Telemedicine: A lifeline in a time of crisis and beyond!

Telemedicine: A lifeline in a time of crisis and beyond!

Wave 1: Many new factors to consider, right from the disease in question itself, the extent of damage it can cause, how to triage cases, allocate care and manage the piling number of cases all while ensuring the judicious usage of the available resources.

It would not be an exaggeration to say that frontline workers at ground zero were akin to the brave soldiers battling it out at any warzone in history.

As we approached the end of 2020, the number of daily new cases decreased, it all seemed fine and normal around us, and we thought the worst was over.

Little did we know that this was just a dress rehearsal for what was coming!

Enter wave 2: This time around we know a tad bit more about the disease, the perpetratorin question and its updated versions and more importantly, the spectrum of its impact.

It is safe to say that although there were many aspects of this novel virus that were still unknown, we were equipped with the most important arsenal of all, ‘Experience’.

We were now aware that not all patients would necessarily become critical and need the highest level of care and that a good number of cases especially those who were asymptomatic, or mildly symptomatic could be safely managed at home. This is how the option of virtual consults and telemedicine turned out to be a big support, not only for patients in these frantic times,but it had also significantly reduced the burden on the already stretched healthcare fraternity.

The World Health Organization has mentioned telemedicine among its recommendations for essential services in strengthening the health systems response to COVID-19 policy. It could be used in forward triage, where patients can be screened before reaching the health care facility. Centre for Disease Control and Prevention (CDC), USA updated their interim guidance on infection prevention and emphasized the implementation of telemedicine facilities to minimize the chance of transmission. They believe this will help in the early identification and transfer of suspected cases without coming in physical contact, thus reducing the risk of infection among health care workers and the public.

The Ministry of health and family welfare (MOHFW), Government of India, has also undertaken various initiatives using information and communication technologies for improving the efficiency and effectiveness of the public healthcare system one of the important aspects of which was the release of the “Telemedicine practice guidelines” in March 2020.

Experiences from breaking the ice in a virtual world.

Here at Kauvery hospital, we have done more than 350 tele consults for mild and asymptomatic cases of COVID 19 alone.

In accordance with the MOHFW guidelines there were few important steps to be followed while providing this service to Covid positive patients.

First consult: In this consult we obtain as much of the patient’s basic information as possible, including drug allergies, relevant medical history, family demographics which is especially important when dealing with communicable diseases, to ensure that strict isolation and home quarantine protocols are followed. And most importantly, it is here that wetry to build a rapport with the patient and assure them that the quality of care will not be compromised in this mode of communication.

Patient or caregiver: The consultation is done with either the patient or their caregiver depending on the patient’s preference and clear instructions are given for caregiver protection and prevention of further spread of the disease among other family members.

Consent: In booking an appointment for a teleconsultation, it is implied that the patient is consenting to a virtual consultation and the risks and benefits of the same are clearly discussed prior to the consultation.

Assessment: This is probably the most important aspect of a virtual consultation; it is extremely important at this stage to triage the patient based on the available information and decide if he/she is eligible for management via teleconsultation in the first place or whether they he/she will necessarily require In-person care.

Treatment plan: The next step would be to draw up a treatment plan which includes advise on the necessary investigations to be done, vitals to be monitored, medications and supportive measures to be followed, and adhering to a follow-up schedule.

Followup: Based on the triaging results and categorising of the patient in to asymptomatic, mild or moderate stage of disease, and also based on the disease course, we would decide how to further manage how frequently to follow-up the patient

Continuity of care: We also make it a point to ensure that the patients feel confident that they can always come back to us, for any COVID related or unrelated health issue, with the same ease and comfort.

Why telemedicine is here to stay?

History: It is interesting to know that from the time of its inception, one of the notable roles played by telemedicine was its application in providing healthcare services to space explorers in 1970s.

This was adapted as the Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC) which delivered clinical care to Papago Indian Reservations in Arizona.

NASA also utilised satellite innovation in telemedicine and found that it had a great role in disaster management during the earthquake in Mexico City and Soviet Armenia in 1985 and 1988 respectively.

Using Telemedicine, NASA laid the foundation of commercial space centre MITAC (Medical Informatics and Technology Applications Consortium) at Yale University.

Similarly our very own Indian Space Research Organization(ISRO), in association with the Department of Information Technology (DIT), Ministry of External Affairs, Ministry of Health and Family Welfare, and the state governments, was instrumental inthe development of telemedicine services in India in 2001. Since then, we have had a steady rise in the use of telemedicine by many of the reputed private health care organizations as well.

Inequitable distribution of healthcare services:

For a country like India, where a sizeable amount of the population resides in remote and inaccessible locations, this virtual form of healthcare could be one of the practical solutions to ensuring that these patients receive timely medical care and advice. Firstly, patients would be able to save a great deal of time and money spent on the long distances they need to travel to reach their healthcare provider, especially for routine consults. Also, days used for in person consults would in-turn mean loss of working/earning days. This could be saved with a virtual consultation. In addition, physicians will be able to have access to a geographically wider population. So, essentially, it’s a win- win situation.

Chronic medical disease management during unprecedented times:

Non-communicable diseases kill about 41 million people each year which is equivalent to 71% of all deaths globally.

During a time when venturing outdoors for any reason other than a dire emergency was not advised, some of the chronic medical conditions like diabetes, hypertension, kidney or liver disease were put on hold.

Patients could not have their medications titrated or continued to take the same dose of a drug that was prescribed during an acute episode, even after the acute phase resolved.

Chronic medical diseases took a back seat during the pandemic, and the repercussions would have been tremendous had it not been for virtual consultations, by way of which patients were able to ensure, they were followed up to the maximum extent possible, virtually, and recommitted to following social distancing norms devoid of the fear of neglecting pre-existing issues.

Role in mental health:

The pandemic saw the rise in a new form of anxiety, and it became a greater matter of concern, when misinformation started circulating in all the channels of media. It was extremely important for patients to stay in touch with their health specialists to avoid untoward outcomes. Telemedicine helped to simultaneously ensure smooth riding over the infodemic wave alongside the pandemic. In addition, mental health experts were also able to provide uninterrupted care to their patients by way of virtual counselling, mental health awareness programs, online support groups etc

The other side of the coin:

All said and done, asdoctors, it is instilled in us from our formative years that, practicing medicine without touching a patient is equivalent to driving with eyes closed. Therefore, we can never expect virtual medicine to be a substitute for the in-person management of disease.

We agree that technology cannot replace the age-old art of forming a doctor-patient relationship, but we must also agree that there is no harm in using technology to support that relationship i.e., ‘Enhancing and not replacing in – person care’.

In Conclusion:

From the dawn of the digital era, we have seen many ways in which technology has aided the medical profession and reduced the overall burden of healthcare.

Telemedicine is one such valuable entity.

The onslaught of the pandemic has taught us a lot about the importance of utilising this resource.

From smart watches with a wearable ECG feature, mobile apps that monitor most of the vital parameters to video consultations with specialists, we can ensure a complete clinic experience at the comfort of one’s home.

The only thing constant is change, so there is no doubt that ‘Smart healthcare’ is not only the new normal but also the way forward!

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