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| REVIEW ARTICLE |
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| Year : 2023 | Volume
: 13
| Issue : 1 | Page : 26-31 |
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Telemedicine: Zero Contagion risk and enabler of healthcare fire sales
Neha Ghildiyal, Monika Bangari
Management (Hospital Administration), Shri Guru Ram Rai University, Dehradun, Uttarakhand, India
| Date of Submission | 25-Jun-2022 |
| Date of Decision | 08-Sep-2022 |
| Date of Acceptance | 23-Nov-2022 |
| Date of Web Publication | 24-Feb-2023 |
Correspondence Address:
Dr. Neha Ghildiyal
Shri Guru Ram Rai University, Patel Nagar, Dehradun, Uttarakhand
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/cmrp.cmrp_57_22
India has made remarkable progress in ease of doing business, competitiveness and technological innovation in the past few years. During the COVID-19 pandemic, telemedicine entered the healthcare sector as a boon. Telehealth witnessed accelerated adoption during the COVID-19 pandemic, finding its niche amongst the emerging digitally enabled India. Medical centres are responding to the needy through the use of digital tools and technology, such as telemedicine and virtual care, along with various other virtual means. This research paper discusses the application of the Internet and other related technologies in the health sector for improving access to and efficiency, efficacy and quality of clinical and corporate processes used by healthcare organisations, physicians, patients and consumers to improve the health status of patients. The use of telemedicine during the pandemic has experienced rapid growth. This study essentially focuses on the importance of telemedicine during such trying times. The literature review was performed to study the importance, advantages and disadvantages of telemedicine in India during the pandemic. In addition, research articles, and databases, including Google Scholar, PubMed and Ovid MEDLINE, were searched to study the changes that are rapidly entering the healthcare sector and the efficacy of the concept of telemedicine for patients.
Keywords: COVID-19, digitalisation, healthcare providers, telemedicine, virtual care
How to cite this article:
Ghildiyal N, Bangari M. Telemedicine: Zero Contagion risk and enabler of healthcare fire sales. Curr Med Res Pract 2023;13:26-31 |
| Introduction | |  |
Telemedicine is a facility that uses telecommunication to provide healthcare services to individuals who are at a distance from health facilities and healthcare providers.[1],[2] It may involve technologies such as facsimiles, medical data transmission, audio-only format (telephone and radio), still imaging and full-motion videos; apart from these, robotics virtual reality interfaces are being used at selected facilities and have not been introduced everywhere.[2] Telemedicine also includes various diagnostic services, such as teleradiology, telepathology, telecardiology and teleorthology.[3]
The coronavirus has adversely and drastically affected the world population. It has also affected the healthcare system across the globe. Delivery of primary healthcare was a big challenge during the COVID-19 times; it was because delivery was hindered by several factors such as risk and fear of transmission of infection from patients to healthcare providers and vice versa, lockdowns, inadequate protective gear and several others.[4] In order to better deal with and manage the pandemic, the physical treatment of patients was replaced with digital treatment, that is, with the use of telemedicine.[5]
Healthcare providers using telemedicine include patient medication history, health awareness and education, health therapy management, review of drug use remotely, diagnosis of the disease other than COVID, follow-ups of patients and measurement of vitals.[5] Virtual care and telemedicine not only provide effective and hassle-free patient care, but also they help in maintaining social distancing, managing long waiting time and eliminating the risk of disease progression and spread.[6] Thus, telemedicine and virtual care have been suggested as two important methods to deliver and maintain a continuum of healthcare for patients.[5] Moreover, for these reasons, the use and prevalence of telemedicine and virtual care had increased during the pandemic.
However, there still is a lot to be done in this area; currently, very few patients and healthcare providers (doctors) are aware of the proper use and handling of these digital services. The number of physicians and patients who are educated and have adequate knowledge on how to utilise and handle digital services in the best ways is less.[5] Therefore, there is a need to provide certain standard operating procedures, guidelines and recommendations to educate both physicians and patients on how they can use telemedicine and virtual care to their fullest potential in order to deliver the best healthcare services to the needy.[7]
| Literature Review | | |
This study explored the public myths and facts about the role of telemedicine in India. At the national and subnational levels, there is also evidence of governmental interest in the benefits that technologies might bring to healthcare. A study by Perrone et al.[8] showed that telemedicine aided traditional medicine in delivering healthcare under circumstances in which distance is a critical issue. Along the same lines, Garg et al.'s study focused on the use of electronic information systems in telemedicine and telehealth to facilitate care from a distance.[9] Telemedicine, where medicine and information, and telecommunications technology, meet, is probably the part of this revolution that could have the greatest impact on healthcare delivery.
