The State of Telemedicine in India

In 2022, India's telemedicine market achieved a valuation of $1.10 billion. Projections indicate that it will experience a robust compound annual growth rate (CAGR) of 21.2% between 2022 and 2030, ultimately reaching an estimated value of $5.15 billion by 2030. This expansion is closely intertwined with the country's escalating digitization efforts, contributing to the enhancement of India's healthcare IT infrastructure. The telemedicine sector particularly gained traction due to the sudden outbreak of COVID-19 and the subsequent implementation of state-wide lockdowns aimed at containing the virus. These circumstances provided a fertile ground for the telemedicine industry's growth, as individuals and their families gravitated towards remote consultations via telemedicine platforms instead of venturing into hospitals or medical offices. The overarching concern about virus transmission and infection prompted this shift in preference. Concurrently, many outpatient services were temporarily halted as healthcare facilities and professionals redirected their focus towards delivering exclusive care to COVID-19 patients.

The introduction of the National Health Digital Mission, encompassing telemedicine, unique health identification, and electronic health and medical records, has instigated a transformative revolution in healthcare accessibility and operational efficiency across India. While telemedicine and home care are still at early stages of adoption in various parts of the country, the implementation of health information exchange, seamless data sharing, the integration of open standards, and the establishment of a national health information network collectively promise to accelerate this process. It would be apt to state that government policies and approach has been favourable for growth and adoption of telehealth in India.

Opportunities and Challenges

Telemedicine offers a range of valuable opportunities in the healthcare landscape:

Patient-Provider Satisfaction: Numerous studies have underscored the high levels of satisfaction both patients and healthcare providers experience with telehealth services. For instance, a study revealed that a substantial 82% of patients who engaged in teleconsultations expressed contentment with their experience and over half, or 58.1%, expressed a willingness to sustain its use in the future. Importantly, the findings suggest that patients and healthcare providers alike are inclined to recommend telehealth services to others, reflecting a strong endorsement of its benefits.

Cost-Effectiveness: Teleconsultations extend access to quality healthcare services right to the patient's doorstep. This convenience becomes even more evident during times like the COVID-19 pandemic when individuals opted for telehealth services to mitigate exposure risks and avoid unnecessary hospital visits. This transition not only saved time but also financial resources that would have otherwise been spent on hospital visits. Beyond the pandemic context, teleconsultations alleviate the burden of long travel distances and associated expenses for patients.

New and Follow-Up Care: Teleconsultations have proven to be particularly beneficial for follow-up care. The convenience of virtual consultations has reduced overcrowding in hospitals, offering a more streamlined approach for patients requiring routine follow-ups. A study focusing on teledermatology found that teleconsultations primarily emphasized follow-up care, which transitioned to encompass new patients during the pandemic. Successful delivery of healthcare services, both for new patients and follow-up cases, highlights the adaptability of telehealth solutions.

Instant Medical Advice: Teleconsultations have proven to be a lifeline for individuals seeking instant medical advice, especially for specific conditions.

Caretakers of children with epilepsy utilized telehealth services to acquire guidance on anti-epileptic drug usage, modification, routine visits, and even concerns regarding the impact of COVID-19 on epileptic children. For regular follow-up patients, teleconsultations facilitated advice related to drug dosage modification or continuation of treatment. Notably, medical advice extended beyond medication to include appointment-related queries and even surgical appointment scheduling.

Bridging Urban-Rural Healthcare Divide: The lockdown measures implemented during the pandemic highlighted the challenges faced in transporting patients, especially in geographically complex regions. Teleconsultations emerged as a potential solution to bridge the gap. While nearly 82% of dermatologists practiced in urban settings, telehealth services have the potential to reach patients in remote areas. This accessibility becomes even more crucial in rural regions, as it eliminates the need for patients to undertake long and often challenging journeys for consultation and treatment. With the availability of internet and telecommunications facilities in many rural and semi-urban areas, teleconsultation acts as a vital conduit for healthcare accessibility, reaching individuals who have limited access to traditional healthcare services.

Challenges

Navigating these challenges is crucial for unlocking the full potential of telemedicine in India.

Digital Literacy and Connectivity: India's internet users are projected to reach 900 million by 2025, with rural users growing by 14%. However, the digital literacy rate remains low, and around half the population faces inadequate internet connectivity. Limited access to resource persons in Primary Health Centers (PHCs) further restricts teleconsultation utilization.

Lack of Awareness: Two levels of awareness gaps exist—information scarcity on healthcare access and unfamiliarity with teleconsultation. This challenge is amplified in rural areas due to lower education levels. Misperceptions about healthcare can lead to dogmatic assumptions. Addressing teleconsultation awareness must coincide with educating on basic healthcare practices.

