The Potential for Telehealth in India: Care is Coming Home

Jeff Kosowsky, Senior VP - Corporate Development, American Well Headquartered in Boston, American Well is a healthcare IT services company specializing in the telehealth and telemedicine verticals. It connects patients instantly with doctors over secure video, thus enabling them have a seamless & hassle-free communication.

With a rapidly growing population, expanding middle class and increase in life expectancy, India is quickly encountering the challenges and expenses of chronic disease at an unprecedented scale. Additional challenges include an underdeveloped ambulatory system, coupled with a shortage of sufficiently-trained providers and specialists. Already more than 70 million Indians suffer from diabetes with hundreds of million more cases expected to develop over the next several decades. As one might expect, there simply are not enough endocrinologists available to treat this huge number of patients and, as a result, many go untreated altogether and often face dire consequences. Rural areas are hit even harder by these realities. Resolving this health crisis would cost India hundreds of billions in capital to build out the full-scale network of modern ambulatory clinics needed to treat these patients.

Telehealth makes it possible to leapfrog this capital intensive and expensive step-and similar to how mobile phones brought connectivity to the masses without having to build out copper networks-telehealth can provide access to healthcare without building a bricks and mortar facility. The technology required to scale telehealth to serve hundreds of millions of people is already here and only minimal capital investment is required. Since the infrastructure is cloud-based, patients can access telemedicine services from their favorite connected data device: PCs, laptops, smartphones, and tablets, alike. We are already witnessing this same phenomenon exploding in the U.S., where virtual visits are projected to exceed physical visits by 2024. Moreover, according to RNCOS, the global telehealth market is expected to grow to $50 billion in 2020.

The advantages of broad telehealth adoption are clear:

Improved Access & Convenience: Patients no longer need to navigate the crowded streets of Indian cities or travel long distances from rural areas to obtain excellent care. Through video on web or mobile, patients can obtain primary or specialty care via an on-demand or scheduled appointment. Beyond the convenience of not needing to leave work, school, or even home, mature telehealth solutions offer a streamlined approach to clinical workflows. Nurses and doctors rely upon electronic intake forms, versus more anecdotal narratives, and can integrate new visit notes into the patient’s EHR, while also prioritizing care delivery and looping in colleagues and specialists as needed. Physicians also benefit from the convenience of seeing patients after hours from home and avoiding the need to travel between multiple clinics; they can also bill appropriately for such service.

Cost Savings: Unnecessary and often repeated trips to the emergency room or
even to a primary-care provider drive significant expense. Early access to triage or care via a nurse or physician assistant over video often eliminates the need for an in-person visit. For instance, when elderly patients require medical attention off-hours, a care facility might not possess the resources needed and a transfer to the ER may be the only option available in the middle of the night. In the diabetes example, a less experienced telehealth GP can be trained to manage stable diabetic patients via video, while more advanced cases might be referred via telehealth to an endocrinologist. The patient thus sees the right doctor, the right way at the right time, promoting efficiency and cost savings.

The opportunity for telehealth in India is truly transformational, bringing with it the potential to address many of India’s most critical problems in wellness and disease

Same or Better Quality of Care & Outcomes: The technological underpinning of telehealth can go hand-in-hand with implementing protocol driven, quality control. Telehealth technology can be used to uniformly train, manage, document and review care, including the ability to insert teleprompter like clinical care guidelines into the workflow. With simple EMR integration, telehealth can be seamlessly embedded in physician workflows along with access to a comprehensive, uniform, patient record. Early data supports the quality benefits of telehealth. A recent study conducted by South west Medical Associates, a multi specialty group located in Las Vegas, Nevada, demonstrated that virtual care is just as effective - if not more effective-as in-person care for treating patients with newly diagnosed upper respiratory tract infections. Of those seen via video, only four percent required follow up care within 14 days, compared to 26 percent for in-person visits, and patients diagnosed virtually had a 45 percent reduced chance of receiving follow-up care within two weeks. In line with the better outcomes, patient satisfaction scores were higher for virtual care (95 percent) than in-person care (84 percent).

Telehealth is much more than ‘medical Skype’. To bring care home, telehealth needs to include all the essential elements of a physical visit, including scheduling, intake, clinical workflows, documentation, e-prescription and labs, discharge notes, opportunity for follow-up, coverage or insurance eligibility, billing, and payments. Additionally, telehealth platforms need to be integrated on the backend into EHRs and claims systems and on the patient-facing end with the increasing range of consumer medical devices, like scales, thermometers, glucometers, blood pressure and heart rate monitors, and many other new sensor technologies poised to enter the consumer marketplace. Above all telehealth platforms must be secure, trusted, reliable, and scalable.

Some considerations for implementing telehealth platforms and programs in India include:

1. Not for startups. Going beyond Skype to bring high-quality patient care to the home requires end-to-end telehealth platforms backed by the experience of well established telehealth players.

2. It's much more than just connecting doctors to patients. Telehealth is more than just point-to-point care but rather the base of a networked infrastructure that brings together key stakeholders, including: hospitals, doctors, consumer device manufacturers, insurance companies, pharmacy and pharmaceutical companies.

3. Consumer and provider engagement are equally critical. From the patient/consumer perspective, care needs to come to them so that they can find it native on their devices or embedded in websites and applications that they frequent. From the provider perspective, telehealth needs to be simple and as easy to use as performing a traditional physical visit. The choice between seeing a doctor or patient via video or in-person must be natural and seamless.

Telehealth will be transformational for India. Today’s industry leaders already have deep partnerships in place with key players, like Android device manufacturers who are choosing to pre install telehealth applications on millions of smartphones. Given the 85 percent Android device share in India, pre installation can instantly bring telehealth capabilities into the literal hands of hundreds of millions of Indians. Mor eover, relationships with global pharmaceutical and device companies and support from global insurers offer the potential to extend the value of telehealth care delivered. The opportunity for telehealth in India is truly transformational, bringing with it the potential to address many of India’s most critical problems in wellness and disease the rate and extent of its adoption is now in the hands of the Indian private and public sectors along with the all-important consumer.