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With government issuing urgent guidelines on telemedicine, hospitals switch to tele-consultations during the lockdown

Tele-consultation, Telemedicine, Guidelines, COVID-19, Pandemic, Telehealth

After the alarming surge in the number of cases of COVID-19 and the spike in the number of death due to it in India, and a complete lockdown of the nation for three weeks, patients have been deeply inconvenienced.  Days before the lockdown, there was a drastic rise in patients with flu-like symptoms and OPDs were crowded, but hospitals as per instructions from the government had to cancel elective surgeries and discourage patients to visit the hospital unless it was for an emergency. Post the lockdown, while hospitals are operating at a minimal service level, the need for medical assistance for the common man is expected to grow at an unprecedented rate. The ailing patients are confined into their homes, unable to get treatment.

Tele-consultation has bridged this gap in times of lockdown and inconvenience in reaching the hospital. Leading healthcare chains in India are switching to tele-consultations with an objective of allowing a greater number of patients to seek medical consultation from the safety of their homes.

Across the world, the use of telemedicine facilities has been leveraged to deal with pandemics. Be it video consultations or voice chat, a large number of people under self-quarantine are seeking medical advice through virtual consultations to better monitor and manage their condition.

The service helps people who are concerned about visiting a hospital or a clinic at the moment as well as the elderly and patients with ongoing health conditions to manage their health needs from home. Telemedicine also helps to reduce the spread of the virus by avoiding crowded waiting OPDs, reducing hospital footfalls and potential infection as well as helps hospitals safeguard doctors and staff who are among the most at risk of contracting the virus.

In the US, many AI-based tele-health services providers have reported a significant jump in the volume of virtual visits ever since the coronavirus scare caught the country. In his bid to promote the use of tele-health, US President Donald Trump announced that his administration is waiving some federal rules to make it easier for more doctors to provide care remotely using video chats and other services.

India's Prime Minister, Narendra Modi, during his address on March 30 emphasised on the use of telemedicine to deal with the current crisis. The Indian Government reliased the potential that telemedicine could play during the lockdown, and guidelines for telemedicine, prepared by the Medical Council of India in partnership with NITI Aayog, were issued  a few days back. These guidelines, which were pending since ages, has finally legalised telemedicine.  The introduction to the guidelines, named ‘Telemedicine Practice Guidelines: Enabling Registered Medical Practitioners to Provide Healthcare Using Telemedicine’ states, “With telemedicine, there is higher likelihood of maintenance of records and documentation hence minimalises the likelihood of missing out advice from the doctor other health care staff. Conversely, the doctor has an exact document of the advice provided via tele-consultation. Written documentation increases the legal protection of both parties. Telemedicine provides patient’s safety, as well as health workers safety especially in situations where there is risk of contagious infections. There are a number of technologies that can be used in telemedicine, which can help patients adhere better to their medication regimens and manage their diseases better.”

It also mentions that telemedicine can also enable the availability of vital parameters of the patient available to the physician with the help of medical devices such as blood pressure, blood glucose, etc. “Disasters and pandemics pose unique challenges to providing healthcare. Though telemedicine will not solve them all, it is well suited for scenarios in which medical practitioners can evaluate and manage patients. A telemedicine visit can be conducted without exposing staff to viruses/infections in the times of such outbreaks. Telemedicine practice can prevent the transmission of infectious diseases reducing the risks to both health care workers and patients,” it points out.

Vikram Thaploo, CEO, Apollo TeleHealth, said, “Globally, as healthcare systems stand overburdened and overwhelmed by the sheer scale of the pandemic, conventional healthcare is finding it impossible to address the disaster. With hospital beds and ICUs grossly insufficient, doctors in severely-hit countries are having to choose which patient to treat and which to ‘let die’ based on the chances of their survival. In India, where healthcare systems are already overburdened, a large outbreak will spell further disaster. It is important therefore to act timely to leverage the use of alternative processes like telehealth and turn them from stop-gap arrangements to the mainstream interventions.”

After the guidelines were issued, Paras Group of Hospitals across Gurugram, Patna, Darbhanga, Panchkula and Ranchi started actively offering tele-consultations to patients seeking medical opinions for a wide variety of ailments including suspected cases of COVID-19 who require monitoring under quarantine.


“In view of the COVID-19 outbreak, we have opened tele-consultation services across all our eight hospitals in the country. This will work to reduce crowding at hospitals and will ensure that a sizeable number of patients who need medical care for different health conditions do not need to visit hospitals at this critical time. In fact, the demand for our tele-consultation services has shot up by 30% in the past week as more and more people try to stay at home. To ensure faster accessibility, we have increased the number of executives manning our tele-health helplines and have also strategically co-opted time from doctors to ensure faster availability,” said Dr Shankar Narang, COO, Paras Healthcare.

