Telemedicine to the aid of home-bound patients in the time of Covid-19

Telemedicine in covid-19 times: You can get to the doctor almost anytime, anywhere, be it on your screen, via voice or plain text for a lower price than in-person consult

Telemedicine in covid-19 times: When 37-year-old Priyanka was down with fever and dry cough, she decided to consult a doctor over a WhatsApp call before giving her blood sample for an RT-PCR test. Based on her symptoms, the physician alerted her that it wasn't a mild Covid infection but a moderate one. His diagnosis was confirmed when the test report showed a viral load count of 20.

“The massive benefits of telemedicine became evident during the pandemic,” says Priyanka’s doctor, New Delhi-based consultant physician Dr Arvind Kumar. “Everything is about time and if my patients have complications late at night like, say, at 11 p.m. or 12 midnight, doctors like me are able to guide them and perhaps save a few lives in the process. If any patient has a Coronavirus infection and there are complications, we can’t wait till the next day.”

Telemedicine gives access to medical practitioners even on holidays, weekends, late nights, or any other situation in which regular medical care is not possible. It comes into play when a patient is unable to step out of the house due to sickness, bad weather, or lockdown.

Welcome to the world of telemedicine where your doctor comes home, on your smartphone or laptop. A surgeon might use telemedicine to do post-operation check-ins with patients, to make sure their wound is not infected. A gynaecologist might use a live telemedicine solution to provide birth-control counseling. An endocrinologist may do live video chats with patients to discuss recent lab results and answer questions. Besides, common medical problems such as headache, sore throat, back pain, digestive troubles can be easily addressed. Mental health is another big area, what with the social stigma associated with “seeing” a psychiatrist.

With the Government of India releasing Telemedicine Practice Guidelines in March 2020, virtual consultation has become a preferred channel for those seeking quality healthcare. Says Prateek Verma, VP–Product at 1MG, “With a base of about 40 million monthly active users, 1MG is seeing significant acceptance of telemedicine on its platform. Consultations on our platform grew 3x in recent months. Telemedicine reduces all contagion risks to zero, provides quick access to medical care, and cuts down the time, effort, and cost of traveling required for in-person consultations.”

The platform saw increasing demand for ENT specialists, gastroenterologists, cardiac specialists, neurologists, physiotherapists, dieticians, and psychiatrists. Says Verma, “There is a notable rise in consultations for chronic conditions, which were earlier skewed towards acute conditions. It’s an indicator that a lot of people are now willing to try newer ways.”

Market for telemedicine

The telemedicine market in India is expected to touch $5.4 billion by 2025, growing at a CAGR of 31 per cent, according to a recent Inc42 Plus report. The key players in the telemedicine market include Practo, 1mg, mfine, Lybrate, docsapp, Pharmeasy, Curefit, myUpchaar, Medibuddy, Portea Medica, anytimedoctor.in, AskApollo.

Remote consulting is of three types–-audio, video, and text-based. Video consult is the closest to in-person consult, allows eye contact, and enables the doctor to see the pain areas and diagnose the health issues better. Audio consulting misses out on the visual examination while text-based has neither oral nor visual cues.

Smart tips

While choosing a provider, ensure the platform and the doctor is legit. Says Amol Naikawadi, Preventive Healthcare Specialist and JMD, Indus Health Plus, “Patient confidentiality and patient data security are of utmost importance.  It is imperative that the doctor has genuine reviews and has met the expectations of his patients. Ensure that the platform/organisation/hospital has a grievance department in case one needs to raise an issue.”

Before making a choice, check the user-friendliness of the platform along with a study of their website, the panel of consultants and doctors on board. Do your due diligence on the doctor, and read the user feedback and star ratings.

The caregiver and patient need to do their homework beforehand to make this a meaningful and seamless experience. The patient must make notes about health issues in advance and keep the previous results and reports ready, instead of giving random answers based on memory, during the consultation. Also, invest in good technology such as hi-speed uninterrupted network and good devices for ease of consultation.

Invest in relevant healthcare devices and fitness gadgets at home. Says Dr Pankaj Dhamija, Centre head, Wockhardt Hospital at Mira Road near Mumbai, “Opt for good-quality devices and check for accuracy. Patients need to invest in blood pressure and glucose monitors. Even electrocardiography (ECG) devices, heart rate monitors and pulse oximeters can be helpful for patients at home.”

