Digital health technologies and telemedicine have tremendous potential in resolving some of the existing disparities in healthcare delivery by increasing access and improving the quality of care while decreasing costs. However, despite policy reforms that have now formalized the role of telemedicine in India, the pace at which it is establishing itself, especially in rural and remote areas, is not at par with available resources.
The penetration and acceptance of telemedicine in rural areas are still poor, while its use even in the urban area is far below its true potential. The problem is not limited to human resources, but includes insufficient awareness or challenges in accessing telemedicine services due to literacy, language or technological barriers among patients, as well as the non-availability of basic physical examination and laboratory parameters that aid in evidence-based clinical decision-making among physicians.
Appropriate use of digital technology and telemedicine can improve the access to specialist health services and reduce the tremendous burden on tertiary healthcare facilities. Also, the need for human touch is of prime importance in making telemedicine services more acceptable in rural settings.
Digisahayam is an assisted telemedicine solution being implemented by the Centre for Chronic Disease Control – BRIDGE Centre for Digital Health. It has developed an interoperable telemedicine platform to provide primary and tertiary-level physician consultation services. These services are delivered with the help of trained healthcare personnel that help bridge current gaps in telemedicine and improve access to healthcare among poor and vulnerable populations living in remote, rural as well as urban locations.
The Star Arogya Digi Seva program is an assisted telemedicine healthcare initiative that has been providing general consultations, specialist consultations, ECG, laboratory tests and diagnostics services to the public since its launch. There are two centres currently operational under this project. At the urban slums of Chennai near Nanganallur and one at Pasuvanthanai Village of Thoothukudi district in Tamilnadu. Since its inception, by way of almost 24500+ consultations, approximately 14000+ lab tests and 2600+ ECGs were performed to date. This program is providing quality healthcare services to the most vulnerable strata of society.
Star Arogya Digi Seva has been designed in such a way that less paramedical staff is sufficient to implement the project activities. It minimizes the use of human resources. It has a well-defined plan for training and educating healthcare professionals on how to use the technology. Two point-of-care clinics set up has been done in Tamil Nadu for collecting diagnostic data, such as blood tests, vital signs and lab work at one location and sending it for in-person consultation with a specialist at a different location, patients in remote towns can now access specialists elsewhere, enabling a skilled specialist to serve a far wider area. As an outreach activity in a camp setting, a medical officer and a trained telemedicine nurse for screening travel to isolated, difficult-to-reach and industrial areas to conduct outpatient clinics.
Regional demonstration project for upgrading the Primary Health Centres (PHCs) supported by World Health Organization. The project is currently operational in collaboration with PGIMS Rohtak at the Chiri and Dighal blocks of Haryana. Under this project, the PHCs at Dighal and Chiri upgraded to provide specialist consultations via assisted telemedicine. While these clinics help in improving access to secondary and tertiary healthcare for the population in remote locations, it also serves as a demonstration project for its adoption and scale-up to other parts of the South East Asian region.
Both PHCs have certified telemedicine nurses who keep track of patients’ vital signs and help them schedule appointments with specialists. The programme makes use of digital health tools such as the electronic clinical decision support system M-power Health, the Swatha Sahayak device for point-of-care testing, the Kardioscreen portable ECG machine, and the Digital Stethoscope.
Assisted telemedicine at a rural health training centre attached to a medical college in collaboration with Share Medical Care, Medchal, Hyderabad, Telangana. This program will ensure an integrated system of care that will guide and tracks patient over time through a comprehensive array of health services spanning all levels of intensity of care. The longitudinal health data, reduction of indirect healthcare expenses associated with travel and lost earnings, greater awareness, early detection, and evidence-based management to prevent and control non-communicable illness. This program has the potential to lower the cases of financial difficulty and catastrophic medical costs. It addresses the lack of high-quality medical professionals and doctors.