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Table of Contents
REVIEW ARTICLE
Year : 2020  |  Volume : 17  |  Issue : 3  |  Page : 205-208

Telemedicine and COVID-19


Apollo Telemedicine Networking Foundation, Chennai, Tamil Nadu, India

Date of Submission07-Jul-2020
Date of Acceptance15-Jul-2020
Date of Web Publication05-Aug-2020

Correspondence Address:
K Ganapathy
Apollo Telemedicine Foundation, C/o Apollo Main Hospital, 21 Greames Lane, Chennai - 600 086, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_84_20

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  Abstract 


The COVID-19 pandemic has within months turned the world upside down. SRS-COV-2 is making us look at how health-care services are being delivered, and how this needs to radically change. Every country is reporting an exponential increase in Telemedicine utilization, as fallout of the enormous stress on health-care systems globally. The notification of the Telemedicine Practice Guidelines by the Government of India has also contributed to the rapid adoption of Remote Health Care. This review focuses on deployment of Telehealth in the pandemic milieu, illustrating how a crisis is turning into an opportunity to provide remote health care. Necessity for “contactless” health care and physical distancing has led to acceptance of Telehealth by all stakeholders, from lingering in the periphery for two decades to center stage.

Keywords: Telehealth and COVID19, telemedicine and COVID19, telemedicine and pandemics


How to cite this article:
Ganapathy K. Telemedicine and COVID-19. Apollo Med 2020;17:205-8

How to cite this URL:
Ganapathy K. Telemedicine and COVID-19. Apollo Med [serial online] 2020 [cited 2020 Dec 1];17:205-8. Available from: https://www.apollomedicine.org/text.asp?2020/17/3/205/291473


  Introduction Top


The term “Telemedicine” encompasses the use of a wide spectrum of telecommunication technologies and deployment of customized software, hardware, and peripheral medical devices. Using these, history can be taken, patients can be physically examined, investigated and a provisional or final diagnosis made, with the consultant and the patient physically separated. Telehealth has made distance meaningless. Telemedicine has existed for decades, but widespread implementation has not been forthcoming. For the last two decades, the author among others have repeatedly stressed that Telemedicine is the only answer to address the ever increasing urban rural health divide.[1] The growth of Remote Health Care in the last two decades has been steady but only incremental. With the outbreak of the COVID-19 pandemic, Telemedicine has become a buzz word in India. The exponential radical transformation ushering in “Contactless Healthcare” has been to say the least, incredible.


  Telehealth in India Before the Corona Virus Pandemic Top


Formal clinical telemedicine was introduced in India on March 24, 2000 with the commissioning of the world's first VSAT enabled village Hospital at Aragonda, Andhra Pradesh, the birth place of Dr. Prathap Reddy Founder Chairman Apollo Hospitals group [Figure 1]. Since then the Apollo Telehealth Division alone has touched ten million lives remotely through various Public Private Partnership projects with several state governments, Public sector undertakings, corporate social responsibility projects, tele review of treated patients, and teleconsults from franchisee centers in suburban India. This has resulted in the presentations and publications nationally and internationally.[2],[3],[4],[5] Almost 7000 teleconsultations were being given per day. Although there are a number of other organizations and many clusters of doctors and clinics providing teleconsultations, the adoption has been slow for a country the size of India.
Figure 1: Inauguration of world's first VSAT enabled village hospital for Telemedicine March 24, 2000 at Aragonda, Andhra Pradesh marking the beginning of formal Clinical Telemedicine in India

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  Telehealth and Covid-19: the Global Scenario Top


Following notification of COVID-19 as a pandemic, in anticipation of the impending global health predicament, particularly the health hazards faced by health-care providers who would be in physical proximity to coronavirus-positive patients, WHO, and Centre for Disease Control USA immediately advocated the deployment of Telehealth. In the first release of funds to tackle the pandemic, 500 million US$ were allotted for Telemedicine alone. Almost all other governments across the world followed. Hitherto strict regulations were relaxed. Insurance companies worldwide included “Telemedicine” for reimbursement. Licensure requirements have been temporarily waived for Medicaid. The use of remote services has escalated from a slow rollout to a “need it now” priority. In the USA, the Centers for Medicare and Medicaid Services, state Medicaid, and state health agencies have relaxed earlier stringent regulations. In the USA, potential HIPAA penalties are being waived for good faith use of telemedicine. FaceTime and Skype can now be used, though a HIPAA compliant platform is recommended to avoid the complications after the emergency has ended.


