda village in the Chittoor district of Andhra Pradesh. Initiatives taken by ISRO, Department of Information Technology (DIT), and Ministry of External Affairs, Ministry of Health and Family Welfare and the state governments played a dynamic role in the expansion of telemedicine services in India.
In an attempt to amalgamate the available public health data and provide easy access, the Ministry of Health in the Government of India has taken up projects like Integrated Disease Surveillance Project (IDSP), National Cancer Network (ONCONET), National Rural Telemedicine Network, National Medical College Network and the Digital Medical Library Network. Laying down standardized telemedicine practice rules by the Department of Information Technology in the Government of India, and setting up of a National Telemedicine Task Force by the Health Ministry, in 2005, were some of the other progressive steps by the government. International projects like the Pan-African e-Network Project and the SAARC (South Asian Association for Regional Co-operation) Telemedicine Network Projects have also been taken up as an initiative of the External Affairs Ministry, purposefully placing Indian telemedicine in the global scenario.
According to a report by Industry Journal 24, India’s telemedicine market is developing rapidly and is impacting the worldwide economy in terms of growth rate, revenue, sale, market share and size, presenting the market size in India. India has a wide growth potential as it has broad rural-urban population and rural India is bereft of medical facilities, giving telemedicine a space for development in India. Lack of education and medical professionals in rural areas is the goal behind government’s ideology to use technology to bridge this cavity. Remote areas not only present a number of trials for the service providers but also for the families who are gain access to these services.
In 2018 and 2019, telemedicine has grown in India. It has accepted a new way for doctor consultations. This sector is at an ever-growing stage with high opportunity of expansion. This swift growth in the last year presents telemedicine as the next frontline in the healthcare. The year 2019 will be an important year for the telemedicine industry. Health data is valuable in many ways and one of them is AI (Artificial Intelligence). In future, this will help in recognizing issues related to medical health. Through IOT (internet of things) perspective medical emergencies like Asthma attack, heart failure, diabetes can be supervised via connected devices.
Role in Family Medicine
With the arrival of modern information and communication technologies (ICTs), telemedicine is now transferring health care delivery from hospitals and clinics into homes, both nationally and globally. It streamlines remote patient monitoring with the help of a CTI system enabled for 24 hour vitals monitoring. CTI system allows the family physicians to carefully monitor chronically ill patients and receive live vitals alerts when necessary. When required, telemedicine also allows a family physician, remote access to expert medical judgement for cross consultation. A good example would be consulting a cardiologist in order to reconfirm a doubtful ECG or consulting a nutritionist to express an ideal diet plan for an elderly bed-ridden patient with numerous co-morbidities.
Telehealth varies from telemedicine in that it encompasses the use of telecommunications and virtual technology to distribute health care outside of traditional health-care facilities. An example would be, virtual home health care, where patients who are chronically ill or the elderly may receive supervision in certain measures while remaining at home. Tele-health services can be of 4 types, namely, video conferencing, store and forward, m-health (mobile health) and patient monitoring.
In spite of having so many encouraging traits for assisting family physicians, telemedicine is yet to reach its complete potential in family medicine practice. Lack of appropriate scientific literature presenting the applications and cost-effectiveness of its deployment in family practice is proving to be the main constraint.
Role in Public Health
The technology used in telemedicine permits providers and patients to be almost anywhere, this is one of the key factors in providing quality healthcare to the population that needs it. With the initiation of telemedicine, distance is no longer an impediment in providing healthcare to the remote areas. The initial test for the commencement of the programme posed by the lack of a primary centre for availing telemedicine services in many remote areas was fixed with the kick-off of mobile telemedicine units with satellite communication. Now, telemedicine services can be made obtainable to all irrespective of time, place, social status or gender. Gujarat Govt.’s e-health scheme, Aravind eye hospital’s tele-ophthalmology unit at Andipatti, the idea of village resource centre (VRC) by ISRO are all instances of India’s steps towards innovation in telemedicine services.
Conclusion
Telemedicine is the roadmap for better-quality medical care in rural areas. NITI Aayog states that, the National Health Stack (NHS) is a virtual digital platform for healthcare in the country. NHS study intends to have digital health records for all citizens by 2022 to make telemedicine and E-Health easy.
However, with the introduction of Ayushman Bharat Scheme, a biggest health financing scheme, Indian government has come up with ICT (Information and Communication Technology) centring on the development of health sector in the country. This scheme comprises Tele-health development ideology for long distance medical care to make a safe, operational, proficient, patient-centred and suitable health management environment.
This combined market of telemedicine platform will have a mix attitude in the coming years. In a developing country like India, there is a lot of possibility for progress. With the communication industry growing at such a quick stride, telemedicine sector is destined to advance too.