Dependency on Healthcare Infrastructure: Effective teleconsultations require proper examinations and transparent information sharing. Well-equipped local Health and Wellness Centers (HWCs) staffed with trained personnel are vital. Absence of proper examination capacity could hinder diagnosing serious illnesses, while rural teleconsultation requires wider medication availability.

Cultural Beliefs and Practices: Cultural norms and beliefs surrounding healthcare can affect telemedicine adoption. Some communities might prioritize physical interactions with healthcare providers or traditional healers, which could hinder the acceptance of remote consultations.

Language and Communication: India's linguistic diversity poses a challenge in effective communication during teleconsultations. Dialects and languages specific to regions might create barriers between doctors and patients, impacting accurate diagnosis and treatment.

Data Privacy: Limited digital literacy in rural areas exposes populations to data privacy breaches. Health data's sensitivity makes safeguarding crucial. Although the Data Privacy and Data Protection Bill is promising, uncertainty persists, as seen in experiences with the Advanced Basic Digital Medicine (ABDM) platform.

A Competitive Landscape

The telemedicine market in India is bustling with a multitude of players. These companies are actively employing organic strategies, including launching new services, offering additional facilities, and enhancing their telemedicine offerings. These measures are aimed at maintaining competitiveness, gaining an advantage over rivals, and ensuring a strong market presence.

Apollo TeleHealth stands out prominently in this landscape as the largest and most established multi-specialty telemedicine network in South Asia. Boasting an impressive record of over 20 million consultations provided to date, Apollo TeleHealth has effectively harnessed technology as a means to break down the constraints of distance. This remarkable initiative has positively impacted the lives of over 15 million individuals, marking a significant achievement in the realm of healthcare accessibility. Apollo TeleHealth was also the first organization globally to attain the standard of ISO 13131, focused standards showcasing capability of managing quality, safety, and patient data security effectively.

Telemedicine Making a Difference in Rural India

Telemedicine bridges the gap between patients residing in rural areas and specialized medical services typically concentrated in urban centers. This technology enables individuals in remote locations to access expert care that would otherwise be unavailable to them. Moreover, telehealth facilitates the provision of specialized services like teleradiology, teleophthalmology, and telepsychiatry, which require specific medical equipment not accessible in all regions. This expansion of services broadens the range of healthcare options accessible to patients across India.

India faces a concerning doctor-to-patient ratio of 1:1456, falling significantly short of the WHO's recommended ratio of 1:1000. The scarcity of hospital beds exacerbates this issue. Compounding the challenge, a significant majority of healthcare professionals gravitate towards urban areas, leaving rural regions—home to approximately 68.84% of the population—underserved. This stark mismatch places an overwhelming strain on the nation's healthcare system, intensifying an already burdened infrastructure.

An illustrative instance of telemedicine's tangible impact on the lives of individuals in remote regions emerges from Uttarakhand, a hilly state in India. Supported financially by THDC India Limited, the Tehri Garhwal Government has established telemedicine centers in the state. These centers are operated by competent healthcare professionals or nurses who serve as intermediaries between specialist doctors in the District Hospital and patients at local health centers. Impressively, nearly 48.7% of inquiries are handled within ten minutes of satellite time, and the physical presence of a specialist is only required around 30% of the time. Overcoming challenges posed by the region's rugged topography, telemedicine has triumphantly addressed the significant hurdle of accessing public healthcare services in the area.

In its endeavors to strengthen the healthcare landscape, the Ministry of Health and Family Welfare has taken concrete steps. The implementation of the Integrated Disease Surveillance Project, which networks district hospitals with medical colleges across states, stands as a testament to enhancing the public health system with a primary focus on disease surveillance. Additionally, the Ministry has pioneered the creation of the National Rural Telemedicine Network in several states, including Himachal Pradesh, Maharashtra, Punjab, West Bengal, Dadra and Nagar Haveli, Assam, and Tripura. Notably, the Ministry has also introduced pilot projects in tele-ophthalmology across various states, showcasing its commitment to advancing healthcare accessibility and services.

Way Forward

As the global landscape witnesses advancements in internet speeds with the introduction of 5G coupled with the rise of transformative technologies, a more interconnected future emerges. This paradigm shift promises swifter, more convenient, and personalized service delivery across various domains, and healthcare is no exception. Augmented and virtual reality, 3D printing, robotics, and advanced capabilities in IoT and AI are poised for integration, paving the way for enriched value-based care for individuals and tailored user experiences. In this era of heightened connectivity, it becomes evident that the application of telemedicine and its allied technologies will revolutionize healthcare service delivery, ushering in an era of integrated and seamless healthcare experiences for all.

The article is authored by Mr. Vikram Thaploo, CEO-Telehealth, Apollo Hospitals Enterprises Limited