  Telehealth and Covid-19: the Indian Scenario Top


The recently notified telemedicine practice guidelines of the Ministry of Health Government of India[6] has led to an exponential increase in the use of Telemedicine in India. With reduction in face-to-face consultations, remote evaluation is becoming mainstream. Simultaneously, hundreds of hospitals in the public and private sector are offering free teleconsultations for the screening of COVID 19 patients. Health Insurance companies in India have recently recognized Telemedicine services for reimbursement. Online Orientation Programmes on Telemedicine were organized by the Telemedicine Society of India. Other organizations have also started similar Programmes. The Indian Psychiatric Society has recently notified detailed Practice Guidelines for Telepsychiatry.[7]

COVID 19 has resulted in reorganization of care teams and expansion of hospital and intensive care units (ICU) capacities. With the strain onICU, eICU' s are being initiated. Karnataka was the first state to establish a dedicated command unit for critical care support, by linking ICUs of COVID hospitals onto a single platform. The unit is monitored by a centralized team of doctors. Cumulative data are monitored and analyzed by experts in real time.[8] The role of eNeuroIntensive care in the current situation has also been commented upon[9] The author has reviewed the increasing use of teleneurology in the pandemic situation.[10]


  Use of Telemedicine in Specific Containment and Management of Covid-19 Top


A unique advantage of Telemedicine is that in the COVID-19 situation, even quarantined health-care providers whose numbers are steadily increasing worldwide, can continue to provide teleconsultations. With personal distancing and shortage of personal protective equipment, face-to-face health-care encounters are increasingly becoming problematic even in a hospital setting. “Telemedicine” of a different type – that is distant monitoring within the premises is also taking place. Communication with an inpatient in an isolated area is through telephone. All vitals can be evaluated from a central monitoring station.

Deployment of Telehealth in management of COVID-19 modusoperandi: ASHA or basic health worker evaluates patients remotely using approved flowchart/algorithm in the local language using her existing tablet. Tele answers filled on Tab is instantaneously stored in a dedicated secure cloud. Real-time big data analysis will help update policies. If video-conferencing facilities are available on patient phone and if algorithm warrants, first remote screening escalated to a video consult with a specially trained nurse or doctor. Tele screening will clinically identify those requiring laboratory tests. Time-specific appointments scheduled in nearest laboratory bypassing Dr. evaluation/OP/ER will avoid crowding. The results of laboratory tests communicated electronically and symptomatic treatment initiated using e-Prescription.

As can be seen from [Figure 2], due to the total lockdown and transport restrictions from March 2020 onward, patients in rural India have been unable to physically reach Telemedicine Centers. This has resulted in a significant drop in teleconsultations throughout India. However, there has been a tenfold increase in telephonic teleconsultations from home – voice and video calls to the Medical Call Centre for Covid and nonCovid problems. The utilization of a Mobile App named Apollo 24/7 illustrates the radical changes in the deployment of virtual health care due to the pandemic. [Figure 3] shows that 2500 doctors have onboarded on this App and almost 100,000 individuals use it daily.
Figure 2: Apollo Telehealth consultations pre- and post-COVID-19

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Figure 3: 24/7 Mobile App offering COVID-19 self-assessment and facilitating teleconsults

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  Use of Telemedicine in Management of Non Covid Clinical Problems Top


No telemedicine program can be created overnight. Existing telemedicine units can leverage available infrastructure for specific response to COVID-19 and non-COVID situations. Telemedicine can provide rapid access to subspecialists normally not available. Telemedicine enabled institutions have started virtual “rounding” with no patient contact. Rounding “styles” will continue to evolve. Solutions will be different for different hospital systems depending on the levels of COVID-19 prevalence.


  Tele-Education Programs for Health-Care Providers and the Community Top


Kondziolka et al.[11] point out that with the COVID-19 pandemic, most conferences of organized associations and societies worldwide have been cancelled or postponed. International and national flights have been banned in most countries. Self-isolation and physical distancing have resulted in a reduction in operative experience and formal in-person resident training. Webinars are playing an increasing role. The author has personally given 24 webinars in the past 3 months on the role of Telehealth in the present situation. Over 30,000 doctors have attended. One webinar was attended by 11,775 doctors. Another webinar was for 8 countries and 808 attended.[12] Several thousand doctors have attended orientation programs conducted by the Telemedicine Society of India and other organizations. The interest has been unbelievable. CME's and resident training will become more and more digital.


