ROLE OF TELEMEDICINE ON INDIAN ECONOMY

INTRODUCTION

“Telemedicine is the natural evolution of healthcare in the digital world,” 1 according to the
American Telemedicine Association (ATA). Telemedicine has been described by the World
Health Organization (WHO) as “the provision of healthcare services, where distance is a critical
factor, by all healthcare professionals using information and communication technologies to
exchange valid information for the diagnosis, treatment and prevention of illness and injury,
research and evaluation, and for the continuing education of healthcare providers, all in the
interests of advancing the health of individuals and their communities.”2 “Literally, the term
telemedicine translates to 'healing at a distance.' In comparison to other practices such as
education, research, health monitoring, and public health promotion, it is also used as the
umbrella term to cover health care delivery.”3
HISTORICAL PERSPECTIVE
Telemedicine's allure lies in its ability to transmit medical knowledge over a distance. In the first
half of the 20th century, the first recorded record of telemedicine was when ECG was distributed
via telephone lines. “Inventions such as electrical telegraph and telephone played a crucial role in
introducing, as we know, modern telemedicine. In a shorter time, telephones were able to serve a
much larger community, as dialing '911' or '101' provided quicker access to emergency medical
services.”4

“Radio News magazine's April 1924 issue carried with it a new dream about future public health.
The cover showed a patient at the other end with a TV and microphone to connect with a doctor;
it was really just a fantasy then because TVs had not yet come into vogue.” 5 In 1959, when
University of Nebraska physicians used digital telemedicine, the first recorded record of real-
time (live) video consultation occurred for transmitting neurological checks.

“When NASA first used telemedicine facilities during the 1985 Mexico City earthquake, and in
1988, during the Soviet Armenia earthquake, where the total fatalities were more than 50,000,
1
Americantelemed.org. [cited 2019 Feb 01]
2
2nd ed. Geneva, Switzerland: WHO press; 2010 [cited 2019 Feb 1].
3
Wilson LS, Maeder AJ. Recent directions in telemedicine: Review of trends in research and practice. Health
Inform Res 2015; 21:213-22.
4
Available from: http://mdportal. com/education/history-of-telemedicine/.
5
Americanradiohistory. com. [cited 2018 Dec 01].
telemedicine discovered its place in disaster management.” 6 Satellite technologies used in
telemedicine proved to be important in overcoming technical boundaries with the interruption of
all other forms of communication and made a mark in history.

The creation by NASA of the MITAC (Medical Informatics and Technology Solutions
Consortium) commercial space centre at Yale University in 1997 paved the way for the current
pattern of private involvement in public health administration using telemedicine.

TELEMEDICINE IN INDIA

“India is a vast country with a population of over 121 million. Because of this fact, the fair
delivery of healthcare services has consistently proved to be a major priority of public health
management. In comparison, the latest trend in the concentration of healthcare facilities in towns
and cities (including 75% of the population of physicians) away from rural India, where 68.84%
of the national population lives.”7

“With a telemedicine pilot project in 2001, ISRO (Indian Space Research Organization) made a
modest telemedicine launch in India, connecting Chennai's Apollo Hospital with the Apollo
Rural Hospital in Aragonda village in Andhra Pradesh’s Chittoor district.” 8 The steps taken by
ISRO, the Information Technology Department, the Ministry of Foreign Affairs, the Ministry of
Health and Family Welfare and the Government of the State have played a crucial role in the
development of telemedicine services in India.

The Government of India's Ministry of Health has taken on initiatives such as the Integrated
Disease Surveillance Project (IDSP), the National Cancer Network (ONCONET), the National
Rural Telemedicine Network, the National Medical College Network and the Interactive Medical
Library Network in an effort to unify the available public health data and provide easy access.
The establishment of formal telemedicine practise standards by the Government of India's
Department of Information Technology and the establishment of a National Telemedicine Task
Force by the Ministry of Health in 2005 were some of the government's other positive measures.

6
Available from: https://www.nasa.gov/content/a-brief-history-of-nasa-s-contributions-to-telemedicine/.
7
Censusindia.gov.in. (2012). CENSUS OF INDIA. [online] GOI. [cited 2018 Dec 2].
8
ISRO Telemedicine Initiative [Internet]. Televital.com. [cited 2019 Feb 1].
“As an initiative of the External Affairs Ministry, foreign initiatives such as the Pan-African
eNetwork Project and the SAARC (South Asian Alliance for Regional Cooperation)
Telemedicine Network Projects have also been taken up, strategically putting Indian
telemedicine in the global scenario.”9

