Telecoms – The spinal cord for telemedicine in times of COVID-19
In our pursuit to recognize the contribution of telecommunications to healthcare delivery, on World Telecommunication and Information Society Day 2020, Voice&Data brings a special feature on India’s self-reliance in telemedicine and its effective deployment in the fight against Coronavirus across the country.
A team of six students of Manipal Institute of Technology recently bagged the second prize claiming a price money of $5,000 at the CODE 19 Online Hackathon. The students were awarded for creating a solution that enables remote diagnosis of COVID-19 patients to reduce the risk of infection for healthcare workers. Their solution, TeleVital, captures a patient’s vital statistics remotely through a webcam and browser. In short, their creation is a solution for the contactless health assessment of a patient. Jithin Sunny, Joel Jogy George, Rohan Rout, Rakshit Naidu, Megha Baid, and Shivangi Shukla are the students behind this solution.
The concept these young minds have brought forward harnesses the combination of communication technology with medical technology. Since mobiles and laptops are readily available at many people’s homes today, the team decided to capture vitals and other health parameters of a person through a web browser and web camera and establish online communication between the patient and the doctor. The innovators have created a solution to record a patient’s heart rate, respiratory rate, body temperature, etc. without any contact-based measurement tool. They have also built a system to check if any individual was at the risk of getting infected or being a carrier of the virus through its AI-based chatbot to check travel history and map other symptoms. Hence, the broad aim of their creation is to reduce overcrowding at hospitals and the attendant risk of infection for healthcare professionals.
QuikDr Healthcare Pvt Ltd, a Kochi-based startup, is involved in providing teleconsulting for the Government of Kerala, the state that had the most proactive and successful measures in the early containment of COVID-19. The startup provides end-to-end telehealth solutions ranging from HD video conferencing through devices to an integrated telecall facility and toll-free IVR support. The USP of QuickDr is its design that can seamlessly enable root level penetration and integration of district, municipality, corporation, taluk, and local bodies in its route to healthcare delivery.
CEO Safil Sunny says that his startup designed the QuikDr telemedicine platform in such a way that it enables access to quality and affordable healthcare through technology. The system is able to handle over 100,000 consultations in real-time. “Using QuikDr a large number of people will be able to have access to affordable healthcare services at a fingertip. Certainly, the ubiquitous availability of smartphones has enabled us to create this platform that can seamlessly work with all the available mobile devices. The platform is designed to function even with low bandwidth availability, enabling patients at remote locations to connect to a doctor,” says Sunny.
India has a massive healthcare gap. The country reflects a shortage of 500,0000 hospital beds, 200,0000 doctors, 400,0000 nurses. Further, the ratio of population to doctors is six times lower in rural India than urban India. Thirty percent of the rural population have to reach a medical facility on foot covering an average distance of 30 km. However, a significant number in the rural population has somehow access to a voice and data network through either a smartphone or a feature phone or maybe even through a laptop.
The World Health Organization recommends a doctor-population ratio of 1:1000, while some analysis indicate that the doctor-population ratio in India is barely 0.62:1000. Training of new physicians is time-consuming and expensive, hence the doctor to patient ratio can be expected to remain low for a long time to come. Under this pandemic condition, there is no way, patient care could be addressed with a deficit of such kind. What’s heartening is that this deficit is partly being made up by the active telemedicine services launched by several thousand providers in various parts of the country.
Televital and QuickDr are a mere nanoscopic projection of India’s many thousand institutes, universities, research facilities, startups, hospitals, and enterprises working in the field of telemedicine and are especially spinning-out solutions that have immediate application in the fight against COVID-19. But what made the world’s eyes turn to India is its super weapon to fight Coronavirus through the Aarogya Setu App and Aarogya Setu Mitr.
India’s testimonial telemedicine application
Aarogya Setu – the App that crossed the mark of 10 crore-registered users in 41 days since its launch on April 2nd. Projected as the ultimate solution for contact tracing, the app has the ability to reach around 8 crore mobile phones in the country. Despite being in the eyes of critics due to privacy concerns, the Aarogya Setu app has gained immense popularity specifically due to the fact that while it was initially voluntary to use by the citizens to limit the spread of COVID-19, it has been made mandatory for many end users, especially those traveling on public transportation facilities.
Dubbed as the “Initial Building Block for India Health Stack”, the App underwent subsequent evolutions since its launch. Apart from launching an IVRS version of Aarogya Setu (in the attempt to reach feature phone users), the ministries roped in several service providers to create Aarogya Setu Mitr – loaded with telemedicine features.
The making of Mitr was facilitated by the offices of the Principal Scientific Advisor to the PM and NITI Aayog, with voluntary participation from organizations, industry coalitions, and startups. The App offers free teleconsultants for patients who may have COVID-19-like symptoms, along with ancillary services like home collection of samples for diagnostics and medicine delivery at home.