According to Perrone et al., although this tool has not replaced medical examination, it has reduced the spread of infection and the need for patients to come to the hospital to visit their doctors during the pandemic.[8] The use of telemedicine has been of great help in terms of providing the platform to continue treatment in various critical departments such as oncology, haematology, dermatology and internal medicine. The conclusion of the study by Perrone et al.[8] was that COVID-19 has given a positive input in accelerating and enhancing these digital tools; telemedicine has and will provide immense and valuable support to healthcare providers by streamlining and facilitating their work.
In countries with unstable or weak economies where healthcare services are often not a priority, telemedicine also permits access to services that would not otherwise be available. The study by Garg et al.[9] aimed to identify the impact of the pandemic on lower-middle-income countries like India and review the current measures in telemedicine that have been adopted during the pandemic. The objective of the study was to analyse how telemedicine has helped in screening for COVID-19 symptoms, delivery of routine needs and follow-up care for patients. Mongesh and Hajizaldeh[6] did a similar study that focused on the importance and role of telemedicine and telehealth services during the pandemic. The main objective of this systemic review by Mongesh and Hajizaldeh was to bring out the significance of telemedicine and telehealth services in the prevention, diagnosis, treatment and control of disease during the COVID-19 outbreak. As per the conclusion and findings of their study, clinicians, healthcare providers and patients were strongly suggested and recommended to apply telehealth tools and techniques to prevent and control COVID-19 infection.[6]
Telemedicine has played an important role in the treatment and monitoring of specific diseases as well. One of the examples is that of diabetes and its associated complications. The study by Galiero et al.[10] focused on the importance of telemedicine in the treatment of diabetes and related complications of monitoring during the pandemic; this use of telemedicine has been increasing remarkably due to the increased risk of poor prognosis. As per the study, the involvement of telemedicine in diabetic retinopathy has helped in its early screening. The spread of COVID-19 had limited the possibility of tracing the actual management of the disease, which is only extractable from previous evidence under normal conditions. This pandemic also highlighted the importance of remote monitoring. Along the same lines, Galiero et al.'s study focused on to increase the accessibility to the deployment of the device and digital application used by general practitioners to increase the screening of individuals and monitor the progressions of retinal disease.[10]
Telemedicine can improve access to health services and information, even in urban areas. Telemedicine has also been shown to improve the consistency and quality of healthcare. It may sometimes also be cheaper than conventional practice, although, as previously mentioned, scientifically sound economic appraisals of telemedicine applications are only beginning to appear. Furthermore, as John Craig and Victor Patterson mentioned in their work, 'Telemedicine can be expected to improve equity of access to healthcare, the quality of that care, and the efficiency by which it is delivered' by enhancing communication up and down the healthcare pyramid.[11]
| Research Methodology | | |
Objectives
- To bring out the advantages and disadvantages of telemedicine as an enabler of healthcare
- To understand the importance of telemedicine in providing hassle-free and effective healthcare services during the pandemic (COVID-19).
Methodology used
Secondary data have been used in this review. Data have been collected from various sources such as websites, journals, the Internet, books and magazines. The result of the study is that although telemedicine is a very important digital tool from patients' as well as physicians' points of view, there is a lot that can be done in order to educate both on the guidelines of telemedicine use in effective ways.
Advantages and disadvantages of telemedicine
Telemedicine is one of the virtual methods of providing medical care through an online platform. Telemedicine offers several advantages and disadvantages for both patients as well as healthcare providers.