Prominent examples of successfully developed telemedicine facilities in India are mammography

services at the Sri Ganga Ram Hospital, Delhi; oncology at the Regional Cancer Centre,
Trivandrum; surgical services at the Sanjay Gandhi Postgraduate Institute of Medical Sciences,
School of Telemedicine and Biomedical Informatics, and many more. “Telemedicine is often
used in areas where large communities occasionally converge frequently at a time when
delivering medical services becomes the need of the hour; for example, during Maha
Kumbhamelas, the Government of Uttar Pradesh performs telemedicine.”10

Telemedicine is one of the sectors that have been influential in invoking a strong interest in the
private sector and taking an important role in the management of public health. Narayana
Hrudayalaya, Apollo Telemedicine Enterprises, Asia Heart Center, Escorts Heart Institute,
Amrita Institute of Medical Sciences, and Aravind Eye Care are some of the current major Indian
private sector players in telemedicine. “They work with funding from the governments of the
central and state governments and from Organizations such as ISRO, which are driven by
relevant and upgraded technologies.”11

ISRO's telemedicine network has come a long way in the last three years. 45 remote and regional
hospitals and 15 mega specialist hospitals have been extended to be linked. The remote nodes
include the Andaman and Nicobar and Lakshadweep islands, the Jammu and Kashmir hilly
areas, Orissa Medical College hospitals, and some of the other states' rural/district hospitals.

9
Ministry of External Affairs, Government of India [Internet]. Mea.gov.in. [cited 2018 Dec 01].
10
Mishra SK, Ayyagari A, Bhandari M, Bedi BS, Shah R. Telemedicine application in maha kumbhmela (Indian
festival) with large congregation. Telemed J E Health 2004.
11
Dasgupta A, Deb S. Telemedicine: A new horizon in public health in India. Indian J Community Med 2008;
33:3-8.
CURRENT SCENARIO IN INDIA

“The WHO proposes a 1:1000 doctor-population ratio, though India's actual doctor-population
ratio is just 0.62:1000.”12 The preparation of new doctors is time-consuming and pricey, so it can
be predicted that the doctor-to-patient ratio will stay poor for a long time to come. This shortfall
consists mainly of successful telemedicine programmers in different parts of the world. The
country's telemedicine facilities fall under the joint authority of the Ministry of Health and
Family Welfare and the Information Technology Agency. MoHFW's Telemedicine Division,
GOI, has set up a National Telemedicine Platform, the creation of a National Medical College
Network (NMCN) to interconnect medical colleges nationally for e-Education purposes, and a
National Rural Telemedicine Network for e-Healthcare delivery to incorporate an e-health green
field initiative.

“The National Digital Health Authority of India (NDHAI)/National e-health authority (NeHA) is
part of the e-health arm of the National Health Portal (NHP) with the aim of ensuring high-
quality health facilities for all Indians through the cost-effective and healthy use of ICTs in
health and health-related fields.”13

In order to ensure stable transfer of data during telemedicine practises, MoHFW has in 2013, it
established a set of guidelines for Electronic Health Records (EHR) and an updated version of
the same in 2016. “In India, telemedicine activities are also applied to conventional medicine
areas. The National Rural AYUSH Telemedicine Network seeks to facilitate, by telemedicine,
the value of conventional methods of healing to a wider population.”14

“Village Resource Center (VRC): ISRO has developed the idea of VRC to provide a number of
resources such as tele-education, telemedicine, online decision support, advisory services for
interactive farmers, tele-fishery, e-governance services, weather services and water management.
In addition to serving as learning centres, the VRCs also provide access to specialty clinics, thus
adding to the villages the expertise of specialist physicians. Almost 500 such VRCs in the
country have been created.”15
12
Density of physicians [Internet]. World Health Organization. [cited 2018 Dec 03].
13
NeHA. National eHealth Authority (NeHA) | National Health Portal of India.
14
AYUSH. AYUSH Telemedicine report [Internet]. Ayush.gov. in. 2018 [cited 2019 Jan 01]. Available from:
http://ayush. gov.in/sites/default/files/report%20on%20TeleMedicine_1. pdf.
15
Mishra SK, Singh IP, Chand RD. Current Status of Telemedicine Network in India and Future Perspective.
“Another internet-based mobile telemedicine conglomerate that comprises several hospitals,
mobile medical specialists and mobile rural units/clinics is AROGYASREE. The project is an
initiative of the Indian Medical Research Council (ICMR). They also partnered with a team of
researchers from the University of Karlsruhe, Germany, who are working on the creation of an
ECG jacket that can be used without hospitalization to constantly track the ECG of a patient.”16

CURRENT SITUATION OF COVID – 19 AND TELEMEDICINE IN INDIA

There were over 2.5 million confirmed cases of Covid-19 around the world as of April 21, 2020,
with nearly 180,000 fatalities. This worldwide pandemic is also sending shockwaves across the
global economy as the human burden of COVID-19 rises. The healthcare sector begins to grow
and respond to the exceptional demands of the Covid-19 epidemic to tackle the corona virus.
Forced by the constraints exercised by covid-19, all primary care physicians and healthcare
providers globally are embracing digital options to deliver patient care.