Make yourself more aware of the early signs and symptoms of diseases. Every layperson needs to learn certain DIY techniques such as how to deal with a heart attack. Says Dr Kumar, “Things such as heart attack or low blood sugar are reversible conditions. However, if not addressed immediately, they can be fatal. The family’s role is key to saving lives here and they must be able to identify symptoms and give first aid. On devices, we have heard good reviews of Apple smartwatches for checking heartbeat, and patients with heart problems can think of buying them.”

Pros & cons

Waiting rooms are a thing of the past with telehealth prescriptions, providing a new and innovative way to receive and order your prescription without the hassle of going to the doctor.

With telemedicine, your medical records and documents are likely to be maintained digitally, minimising chances of missing out on advice from the doctor and other health care staff. It is definitely more useful for doctors to have printed or soft copies of prescriptions rather than handwritten ones.

Doctors feel they can see more patients and can make better decisions with analysis of stored data as it increases the practice efficiency. Says Dr Dhamija, “We do digital OPDs that enable video consultations and obviate the need to make a trip to the hospital. The stored prescription record certainly helps in the follow-up process.”

He, however, adds that in certain situations, it is in the best interest of the patient to visit the hospital. Physical examination plays an important role in the diagnosis of certain diseases such as mucormycosis (black fungus) and other post-Covid complications such as lung problems of oedema, swelling, heart failure.

Teleconsult turns out to be cheaper than conventional consultation. There are either hospital-based e-counselling or health apps, wellness centers, healthcare companies that provide such services, so the pricing varies. Health apps normally have packages-–timewise, specialty-wise, regular/ first-timer, and such like. There is some variation for general and premium subscriptions, general physicians, and specialists. It can roughly range from Rs 300 to Rs 1,500 per consultation based on specialty.

Will telemedicine be effective in paediatric ailments? Dr Tushar Parikh, Consultant Neonatologist & Paediatrician, Motherhood Hospital shares, “In our experience, almost 80 per cent of the cases consulted online get better with the treatment prescribed. Also, if any lab tests are ordered, samples can be collected at home. We recommend children teleconsultation when they have any of the symptoms suggestive of Covid infection. Primary treatment remains symptomatic care such as control of fever with Paracetamol...medicines for controlling cough, vomiting, etc. It is only when symptoms are severe and if the child's actual physical examination is needed, there is a need to take the child to the hospital. In other cases of common health problems in kids like cold, cough, vomiting, loose motions, fever, gases, a minor injury that can be treated at home.

Finally, thanks to advanced technology, patients can now be monitored at home and doctors are able to manage them and filter out those who need hospitalisation.

Table: Indicative prices for remote consulting on India’s top telemedicine platforms

Service Provider	Charges for General Physician and Specialist	General Vs Premium Subscription
Practo	Rs 399 (General Physician)	Rs 799 for 1 month; Rs 1,499 for 3 months
	Rs 200-1,000 (Specialist)
1mg	Rs 249-299 (General Physician)	Rs 249 for 6 months
	Rs 349-399 (Specialist)
mfine	Rs 249-299 (General Physician)	--
	Rs 199-1,249 (Specialist)
Lybrate	Rs 300-1,000 (General Physician)	--
	Rs 500–1,200 (Specialist)
docsapp	--	Rs 999 for one month; Rs 1,999 for 12 months
Curefit	Rs 299-850 (General Physician)	--
	Rs 350-1,200 (Specialist)
myUpchaar	Rs 1,750 for 15 teleconsultation and Rs 3,000 for 25 teleconsultation; Rs 1,000 for 25 chats with doctor	Rs 1,500 for Coronavirus packages, Rs 199 for unlimited chat consultations and Rs 399 for unlimited teleconsultations
Medibuddy	Rs 297-700 (General Physician)	Rs 999 for one month, Rs 1,399 for 3 months and Rs 1,799 for 6 months
	Rs 200-1,000 (Specialist)
Portea Medical	Rs 199-499 (General Physician)	--
anytimedoctor.in	Rs 500-1,000 (Specialist)	--
AskApollo	Rs 399-999 (General Physician)	Rs 350 per day - Basic Plan for 14 days
	Rs 499-1,299 (Specialist)
	Rs 7,500 (Super Specialist)
DocPlus	Rs 500-750 (General Physician)	---

Source: TechSci Research