Advantages for patients
- Saves transportation time and cost: Seeing a doctor on a mobile phone or a laptop/computer saves money and time indulged in public transportation and parking. Furthermore, patients do not have to waste time traveling or risk running into traffic jams which most of the time makes one late for appointments or results in getting late back to work[6],[12]
- Saves time at work: When we talk of telemedicine, it enables one to save time during work. Video visits largely remove the need to take time off work. One can schedule an appointment during breaks or before and after working hours[13]
- Reduces child or elderly care issues: Telemedicine has made it possible for us to take care of ourselves as well as fulfil the responsibilities we owe to children or older ones at home. Telemedicine allows seeing your doctor while fulfilling your family responsibilities
- On demand: During the time of the pandemic, demand for telemedicine increased drastically. More numbers of physicians have begun to offer telemedicine these days. They cannot treat all people and every disease using telemedicine but can tackle and deal with many problems via videos/online platforms[6]
- Access to specialists: When it comes to serious health issues, telemedicine allows leveraging the expertise of specialists who are not nearby. Telemedicine is of great help to patients who need care and consultations from specialists but cannot travel long distances and invest a huge amount of time on each visit[2],[12],[13]
- Reduces the chances of catching new illness: As we know, telemedicine involves communicating with patients via online platforms; therefore, one can mostly get the required care sitting back at their home only, rather than standing outside the clinics in long queues for long hours and increasing the chances for catching infections in addition to the disease they are already seeking treatment for. During the pandemic, telemedicine played a great role in decreasing the chances of the spread of the virus by maintaining social distancing norms as it made the use of online platforms[8]
- Eliminating the waiting time: Telemedicine has reduced or eliminated the waiting time at doctors' clinics as telemedicine allows patients to receive treatment sitting in the comfort of their homes itself[6]
- Better health: The patient is able to see his/her doctor whenever and wherever he/she wants without any hassle of having to visit the clinics or hospitals. Along with this, one can practice better management of medicine, lifestyle and any chronic condition one might have. These all things add to better patient care and health[13]
- Medical access to patients in rural areas: For people and patients who live in places far from healthcare facilities, telemedicine holds great advantages[13]
- Reduces anxiety: Some people experience anxiety when they enter hospitals; telemedicine was a boon for such people as they could consult online and did not have to visit the hospital in person.
Disadvantages for patients
- Although most insurance companies cover the cost of telehealth visits, sometimes all services are not covered by them, increasing the burden on the patient's pocket
- The security of the personal information shared by the patient with the physician online is another matter of concern[12]
- It may not be possible to do everything virtually as some diagnosis requires hands-on approach[2]
- If a patient needs emergency care, providing it through telemedicine first may cause delay in the treatment. Furthermore, the doctors might not be able to give lifesaving treatment online[13]
- The patient's satisfaction level may not be the same as what the patient experiences in a traditional method in which they can physically interact with the doctors in their clinics.[14]
Advantages for healthcare providers
- Reduces/decreases overhead costs: Healthcare providers giving healthcare services digitally through telemedicine bear fewer overhead costs. For example, they may pay less for front desk support or be able to invest in office spaces with fewer rooms, reducing the overhead costs[2],[12]
- Generates more revenue: As telemedicine helps in connecting to a greater number of patients, it helps in generating more revenue for the organisation or healthcare provider[6]
- Reduces the chance of catching infection and illness: As physicians see patients online, it helps in decreasing the chances of catching illness or infection from infected patients[6],[8]
- Increases patient satisfaction: As the patient gets all required healthcare services sitting back at home, he/she does not have to travel, which increases the patient's satisfaction level. Satisfied patients prove to be very important for any healthcare provider
- Healthcare providers get to stay home, too: During the time of the pandemic, many healthcare providers opted for telemedicine in order to communicate with their patients, as exposure to probable infection was not safe for them as well. Therefore, telemedicine also allows physicians to treat their patients through online platforms while sitting in their homes.
Disadvantages for healthcare providers
- Issues related to licensing: State laws vary as clinicians are, in some places, not allowed to practice out of the states for which they are licensed. It depends upon the state for which the clinician holds a license and also to which the patient belongs[12],[13]
- Technological factors: Telemedicine totally depends upon technological factors such as the Internet and connectivity, as poor connectivity may hinder the delivery of care to the patients[13]
- Examining patients is difficult: A physician is unable to physically examine the patient when using telemedicine. Some conditions or ailments require a physical examination of patients, which is not possible through telemedicine.[12]
| Role of Telemedicine During COVID-19 | | |
Telemedicine has stepped out in the spotlight during the pandemic, helping out healthcare providers and their organisations to better respond to the needs of the people and patients who contracted the virus[7] and also the patients who needed to touch base with their providers on status of their health.