Besides providing the services of eSanjeevaniOPD, the National Teleconsultation Service of Health and Family Welfare, Aarogya Setu Mitr App has partnered with Tata Bridgital Health (healthcare initiative of the Tata Group), Tech Mahindra’s Connectsense Telehealth, StepOne, and Swasth Foundation to offer the telemedicine service. The App also allows users to book lab tests from 1mg, Dr Lal Pathlabs, Metropolis, SRL Diagnostics, and Thyrocare. Online delivery of medicines has also been made possible with services by 1mg, netmeds, PharmEasy and MedLife.
Telecoms – The connectivity partner for healthcare delivery
Launched in March 2020, StepOne is the telemedicine collective, representing the largest number of nationwide volunteer doctors, 21 startups, and active citizenry to power state government helpline numbers to combat COVID-19 and mental health. StepOne is an empanelled partner for telemedicine consultations on the Aarogya Setu Mitr, an ancillary service on the Aaroya Setu App that enables free teleconsultation for those with COVID19-like symptoms.
“As soon as we heard that our frontline healthcare workers and doctors were getting infected from COVID-19, we realized we needed a solution that keeps them safe while allowing them to screen and examine patients. The very same time lockdown got announced and we were wondering how to ensure people with medical needs also stay indoors? The only answer was a telemedicine solution and we very quickly built a voice-first telemedicine solution ensuring we build a very inclusive solution that could cater to the masses. Our solution was built to deliver in 6 Languages – (Marathi, Punjabi, Odia, Kannada, English & Nagamese) and it works well whether one calls from a feature phone, landline or from a smartphone,” comments Rahul Gupta, co-Founder StepOne, whose proactive telemedicine solutions are integrated into the Aaroya Setu.
Comparing the success of telemedicine to demonetization, Gupta says, “What demonetization did to UPI, COVID-19 has done to telemedicine urging GoI to bring in clear regulations and promote the use of telemedicine. COVID-19 is proving to be a boon to the adoption of telemedicine, as it will prove to be a behavior changer. There’d be millions of people who’d continue to consult doctors distantly, whether it is for a person in rural areas who has to travel all the way to a town by just to get to a doctor or a person in the city, who wants to do a follow-up or talk to a particular doctor, a very vast majority would move to telemedicine.”
StepOne apparently received a million calls across seven states in 26 languages. The platform addressed over 80,000 consultations through 6,000 doctors in less than a month since its launch. This is marked as India’s largest combined telemedicine effort made by the government in its effort to battle COVID-19.
To enable StepOne to deliver its objectives, the platform partnered with Reverie Language Technologies for local language deployment and cloud telephony companies like Exotel Techcom Private Limited, Kaleyra, Ozonetel Communications, and software provider Freshworks.
Chaitanya Chokkareddy, Chief Innovation Officer, Ozonetel, believes that StepOne showed everyone how a scalable system could be architected to handle millions of calls coming on the COVID helpline. Ozonetel has been instrumental in providing the local language IVR system in this platform.
“StepOne has shown what is possible when you can leverage the power of collaboration of the best of the brains in the ecosystem. Even working remotely is not a constraint. COVID-19 created a lot of anxiety in people. They are worried about symptoms and need access to information. This is where telemedicine steps up not only to quell anxiety but also potentially save lives and help contain the spread of infection. Besides anxiety around COVID-19 itself, people also need to safely consult doctors for regular ailments. Telemedicine is critical for solving both these issues. So, we have built solutions such as helplines, as well as telemedicine technologies both showing a lot of usage and growth, says Chokkareddy.
Ozonetel’s delivery teams have been enabling remote call centers to function within 24/7. This includes support to pharma companies as well as pathology labs that are playing a critical role in COVID testing. The company already had the expertise in call center solutions and COVID made Ozonetel escalate its offerings in phone consultations. By associating with StepOne, Chokkareddy says that his company was able to deliver services free of cost to doctors across the country through the helpline built.
Telecommunications in its different avatars can be put to use in healthcare. Not alone IP telephonies, Apps, and fixed lines, we have wireless network connectivity that enables healthcare delivery to a large extent.
Bharat Sharma, Sales Director in India, Cambium Networks, says, “With the COVID-19 virus affecting more people, hospitals are challenged to provide care for several patients that exceed the capacity of the facility. Turning patients away is not an option. Hospitals are looking at constructing temporary facilities in adjacent parking lots to provide professional care to people in need. Wireless technology has proven to help people in need when natural disasters strike. A wireless network composed of a point-to-point link and a Wi-Fi access network can be rapidly created to provide: secure access to patient records, low latency to support video conferencing for healthcare professionals, high bandwidth to provide seamless conference calling and data transfer and most importantly video surveillance capability.”
