Telemedicine: The Next Important Health Vertical for Neurosciences In India

P Sarat Chandra 
 Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India

Correspondence Address:
Dr. P Sarat Chandra
Professor and Head of Unit 1, PI and Team Leader, COE Epilepsy and MEG center, In Charge, Core Faculty, Epilepsy and Functional Neurosurgery, Room 7, 6^th Floor, CN Center, Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi - 110 029
India

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”Necessity is the mother of invention.”

The author of this oft used proverb is unknown though it is commonly misattributed to Plato (1871 translation of Plato's Republic), where it reads: “The true creator is a necessity, who is the mother of our invention.” Jowett's translation is noted for injecting the kind of flowery language popular among his Victorian-era audience. Jowett himself, in Plato's Republic: The Greek Text, Vol. III “Notes”, 1894, p. 82, gives a literal translation of Plato as “our need will be the real creator”, without the proverbial flourish.

How important is Telemedicine for India in the coming years?

I think a better question would be “What is the best strategy to develop Telemedicine for India?”.

The importance of telemedicine cannot be overemphasized more considering the statement given by Hon'ble Prime Minister of India Shri Narendra Modi on June 1st stressing on developing Telemedicine through “Made in India” strategies.

As mentioned by Ganapathy [1] in an exhaustive article in this issue, Telemedicine in its basic form has been now existing in India and worldwide thanks to the extensive development of the IT sector and now a mercurial necessity arising due to the COVID crisis.

Surprisingly, even though Telemedicine existed for decades, its widespread implementation was not forthcoming.

Until now.

Rapid push for Telemedicine occurred following the COVID onslaught. Several institutions within the USA adopted telemedicine within a record 8 week. Various insurance companies like Medicaid immediately provided a temporary waiver for licensure requirements.[2] The recent Ministry of Health and Family Welfare guidelines [3] is now leading to an exponential increase in use of Telemedicine facilities in India.

But most important I think is the change of perception in the opinion of the general public towards tele-consults in India, where the general public is now becoming more amenable and serious towards advice given on tele-consults. As mentioned by Ganapathy, large tertiary level hospitals in the US like the Mount Sinai use a large number of specialists to provides tele-consults to as many as 300 sites. The author himself is credited for having had significant experience in establishing telemedicine in hostile terrains like Himalayas.[4] In fact, recognizing the patient's need to have access to inexpensive and convenient health care, Duffy and Lee recently questioned in-person visits should become that last option for meeting patient's needs.[5] Understanding the limitations of telemedicine, the American Academy of Neurology has suggested a series of algorithms for assessing a complete neurological examination which includes vital signs, mental status, speech, cranial nerve examination, motor/sensory examination. They also mention the limitations of the current facilities available for telemedicine and also emphasise the need for “tele-examiner” for certain situations.[6]

When implementing Telemedicine for countries like India, the strategies obviously have to be different and again customized for this country. Firstly, the low bandwidth of internet connectivity has to be taken into consideration. Hence strategies have to be developed in such a manner that there is no interruption of audio or video connectivity. Thus, a lower video resolution is better acceptable than compromising on audio quality. Secondly, the telemedicine facilities should be operable via mobile apps, direct phone calling (for persons without smartphones) and also via laptops. Thirdly, the investment may be made in creating “Health Kiosks”. These may include “ATM” sized machines accessible by the general public which would have much more capabilities (e.g., measuring vital parameters) and even perform certain remote patient examination. Another major problem is lack of central electronic medical records in India which make inter physician-patient consultation difficult. Most of the patients face immense difficulty carrying multiple papers and investigation reports between doctors. Thus, easy transfer of data like imaging etc., should be facilitated via cloud-based programs. There are potential threats to patient privacy but mechanisms can be created to safeguard the same. Virtual rounding is another option especially within the COVID wards where by doing this, exposure of infection to health care workers may be minimized. In addition, the cost towards expenditure on PPE may also be reduced which is a huge challenge especially in the COVID pandemic. Several universities have been using robots for virtual rounding. In financially challenged countries, use of a simple mobile/tablet held by the nurse or the ICU/ward resident may suffice for most purposes.

Summarizing, while telemedicine has been existing for several years, an acute impetus has been provided in the current times during the COVID pandemic. Telemedicine would evolve one of the important verticals for dealing with the COVID pandemic. It would be important to provide safety for health care workers, providing treatment and would also work towards reducing the cost of healthcare.

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