Telemedicine has made a very positive contribution to the healthcare sector during the times of COVID-19 and is still being used in a variety of ways in order to help the needy.[7] However, along with these facilities, telehealth also has some limitations and restrictions when it comes to treating patients during times like the COVID-19 pandemic. Many hospitals and healthcare workers are still learning how to adapt to and utilise telehealth to the fullest.[5]
During the times of pandemic, telemedicine arose to provided medical assistance not only in rural areas but also in other areas where access to care became very difficult. Moreover, it also aims to deal with chronic disease management, mostly in emergency settings.[15],[16]
Over the years, it has been seen that an epidemic or pandemic situation always leads to the employment of increasingly novel digital technology strategies, and this is what also triggered the use of telemedicine, much frequently, such as during 2003 in case of SARS epidemic and later on in 2013 MERS-CoV.[4] [Figure 1] illustrates the role that telemedicine has played during the COVID-19 pandemic.
| Community | | |
Telemedicine platform during the times of COVID-19 provided the latest information in real time, which included instructions on how to get oneself quarantined at homes, personal protection applications and right time to seek medical assistance.[4] It also played a crucial role in educating vulnerable population including pregnant women, cancer patients and diabetic patients. Telemedicine also provided an online consulting helpline clinic which had some physicians/experts available 24 h/day. These experts helped telling symptoms, screening and suggesting appropriate medication for the needy. This not only helped to maintain social distancing but also helped to relieving pressure from designated hospitals for COVID-19 patients.[4],[6],[17]
Patients
People with positive symptoms were able to consult doctors via telemedicine platforms as these teleconsultation services were available at various places. Healthcare providers conducted screening of patients online and, wherever required, gave suggestions whether to continue staying isolated at their homes or if there was a need to go to a hospital.[17] Non-severe cases were asked to stay back at their homes from where they could consult their doctor or expert from time to time and know about their medication and other measures that were needed to be taken for recovery. For severe cases with severe illness in some remote areas, communication was arranged via telemedicine.[7]
Patients who had recovered from COVID-19 were followed up using telemedicine only. Telemedicine was of great help in keeping record and maintaining data of patients from initial triage to post-discharge. Telemedicine not only saved time and cost, but also it decreased the risk of spread of infection by eliminating the chances of contact between patients and healthcare providers.[17]
Healthcare providers
As medical staff resources are distributed heterogeneously across the globe, the level of medical treatment and care also varies accordingly. Many regions do not have intensive care units (ICUs), or adequate and competent ICU medical staff to deal with critical patients infected with COVID-19. Along with this, many hospitals deal with infectious diseases but somewhere lack knowledge and experience to deal with management of critically ill patients. Medical experts also differ in their experience, training and resources with regard to the patient's management including oxygen therapy, intubation training and also application of therapeutic agents like corticosteroids.[17]
It was utilisation of telemedicine platforms that helped carry out pandemic control activities across the globe. This was possible through telemedicine which ensured sharing of videos in a secure and protected environment and also conducted training for healthcare experts in various countries. Various panel discussions were possible wherever required via telemedicine/online platforms.[7] Healthcare experts working in ICU are prone to infectious diseases, and even more in the times of pandemics; however, even they could get connected to give their valuable suggestions in a panel discussion and training sessions conducted online via telemedicine.[7] Many healthcare workers also participated worldwide via video conferences in topic including diagnosis, respiratory support, circulation, immunisation, personal protection, psychological counselling and management of critically ill patients with COVID-19.
A Shandong province expert group invited Chinese authorities to use 'cloud ICU' platform to share their experience, via telemedicine, on how to manage patients critically ill with COVID-19, in order to mitigate the global spread of COVID-19.[17]
| Conclusion | | |
COVID-19 is an entirely new disease with various types of information floating on media and the Internet. Telemedicine is a platform which helps to maintain social distancing and also provides correct and reliable information to medical experts as well as patients. It is a platform where medical staff can communicate with the colleagues, listen to useful related lectures and apply for consultations. Furthermore, patients can opt for online treatment, consult doctors, maintain their follow-ups, etc., On the other hand, telemedicine also faces some drawbacks such as technological problems including connectivity, and licensing issues. However, the drawbacks are overshadowed by the advantages which telemedicine provides to healthcare providers and patients.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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