Digital Health – A Hobson’s choice for caregivers post COVID
By Prof. Rajendra Pratap Gupta COVID has brought the world to a grinding halt, and it has questioned the science, strategy, and systems in healthcare. COVID has bared the reality of the world’s unpreparedness for such catastrophes. Let us look at what it means for India’s healthcare systems.
For healthcare, it means a change in industry dynamics, practice behaviour, customer engagement, and supply chain. The overarching theme will be ‘domestic self-sufficiency and digitalized healthcare.’
On the practice behaviour: Over the next few months or a year, we are not going to see normal clinician-patient behaviour. Already, the footfalls in hospitals are down by 80 percent, and both the patient and doctors will try to play safe. This means increasing the adoption of digital technology in practice, and this is a good sign. Digital adoption will be driven by patients’ needs and doctors’ interests to safeguard each other.
I led a study that examined people’s comfort with using technology in 100 countries. More than 82 percent who participated in the study expressed the wish to use technology for their healthcare needs. Whereas, before COVID, this was less than 10 percent.
In another study with healthcare providers, the majority of the doctors interacted with patients through WhatsApp, SMS, telephone, and video calling, and WhatsApp appeared to be a preferred medium for medical consultations.
The government of India also moved fast and released the telemedicine practice guidelines for medical practitioners on 25th March, and the same has been done for AYUSH separately. Digital adoption has been fast-tracked. Also, recently, NABH started work on accreditation guidelines for digital health. With digital services providers being accredited, it will ensure patients’ safety and quality of care delivered.
Supply chains are going digital, and solutions are linking doctors to pharma companies for e-detailing. This means that there will be layoffs of medical representatives in the future. Also, it is likely that e-detailing will be linked to e-supply chain solutions. So, the retailer quantification and order placing and fulfilment will become live, and lead to lesser stockouts or oversupply, and this will lead to rationalizing the supply chain costs and improving efficiency. Intermediaries (sub-stockists) will disappear over time, and so will be the substandard and fake medicines.
The crisis of 2008 led to major reforms in the banking and finance sector; the crisis of 2020 will lead to a major reform in the healthcare sector, with digital health being the overarching theme.
Prof. Rajendra Pratap Gupta is a leading public policy expert and author of the book ‘Tough Choices & Hard Decisions – Rebuilding India’.
Towards sustainable development goals
Every year, the World Telecommunication and Information Society Day 2020 is celebrated on this day 17th May. For this year 2020, “Connect 2030: ICTs for the Sustainable Development Goals (SDGs)” is the theme set by ITU.
ITU adopted Connect 2030 Agenda for global telecommunication/information and communication technology, including broadband, for sustainable development to reaffirm a shared global vision for the development of the telecommunication/ICT sector, envisaging an information society, empowered by the interconnected world, where telecommunications/ICTs enable and accelerate social, economic and environmentally sustainable growth and development for everyone.
The modern-day telemedicine that harnesses ICT is slowly building that ‘Connect’ and is working towards achieving the UN’s sustainable goals. The intervention of computing devices and gadgets is bringing that necessary connect between the patient and physician, changing the way healthcare is delivered in the most inexpensive way. Self-owned equipment like smartphones cameras, wearable biosensors, etc., are all exploited to a large extent for gathering clinical data allowing quicker medical intervention and speeding prophylaxis.
Vas Metupalle, co-Founder and CIO, MyDoc, a UST Global portfolio company, “Telemedicine done effectively should be a gatekeeper of care and be part of the entire patient journey. India lacks a quality primary care network, and technology could solve this problem. Over-reliance on private hospitals and increasing bill sizes will make this more attractive as well. Chronic illnesses like diabetes, hypertension, and high lipids can be better controlled. We should hopefully see the wearing off of interest on direct e-pharmacy and have telehealth companies lead the funnel to triage and decide who needs medication or follow-up with specialists.”
“Telemedicine has been available in India for the last couple of decades and taken off during the last couple of months. It would not have happened without the ubiquitous availability of telecom bandwidth in India. Teleconsultation is possible effectively only when a video is available on a smartphone allowing the doctor to visually examine the patient. Similarly, teleICU or remote patient monitoring requires low latency networks. In the COVID situation, internet providers have stood up to the test of needs for real-time data needed for remote monitoring by specialists to advise their clinical team on case management. Going forward, the challenge will be to provide the required quality of service to remote locations in rural areas where often telemedicine is the only available and reliable option for healthcare,” Bharat Gera, ex CIO of St John’s National Academy of Health Sciences and an Industry Expert on Digital Transformation in Healthcare, shares his advice.
Nevertheless, the combination of ICT with healthcare has and will always unfold a sea of opportunities. While exploiting emerging technologies like cloud, AI, VR, AR, IoT, and ML, the future of healthcare is constantly redefined. From digital payments to online deliveries to diagnostics, telemedicine has the power to connect services of all kinds for the well-being of a healthier world. Not to forget, if videos are going to be the preferred medium of delivery, then the need for a faster roll-out of 5G becomes imperative.