  Conclusion Top


The challenges facing telemedicine today are perhaps less than what the author encountered 22 years ago. Awareness is being followed by acceptance. The challenge is not to convince the health-care provider and beneficiary that Telemedicine has advantages over face to face, in person visits. The challenge is to quickly customise and make available a cost-effective, need based, user friendly, technologically efficient, secure Telehealth system which is compliant and adherent to ever evolving regulations. Any Telemedicine system must be future ready and culture sensitive. Revenue generation is critical for ensuring sustenance. Necessity is the mother of invention. There is a pressing need not tomorrow, not today but yesterday! Doctors providing telehealth are concerned that with the public and private sector offering teleconsultations probono during the pandemic this would be considered the gold standard!! even in the postpandemic era.

It was never foreseen that the slow incremental growth of Telehealth would change into an explosion. A strand of RNA has become the Global Chief Transforming Officer for Telehealth. Contactless Health care will be the new normal. Distance will become meaningless. Geography will become History! Formal recognition of Telemedicine by the Government of India and state governments is making all the difference. Even the Prime Minister of India has repeatedly stressed the importance of deploying Telehealth. One day doctors and patients will probably ask “Should it not have been like this always.”

After Corona era will never be the Before Corona era. Impact of telemedicine is unlikely to recede. Telemedicine capabilities are likely to be embedded within normal operations, scalable, interoperable, and built on a strong, reliable infrastructure, so that it is useful even after the acute COVID-19 calamity resolves. As responsible health-care providers, it is imperative that we adopt Telemedicine to extend our reach. Every single individual healthy or sick, rich or poor, urban or rural, educated or not, can benefit in different ways through “contactless”medicine To paraphrase Charles Darwin “It is not the strongest of the species that survives, not the most intelligent, but the one most adaptable to change.” The writing is on the wall. Work from Home culture will include doctors as well. It is imperative that we accept and start deploying the “New Normal.”

Acknowledgments

The assistance rendered by Vikram Thaploo CEO ATHS and his team in providing the details of Teleconsultations done immediately before and during the lockdown period is acknowledged. I also wish to place on record our gratitude to all the staff of the Telehealth division who indeed are justifying their recognition as “Corona Warriors” by being available when it is needed the most.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.







 
  References Top

1.
Ganapathy K. Telemedicine and neurosciences. J Clin Neurosci 2005;12:851-62.  Back to cited text no. 1
    
2.
Ganapathy K. Telemedicine and neurosciences. Neurol India 2018;66:642-51.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Ganapathy K, Alagappan D, Rajakumar H, Dhanapal B, Rama Subbu G, Nukala L, et al. Tele-emergency services in the Himalayas. Telemed J E Health 2019;25:380-90.  Back to cited text no. 3
    
4.
Ganapathy K. Distribution of neurologists and neurosurgeons in India and its relevance to the adoption of telemedicine. Neurol India 2015;63:142-54.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Ganapathy K. Presentations on Telemedicine. Available from: http://www.kganapathy.com/resumekg.html. [Last accessed on 2020 Jun 05].  Back to cited text no. 5
    
6.
Telemedicine Practice Guidelines. The Ministry of Health and Family Welfare, Govt. of India. Available from: https://www.mohfw.gov.in/pdf/Telemedicine.pdf. [Last accessed on 2020 Mar 25].  Back to cited text no. 6
    
7.
Available from: https://indianpsychiatricsociety.org/e-book-telepsychiatry-operational-guidelines-2020. [Last accessed on 2020 Jun 05].  Back to cited text no. 7
    
8.
Karnataka Sets up Critical Care Support Unit by Linking COVID Hospitals Across State. Press Trust of India. Available from: https://www.business-standard.com/article/pti-stories/karnataka-sets-up-critical-care-support-unit-by-linking-covid-hospitals-across-state-120041500931_1.html. [Last accessed on 2020 Jun 05 and Last cited on 2020 May 06].  Back to cited text no. 8
    
9.
Haranath SP, Reddy K, Deepak KS. Under Publication e NeuroIntensive Care in India: The need of the Hour.  Back to cited text no. 9
    
10.
Ganapathy K. Telemedicine and Neurological Practice in the COVID-19 Era. Neurol India 2020;68:555-9.  Back to cited text no. 10
[PUBMED]  [Full text]  
11.
Kondziolka D, Couldwell WT, Rutka JT. Introduction. On pandemics: The impact of COVID19 on the practice of neurosurgery. J Neurosurg 2020:1-2. Published online 2020 Apr 10.  Back to cited text no. 11
    
12.
Available from: http://kganapathy.com/covid.html. [Last accessed on 2020 Jun 05].  Back to cited text no. 12
    


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