Accessibility in the Indian healthcare sector has been a perennial problem. India has a shortfall of
about 600,000 doctors and 2 million nurses, according to a survey by the Centre for Disease
Dynamics, Economics & Policy (CDDEP) in the US. Telemedicine will boost healthcare for the
largely rural population of India. Main developments shaping healthcare technology use include
the Digital India Mission encouraging broader mass acceptance of technology, deeper
penetration of smart phones and mobile applications, omnipresent last-mile access, and
affordable data plans.

Telemedicine is a fusion of medical research and information and communication technology.

The Indian government is committed to providing everybody with fair access to quality care, and
digital health is a vital enabler for the health system's overall transition. India's digital health
policy promotes the use of digital technologies to boost the healthcare system's productivity and
outcomes and focuses significantly on the use of telemedicine services, especially at the
grassroots level in the Health and Wellness Centers, where a mid-level provider/health worker
may link patients to doctors across technology platforms to provide timely and best.

I am surely delighted to see the new structure drawn up by the Government of India. The use of
telemedicine solutions to treat corona viruses has been improved. On March 26, 2020, the
16
ICMR Project [Internet]. Dos.iitm.ac.in. 2018 [cited 2019 Jan 08].
Ministry of Health released telemedicine guidance authorizing clinicians to write telephone-
based prescriptions that minimize transmitting risks for both medical professionals and patients.
It also decreases the inconvenience/impact and social variables for families and caregivers. In
determining who needs to be checked for Covid-19, virtual visits allowed by telemedicine will
prove very successful and beneficial. Tele health is mainly a means for frontline doctors to
administer Covid-19 and other urgent-care screenings.

Telemedicine and telehealth could turn out to be the easiest and quickest way to not only cross
the rural-urban health gap, but also to handle the Covid-19 crisis in the current scenario. Given
the pace at which Covid-19 engulfs our medical personnel, it could lead to a devastating situation
if physicians, nurses and paramedical workers need to be quarantined. Without exposing
personnel to viruses/infections at the time of such outbreaks, a telemedicine-enabled virtual visit
by registered medical practitioners (RMP) may be carried out, thereby avoiding the spread of
infectious diseases and reducing the risks to both health care workers and patients.

For our strained healthcare system, telemedicine is a safety net. In filtering and short listed the
most severe patients who require hospitalization, taking the telehealth path will help. Via
teleconferencing, physicians will monitor the symptoms of patients, inform them about medicine,
precautions, and testing needed, and send them to a health care provider if their symptoms
worsen. Arrangements for pathologists to be able to take samples from home must also be made.

Also, at any given time, approximately 5% to 10% of the population would need any type of
healthcare services. For those with non-Covid-19 health conditions, imposed mass quarantine
would make it very hard to access hospitals. These patients may be remotely screened using
telemedicine, thereby providing easy access to RMPs that might not be readily accessible in
person at a distant venue.

Indian healthcare institutions that have invested in telemedicine are well placed to ensure that the
care they require is provided to patients with Covid-19 forms of problems. When physicians and
nurses have access to more data, the quality and efficacy of treatment improves exponentially. A
detailed system for applications, mode of communication, medical ethics, data protection and
secrecy, paper specifications, fees, procedure, drug list, technology platforms and more will be
given. We do face some obstacles, though. Though millennials are tech-savvy, Indian medical
professionals, especially more seasoned senior doctors in general, are not computer-savvy, with
regard to the application of information and communication technology in medicine, practically
lacking knowledge and visibility. These are primarily bottlenecks in India's telemedicine growth.

To conclude, crises and pandemics face specific threats to healthcare provision. While
telemedicine can not cure it all, it is better tailored to situations in which patients can be
examined and treated by medical practitioners. In health services, the introduction of
telemedicine would minimize disparities and barriers to entry. While the future beyond Covid-19
is impossible to foresee, we anticipate this to be a major point of inflection in the use of virtual
treatment.

IMPACT OF TELEMEDICINE ON ECONOMY

Most notably, telemedicine can be a particularly cost-effective delivery process. Telemedicine

helps physicians and patients to bridge the distance and time gaps that divide them when treating
patients directly, which in turn decreases costs for both parties. In a study conducted by the
Center for Leadership in Information Technology, it was revealed that telemedicine is critical in
lowering total healthcare costs and generating revenue growth. The study projects that extensive
use of telehealth services to facilitate preventive treatment, early detection and productive
exchange of knowledge could save $3.61 billion annually for the United States. Telemedicine
lowers travel costs, especially for people living in remote areas where they would usually have to
travel hours out of their way to reach essential health facilities.

