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EDITORIAL COMMENTARY
Year : 2023 | Volume
: 69
| Issue : 3 | Page : 132-133
Contribution of Indian publications to research in telemedicine
MS Tullu
Correspondence Address:
Dr. M S Tullu
Department of Pediatrics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra
India
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/jpgm.jpgm_415_23
How to cite this article:In this issue of the Journal of Postgraduate Medicine, Behera et al.[1] have presented interesting findings on the contribution of Indian authors to the field of telemedicine research. The authors have conducted this scientometric study on the intellectual output (from India) in terms of publications on “telemedicine” till the year 2021 using the Scopus database. Their main findings are that Indian publications (2,391) were 4.32% of the total 55,304 publications, 886 (37.05%) papers were in open access mode, a noticeable increase was seen in the publications in the year 2020 (a spike of 97.41% when compared to the year 2019), the commonest journal being the ”Journal of Medical Systems” (54 publications), the All India Institute of Medical Sciences (AIIMS), New Delhi, contributed the highest number of publications (number = 134), and that overseas collaboration was noted (USA: 11%; UK: 5.85%).[1] The publications attributable to Indian authors (2,391) were of various kinds, including research articles (49.10%), conference papers (24.80%), reviews (10%), book chapters (3.43%), etc., and included medical as well as non-medical publications; thus forming a heterogeneous group of publications.[1] All these publications may or may not have undergone a rigorous peer-review process, and there is an occasional possibility of duplication of research findings (especially when conference papers are converted to journal publications). The encouraging finding is that average citations per document were 9.269 (1.71 per year per document), and this highlights the importance, popularity, role, and utility of telemedicine in the current era.[1]
The growth of scholarly literature on telemedicine, as documented by Behera et al.,[1] also highlights the importance and current status of telemedicine.[1] Telemedicine has gained popularity and acceptance in the last couple of decades, with the COVID-19 pandemic playing an important role in bringing this modality of medical consultation to the forefront.[1],[2],[3],[4] The inability of patients to travel to the clinics or hospitals during the lockdown periods in 2020 and 2021 and the limited availability of transport services have had a favorable effect on the choice of telemedicine as a mode of acquiring medical help by many patients and as a mode of professional consultation by the practitioners.[1],[2],[3],[4] A noteworthy feature in the article by Behera et al.[1] is the fact of international collaborative publications, with co-authors from many countries, such as the USA (263 publications), the UK (140 publications), and Australia (67 publications). This highlights the research need and importance of the topic of telemedicine globally and underscores the feasibility of international collaborative research.[1] Behera et al.[1] have presented in detail the information related to the leading authors (Mishra SK from SGPGI, Lucknow, had the highest number, that is, 24 publications), the institutions (AIIMS, New Delhi, contributed the highest number of publications, 134), the impact, and the yearwise topic trends in Indian publications on telemedicine.[1] A deeper insight can be obtained into this subject, especially if the titles and contents of these studies are analyzed so as to understand the “core matter” of the publications, that is, whether they are related to clinical care and treatment, counseling, describing the infrastructure, stating the role of public or private enterprises, systems description, or describing the use of technology and software. The Journal of Medical Systems had the highest number of articles published (54; 2.25%) with 1789 citations, in addition to fewer articles published in core medical journals like the Indian Journal of Ophthalmology.[1] The range of journals suggests the availability of a wide array of journal platforms and opportunities for authors to publish their research. There also exists an opportunity to collaborate with engineering or technology institutes as well as various other non-medical institutes in conducting such collaborative research. This list of journals may also reflect the willingness and adaptability of the respective editors to publish research on telemedicine in their journals by expanding the scope of the manuscripts (accepted in their journals) to suit the current needs of society (and scientific research).
The applications for the use of telemedicine range from chronic illnesses like diabetes, hypertension, and various systemic disorders to cancer care, psychological illnesses, and use in disasters.[3],[4],[5],[6],[7] Although it cannot be an alternative to the physical examination of a patient, telemedicine can aid (either in real-time, that is, synchronously, or via appropriate software, that is, asynchronously) certain clinical aspects (like history-taking) and limited examination (inspection of various organs, for example, skin, ophthalmological corneal abnormalities, orthopedic deformities, etc.).[2],[4],[5],[6],[7] Advice like investigations, monitoring, interpretation of reports (especially radiological or pathological), use of medications (including asthma devices and insulin injections), and patient follow-up can be successfully done using telemedicine.[2],[4],[6] Using telemedicine allows the patient to receive the best possible treatment near their place of residence without having to travel long distances, thus saving travel time, outstation stays and other expenses.[2],[3],[5],[6],[7] Telemedicine allows the patient to obtain the best possible opinion on difficult cases from senior and experienced specialists or consultants from specialty hospitals, medical colleges, and tertiary care centers.[5],[6] Telemedicine also allows for the development of rapport between the consulting doctor, the patient, and the referring doctor by (on-web) face-to-face consultation.[4],[5],[6],[7] Telemedicine is very useful for chronic illnesses, non-communicable diseases, difficult-to-diagnose cases (including their follow-up), the cancer care continuum, and allows for collective decision-making about appropriate referral (as may be necessary).[3],[5],[6] Telemedicine can also promote rural health care and the well-being of the rural populace, and the deficiency of non-availability of consultants at district hospitals or rural areas can be overcome.[3],[5],[7] Telemedicine can be extensively used for conducting community education and professional education or training programs, for providing more coordinated healthcare to the rural populace through the district hospitals, and for carrying out collaborative research.[5],[7]
Though very useful, the use of telemedicine needs a cautionary note regarding the quality of care or advice provided due to various limitations, and a closer look into the issues related to the medicolegal implications has become necessary.[2],[3],[4] Issues like limited physical examination, missed diagnosis, prescription errors (due to inadequate communication), linguistic issues, low video quality, inherent limitations of electronic devices and other technological issues, issues related to informed consent of the patient, doctor liability, drugs which can and cannot be prescribed, record-keeping, photographs, confidentiality/privacy issues, data recording or preserving, fee structure, trust of the patient in the consultant/practitioner, educational or literacy status of the patient and understanding of the disease by the patient/caretaker, limitations in emergency situations, incorrect interpretation by the patient/referring doctor, inadequate training of healthcare staff, and limited availability of support staff knowledgeable in telemedicine technology are some of the challenges and limitations which are being faced in our country.[2],[3],[4],[5],[6],[7]
The applications of telemedicine and related technology will keep on evolving, and hence appropriate training of healthcare professionals, guidelines regarding the use of telemedicine, availability of the necessary infrastructure and good quality internet services or connectivity, use of recent technologies (like artificial intelligence and blockchain), and developing public-private partnerships for the implementation of telemedicine programs across the country will go a long way in optimizing the use of telemedicine services, allowing them to reach their true potential, achieve the 'boom' that telemedicine is supposed to create, and make telemedicine an integral part of healthcare services in India.[2],[3],[4],[5],[6],[7],[8],[9],[10] Tele-healthcare, tele-home healthcare, use in medical specialties (like tele-ophthalmology, tele-psychiatry, tele-cardiology, and tele-surgery), use for diagnostic purposes (like tele-radiology and tele-endoscopy), screening of diseases, and m-health (mobile health) are some of the other upcoming applications (either similar to telemedicine or using the principles of telemedicine).[5],[7] There is a relative paucity of literature from India on telemedicine and documenting the applications and cost-effectiveness of its utilization in family practice, and this needs to be addressed.[5] Research similar to that conducted by Behera et al.[1] and encouraging the authors and institutions to publish their research findings (related to telemedicine) in appropriate journals is the need of the hour.
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