Doctor on call: Telemedicine guidelines a step toward healthcare-for-all

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Published: March 30, 2020 4:15:55 AM

Against the WHO mandated one doctor for every 1,000 people, India has one for every 1,457; China has one per 671 people, Germany one per 242, and Cuba one for every 122.

In 2019, a McKinsey Global report stated that India could save $10 billion if telemedicine replaced 30-40% of in person outpatient consultations.

The government coming out with telemedicine guidelines is a timely reform, and not just in the backdrop of the Covid-19 crisis. It will lessen the pressure on the country’s healthcare infrastructure, and, in the context of the coronavirus, also help observe social distancing as patient-doctor consultations can now be virtual. Against the WHO mandated one doctor for every 1,000 people, India has one for every 1,457; China has one per 671 people, Germany one per 242, and Cuba one for every 122. This problem worsens when it comes to public healthcare, with just one functioning primary healthcare centre (PHC) for every 64,800 people, and one PHC doctor for every 38,000.

In 2019, a McKinsey Global report stated that India could save $10 billion if telemedicine replaced 30-40% of in person outpatient consultations. It further highlighted that it would improve care for poor and those living in rural areas, and at an accelerated pace, the country could cover 50-60% of outpatient consultants by 2025.

The new guidelines allow patients to reach a registered medical practitioner over WhatsApp, phone call, or Skype. Any prescription sent by a doctor, either over email or WhatsApp, will be acceptable at pharmacies, barring drugs classified under Schedule X of Drug and Cosmetic Act and Rules, and any narcotic and psychotropic substance listed in the Narcotic Drugs and Psychotropic Substances Act, 1985. Doctors have been made responsible for privacy, and protection of patient data. In future-wise thinking, the government has also allowed the use of artificial intelligence and machine learning to assist a registered medical practitioner, though it proscribes the sole use of AI/ML for counselling of patients, or prescribing medicine. It has also recognised teleradiology, telepathology, and teleopthalmology solutions.

Given telemedicine has been around for some time now, the guidelines formalise the environment for its operation, and remove the chances of regulatory arbitrage. While the guidelines offer policy certainty, telemedicine moving meaningfully into rural areas will need government support. 5C, a Bengaluru-based teleradiology startup, provides consultation from a panel of radiologists assisted by AI via an app. While it has been catering to many big radiology labs, not many district hospitals have adopted such solutions—imagine the gains from such an app coming to the aid of diagnosis at district hospitals that don’t have enough radiologists. If the government moves meaningfully on creating a public health record database—a 2018 NITI Aayog consultation paper talks of something similar—it will not only help tap telemedicine’s full potential but also sharpen India’s AI/ML capabilities in healthcare.

And, the DigiLocker project can allow individuals to keep uninterrupted records of their health which can, when required, be sent to the doctor; a laboratory running diagnostic tests can just send results to a Digilocker linked to the patient. Telemedicine is taking off, the government must focus on building the right ecosystem around it.

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