Telemedicine during COVID-19 in India—a new policy and its challenges

The positive externalities of investing in and broadening the scope of telemedicine in a resource-poor country like India are many. While the COVID-19 pandemic is ongoing, many cases of non-communicable and other diseases that cause more than 60% of natural deaths in Indians can be addressed using a robust telemedicine infrastructure [20].

The skewed healthcare force distribution in India, where 60% of the force caters to 30% of the population that lives in urban India; with an urban to rural doctors ratio at 3.8:1, can be somewhat mitigated by effective and accessible telemedicine programs [21]. More than 50% of healthcare practitioners in rural India do not have any formal training and with poor access to formal healthcare facilities in vast swathes of rural India, quackery remains a major issue in healthcare [22]. Remote access to Registered Medical Practitioners, or those who have a MBBS degree, using telemedicine can reduce widespread quackery. Telemedicine can bring quality health care, including specialists, to a large population through smartphones. Success will, however, be limited unless India also effectively addresses the country’s social determinants of health like gender inequality, education status, gender disparity in education, women’s participation in labor force and others [23].

In this era, it should be possible to integrate telemedicine with Artificial Intelligence technology, to enhance the quality of healthcare and create new models of care [24]. India is already experimenting with these elements in many initiatives. In Madhya Pradesh, a large state in India, the state government has linked its eSanjeevani telemedicine platform to about fifty Primary Health Centres (PHCs) for patient follow-up and care; these centres depend on tertiary care hospitals several hundred kilometres away. With guidance of local medical officers, patients have been seeking consultation from experts. By August 20, 2020, five days since the rollout on August 15, about 1000 patients availed themselves of service. The State plans to extend the program to all its 11,000 PHCs [25].

Data privacy and security protections need to be strengthened in India. The Parliament tabled a Personal Data Protection Bill in December 2019 that would set up a Data Protection Authority and enable imposition of heavy penalties for violations of the law about storing of data and require consent from individuals before accessing their data [26]. A German security firm, Greenbone Networks, have reported several health data breaches and leaks in India. It was a February 2020 report of a leak of patient data from India, including X-ray images, names, ailments, treating physicians, which pointed to gaps in the confidentiality and data protection system [27]. Use of third-party apps (applications on computers, tablets, and telephones) to transmit personal information would make users of telemedicine wary. Strengthening of protections will be essential to success.

This pandemic has boosted initiatives to expand telemedicine. The COVID-19 situation has opened a so called ‘Overton window’ of political possibility, a wider range of options the public is willing to consider and accept. This opening should trigger policy formulation followed by legislation to codify new policies.

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