The organisation is advising patients to increasingly seek virtual consultations and visit hospitals only in cases of medical emergency.  A bulk of patients have shifted to the virtual consultation route as it is also insisting people to seek video consultation and teleconsultation through ‘Paras Health Mate Application’, designed for this purpose. The video consultation is through the app i.e. Paras Health-mate app, wherein both the options for tele and video consultation are available wherein healthcare consultant actively provide consultation basis on the availability.

Leading single speciality chain, Bengaluru-based Motherhood Hospitals, is also using telemedicine technology to provide continuity of care to women and children and has launched an integrated online tele-consultation service. The video consultation services can be availed in gynaecology, obstetrics and paediatrics. Pregnant women can go through their routine follow up consultations through this technology, so that they have continued access to their care. Similarly children requiring routine consultations particularly at this time to distinguish between common cold and other issues can also be provide through this service.

Patients opting for online consultation can access the Motherhood Hospitals website to book an appointment, which will be facilitated via a video call. Post completing the registration process, the patient will receive an email with a link to join the video call. All patient details, observations, etc. will be digitally recorded on a central system, so these will go under the outpatient records of the patient. At the end of the consultation, the patient will receive a digitally signed copy of diagnosis, investigation advice and prescription via email.

On the introduction of the online consultation services, Vijayarathna Venkatraman, CEO, Motherhood Hospitals, said, "In the current times of uncertainty and restrictions, we at Motherhood want to ensure that women and children are provided appropriate medical advice through virtual doctor consultation sessions. At this time the anxiety levels particularly with expectant mothers and children are high, having access to their doctors will give the patients extreme comfort and confidence. We believe through the launch of this service most of our patients will not have any break in their medical treatment and all our senior consultants in gynaecology and paediatrics will be available through this technology interface."

He further added, “Social distancing processes have created their own challenge in healthcare services and we are creating solutions to meet our patient expectations. All our services at the hospitals are continuing and our emergency department is open 24/7 to extend medical attention.”  The telemedicine service is extended beyond Motherhood patients to the larger community on the whole.

Bengaluru-based Cloudnine Group of Hospitals, India’s leading chain of maternity, childcare and fertility care group of hospitals, also announced the launch of its tele-consultation service  across Gurgaon, Noida, Chandigarh, Mumbai, Pune, Bengaluru and Chennai units of Cloudnine.  This service will allow customers to consult doctors from their homes via video thereby avoiding all the non- essential travel to the hospital.

Doctors will advise and follow up with patients according to their conditions and symptoms. Customers may use this service for follow up consultation on their ongoing treatment as well. This value-added health service shall be available on mobile phones through 'It’s our Baby' app which has currently 1,00,000 users. This will include doctor consultations, electronic prescriptions and electronic medical certificates.

Raviganesh Venkataraman, CEO, Cloudnine Group of Hospitals, said, “In the wake the ongoing COVID-19 pandemic in most parts of the world, the use of remote health consultation can be an effective way of triaging potential cases and also can serve as a form of first line of defense, while keeping frontline healthcare staff safe unless there is an urgent need for immediate medical attention/treatment.  By combining revolutionary health technology and the convenience of telemedicine, Cloudnine is helping to empower consumers to take control of their health, anytime, anywhere.”

He added that providing digital solutions has always been core to its business.  "The introduction of extensive tele-health capability adds to our comprehensive functionality for practitioners and patients. For customers, the technology partnership helps to connect their doctor at their fingertips — saving on travel and waiting time. It also provides incredible convenience for people who are working to see a practitioner without needing to leave home to do so," he added.

Chaitanya Shravanth, chief digital officer & chief marketing officer, Cloudnine Group of Hospitals,  said, "This service was developed by our in-house team of experts in less than 36 hours. We are trying to put all the B2C services (pharmacy, delivery, and others) and we are confident that the tele consultation in real time shall facilitate simultaneous and rapid exchange of information with all our customers."

Leading fertility treatment provider, Nova IVF Fertility, has also introduced tele counselling services across all its 25 centres in the country. The service which will be provided by Nova’s highly acclaimed team of IVF specialists can be availed by existing patients as well as those seeking advice on IVF and other fertility treatments.  This service will ensure continuity of care for patients who are currently going through IVF treatment while creating an opportunity to help those who are seeking to start their IVF treatment.  

Speaking on the introduction of teleconsulting services, Shobhit Agarwal, CEO, Nova IVF Fertility, said, “Under the present circumstances it is increasingly becoming difficult for patients to physically reach out to doctors not only for their follow up consultations but also for many who wish to do their first consultation. By leveraging the teleconsult technology, we are enabling the virtual interface of patients with their doctors. As India’s leading network in the IVF space it was important for us to provide all possible support in these uncertain times. We are not restricting this service to Nova’s patients but to the community at large”

Hospitals in Hyderabad have also turned to telemedicine to continue their OPD operations in the fight against the Coronavirus outbreak. Sunshine Hospitals, Medicover Hospitals, Srikara Hospitals & AIG Hospitals are some of the hospitals using virtual medical consultations to connect with their patients.