In addition, the number of days off work people take for regular appointments has a major
negative financial effect, particularly with regard to missed wages. “According to the recent
report, 92% of patients saved $32 in transportation costs; 84% saved $100 in wages; and 74%
saved $75-$150 in family expenses. Perhaps more shocking, in situations where office visits are
not possible, $1.2 billion may be saved by video meetings with doctors and patients. Moreover,
with a telemedicine appointment, certain services currently charge less than they do for a face-to-
face visit.”17

According to an EY-IPA report which said the domestic telemedicine market will hit USD 5.5
billion by 2025; the Indian healthcare industry needs to move from conventional in-person
17
http://accesstelehealth.org/benefits/lower-cost
doctor-patient contact to digitally-enabled remote consultations. "15-20 percent of the healthcare
environment is expected to move to virtual treatment, through triage, referral, online supervision,
home wellbeing, etc., the report,’ Healthcare goes mobile: Modern Normal's evolution of
teleconsultation and e-pharmacy’ said.

The exponential growth led by accelerated digitisation, however, could face problems related to
data protection and drug replacement for patients. In the interest of patients and customers, there
is also an urgent need for a robust regulatory system, it said. "For the period 2020-25, the
telemedicine market in India is expected to grow at a compound annual growth rate (CAGR) of
31% and to reach USD 5.5 billion," the study said. Digital treatment is comprised of
teleconsulting, telepathology, teleradiology and e-pharmacy, and due to the pandemic, it added,
is experiencing a motivating stimulus in India. This stimulus has the potential to account for
about 95 percent of the telemedicine industry in teleconsultation and e-pharmacy by 2025, which
amounts to USD 5.2 billion, the study said.

The opportunity to increase sales is another economic advantage of telemedicine. When time and
distance health care barriers are reduced, the usage of facilities is expected to increase and the
increased demand usually produces incremental profits. Hospitals that used telemedicine
technologies and referred patients to other hospital services, especially children's facilities, saw
their income rise dramatically, according to a new report of Telemedicine and e-Health. The
report analysed the billings of 16 hospitals before and after the introduction of telemedicine
instruments. The 16 hospitals reported 143 move patients prior to telemedicine implementation.
The number rose to 285 after deployment, resulting in a rise in sales, moving from $2.4 million
to $4 million.18

It has also been found that telemedicine eliminates the need for re-admissions to hospitals, which
can be expensive for both patients and health care providers. It also has added incentives, in
addition to the persuasive economic advantages of telemedicine, which some argue greatly
outweigh the expense considerations. For starters, patients are now able to see physicians who
are specially qualified in the patient's case because of quicker and improved access.

18
http://healthworkscollective.com/waxcom/116071/using-telemedicine-increase-hospital-revenue.
This encourages more personalized treatment and thereby facilitates contact between physician
and patient, leading to higher levels of patient satisfaction. In comparison, telemedicine helps
build a more comprehensive network of healthcare specialists, enabling medical consultation
services to be linked internationally and diagnosed with only a click of a button. For both
professionals and patients, this provides tremendous benefit.

According to the report, in the next five years, India's e-pharmacy market is expected to hit 10-12
percent of total pharmaceutical revenue, led by strict legislation, increased funding and digital
infrastructure creation, he added. Consumer behavior and patterns are evolving rapidly as the
COVID-19 pandemic poses unparalleled challenges. Traditional forms of in-person doctor-
patient engagement are digitally allowed by virtual consultations with the latest principles of
'social distancing,' Secretary-General Sudarshan Jain of the Indian Pharmaceutical Alliance
(IPA) said. Although technology will be a big enabler, changing legislation can safeguard areas
of patient privacy that are important to healthcare, he said.

"Sriram Shrinivasan, Partner & Leader of EY India Life Sciences, said: “With the current levels
of patient and physician adoption together with evolving technology and ecosystems, India is
well positioned to extend the digital health ecosystem.” There is a need for a clear regulatory and
governance structure for wider acceptance and use that provides the right support for
development, he added.

CONCLUSION

Telemedicine cannot be the solution to all problems, but in solving a large variety of problems, it
can be very important. In the world of healthcare, facilities such as tele-health, tele-education
and tele-home healthcare are proving to be wonders. In the emergency relief sector, the
importance of satellite communications is highlighted when all terrestrial means of
communication are interrupted. The world is moving closer to multinational telemedicine
programmers and distance is no longer a hurdle to delivering quality healthcare. Despite
possessing so much promise, telemedicine has not yet experienced the 'boom' it was supposed to
produce. It is held up by a lack of understanding and adoption of emerging technologies by both
the public and practitioners. Governments are already beginning to take a strong interest in the
growth of telemedicine practices, resulting in a gradual but steady increase in public health use.
Hopefully, in a few years, the practice of telemedicine would achieve its true potential.