Prof (Dr) K Ganapathy, Manager, Apollo Telemedicine Networking Foundation and Apollo Telehealth Services, speaks with ETHealthworld about the growth of telemedicine services in India and the need for standards and accreditation in online medical consultation to continue safe clinical practice. Edited excerpts
How do you analyze the rise of online consultations after Covid-19 lockdown?
People all over the world have suddenly realized that you don’t have to be in front of a doctor physically. When we started telemedicine, connectivity was the most important issue, but now technology and connectivity are improving and costs have dropped. We have been advocating this for 2 decades, but necessity is the mother of invention.
For the next 6 months to 1 year, people will reach the phase of encompassing telemedicine from the acceptance stage, and we will realize that it is not a face-to-face replacement, but should be the default condition.
People generally believe that telemedicine is only for villages, rural areas where doctors are unavailable, but the pandemic has proven that this is not the case. In the next 2 years, telemedicine will be the new normal because the technology is also evolving to such an extent that 90 percent of the final diagnosis can be done with the patient and the physician physically located in different locations.
How have the latest guidelines for telemedicine affected the growth of Telehealth services in India?
Most important is the announcement of the guidelines for telemedicine on March 25, and it has made all the difference. Although we practiced telemedicine for the last 20 years, it was a gray area as many doctors were concerned because they did not know if it was legal or illegal to consult, especially when the patient is in a different condition.
Due to the lack of clear guidelines, a majority of the doctors who would normally have used telemedicine were reluctant to use it. This has been completely addressed by the government review, and online medical consultation is a revolutionary change.
Every government advocates for telemedicine. From being a neutral entity, they have now become proactive and almost all medical colleges will have a nodal medical officer in charge of telemedicine. This will be a huge boost to the practice of telephone health, and it is not only related to the Covid-19 situation. The pandemic has precipitated and accelerated the effort, it can run in 6 months to 1 year, but telephone health is here to stay.
With mushrooms from several telehealth providers, how crucial is the need for standards in telehealth services?
With announcements of telemedicine practices, the standards, accreditation and certification will follow soon. I am pleased to tell you that for only two weeks, the Quality and Accreditation Institute has already formed a committee that exclusively develops standards and guidelines for the accreditation of telemedicine units. I am also a member of that committee and we are in the process of preparing guidelines in a few weeks and also proposing methods for detailed guidelines.
We also hope the government establishes approval standards and enforces that no one practices telemedicine in the future unless they are certified. In the guidelines for telemedicine practice, the government has very clearly stated that because of the semi-emergency, they are allowed to practice telemedicine, but within 3 years every registered medical contraction in India must provide evidence that he has completed a course, that will be notified by the Ministry of Health. The Telemedicine Society of India hopes to be the body that will be asked to complete this course.
After 3 years when MBBS graduates show up for their exit exams, they will also be tested on telemedicine, so anyone who becomes a registered physician in 2023 has already undergone a formal education in telemedicine and telehealth.
As the acceptance of telemedicine evolves, what are the challenges you see?
To transform telemedicine from necessity into standard mode, there must be an incentive as at the end of the day it is about ROI. Stakeholders in the ecosystem such as network operators, software companies, medical device manufacturers are all people who get paid in advance, while the poor doctor is expected to do everything pro bono and this attitude needs to change.
The new guidelines for telemedicine practice make it very clear that a physician can charge consultation fees for a telecommunications consultation. The legal position also said teleconsultation can be conducted anywhere in India and is not limited to the state where you are registered.
At Covid, the government has done a wonderful job, and they have given doctors guidelines on what to do and what not to do. As far as Covid-19 is concerned, it is the entire protocol driven task of the physician to explicitly implement the specific guidelines given by the Indian government and the State Ministry of Health, etc.
What are your views on digital technologies that disrupt the delivery of healthcare in the future?
With telemedicine, there is a silver lining in the black cloud and it is not all gloomy. I am very sure that with all the measures taken we flatten the curve. Today, there are AI-powered systems that analyze data around the world, summarize and broadcast how the clinical picture has changed.
I think there will be a 20x increase in digital healthcare growth and the world will be completely different. Telemedicine is a win-win situation for all patients, doctors, hospitals and healthcare providers will switch from a 20-storey hospital to individual patients’ rooms.
Everything goes on except the displacement of the physical location, and that doesn’t mean it’s financially unavoidable. So do not look at setting up large hospitals but providing healthcare for a patient’s comfort all the time.