These hospitals together already see more than 4,000 patients every month on mfine’s virtual OPD. mfine together with these hospitals is offering consultation through its mobile app to help alleviate their fears and asserting if a patient requires immediate attention or not. mfine’s 'Coronavirus Assessment' is built specifically to triage coronavirus symptoms at the earliest. It lets doctors consult with patients over a digital voice or video rather than in person and this enables them to see more patients without being exposed to the virus.

Prasad Kompalli, CEO and Co-Founder, mfine, added, “Telemedicine is much more advanced now and in such a crisis it is possible to rapidly scale the system and provide the assessment to a large number of people.”

Digital healthcare and on-consultation companies have also chipped in. vHealth by Aetna has announced a special initiative of providing free access to its virtual doctor consultation service, until 15th April, to help ensure people have access to healthcare during the COVID-19 outbreak. vHealth provides professional and confidential medical consultations by telephone and video for people across the country. Dr Sneh Khemka, president, population health, Aetna International, commented,  "As a primary healthcare service provider, we feel there is a need for us to step up and support the community at large.”

Credihealth, India’s first digital health gateway, announced its launch of a dedicated tele/ video consultation service with India’s leading hospitals.  Credihealth has launched this dedicated service for cancer, cardiac and other tertiary care specialities. Ravi Virmani, founder and managing director, Credihealth, said, “Credihealth is providing fast, secure and reliable access to serious illness patients in the current lockdown scenario. Currently, we are offering the service for hospitals in Delhi NCR, Bengaluru, Kolkata, Mumbai and Hyderabad and would soon be adding other key cities. These are testing times for all, and we would like to assist all in need of medical assistance.”

Through the service, the patients can book appointments with doctors from hospitals like Medanta, Nanavati, Fortis, AIG, Wockhardt, Manipal, Yatharth, AMRI, CARE  and more. The consultations can be booked through Credihealth’s web portal and Android App where the hospitals and doctors are connected on the Credihealth platform. Hospitals and doctors have dedicated specific hours of the day, and patients can book online from the comfort of their homes. The appointments are at a nominal fee.

India’s leading digital healthcare platform, Practo has been receiving requests from a large number of hospitals to make online consultation accessible to them. It has expanded its doctor base by close to 50% in the last few days to ensure continuity to care

Onco.com, India’s only internet aggregator for cancer care, has introduced a teleconsultation service to help cancer patients and care givers get advice from oncologists through a telephonic call or video conferencing. The recently launched teleconsultation service ‘Call Onco’ offers support to patients to get their questions answered, with queries ranging from their current treatment status, diagnosis, and precautions against COVID-19. The teleconsultation will be 20 minutes long and will be scheduled within 24 hours.

For patients who are looking for a detailed treatment advice, Onco offers a premium online opinion service called 'Onco Tumour Board' where patients and their caregivers can get treatment advice in the form of an online report from a multi-disciplinary panel of senior oncologists.

Commenting on the launch of Call Onco, Dr Amit Jotwani, co-founder and chief medical officer, Onco.com, said, “Cancer patients undergoing active treatment or those with blood cancers have reduced immunity and they are at a much higher risk of acquiring COVID-19 infection. They need to be more careful about prevention.  At Onco.com, we have also taken the responsibility to create awareness about COVID-19 precautions for cancer patients and we are releasing informative videos and articles to spread the right information.”

Experts state that the COVID-19 pandemic will go down in history as a turning point in the journey of tele-health, given the fact that it is the first time that the use of tele-health is being co-opted on a large scale to address a public health crisis. Telehealth will act as a major cog in the wheel of effective coronavirus management and containment.


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Purpose of telemedicine guidelines issued by Government of India

The purpose of these guidelines is to give practical advice to doctors so that all services and models of care used by doctors and health workers are encouraged to consider the use of telemedicine as a part of normal practice.

These guidelines will assist the medical practitioner in pursuing a sound course of action to provide effective and safe medical care founded on current information, available resources, and patient needs to ensure patient and provider safety.

These telemedicine guidelines will help realise the full potential of these advancements in technology for healthcare delivery. It provides norms and protocols relating to physician-patient relationship; issues of liability and negligence; evaluation, management and treatment; informed consent; continuity of care; referrals for emergency services; medical records; privacy and security of the patient records and exchange of information; prescribing; and reimbursement; health education and counseling. These guidelines will provide information on various aspects of telemedicine including information on technology platforms and tools available to medical practitioners and how to integrate these technologies to provide health care delivery.

It also spells out how technology and transmission of voice, data, images and information should be used in conjunction with other clinical standards, protocols, policies and procedures for the provision of care. Where clinically appropriate, telemedicine is a safe, effective and a valuable modality to support patient care. Like any other technology, the technology used for telemedicine services can be abused. It has some risks and limitations, which can be mitigated through appropriate training, enforcement of standards, protocols and guidelines.

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