Future of telemedicine: Regulation and quality will decide
Soon-to-be mothers and those who have just given birth worries over every bit of new experiences they encounter – with their body and mind. Visiting a doctor for advice is no less daunting in the throes of the coronavirus pandemic.
This sets the context, in which Ma Telehealth Center was launched by the women and children affairs ministry to provide services to pregnant and lactating mothers.
These women are, however, not the only segment of the population who need easy access to health care from home when the virus seems to linger for no one knows how long and so is the fear of contagion. Hence, doctors and many healthcare organisations have seen a rising number of patients seeking remote treatment and counselling.
But the future of telemedicine services beyond the ongoing health crisis depends highly on building trust in the healthcare system that is often questioned over conformity to quality.
"The challenge [of gaining trust] is made worse when a patient is interacting with a doctor, in some cases for the first time, over telemedicine," said Sylvana Q Sinha, founder and chief executive officer of Praava Health.
She also said she strongly believed telemedicine's role was limited without underlying quality infrastructure.
Health experts insist on government regulations and guidelines, which will not only discipline the sector but also help the sector play its due role in ensuring access to healthcare.
About 30 organisations have so far been registered with the ICT ministry to provide telemedicine in varied capacities. Many private hospitals have also branched out to telemedicine in efforts to cater to the demand for remote health care among their clients.
To impose e-health standards, the Ministry of Health and Family Welfare made a draft framework.
"The authority should make that draft into a law and enforce it so that a minimum standard and quality is maintained," said Dr Khaled Hasan, head of clinical operations of Digital Healthcare Solutions under the Grameen Telecom Trust.
According to him, Covid-19 acted as a catalyst for promoting telemedicine.
The beginning was launching of hotline numbers associated with campaigns that dissuaded people from going to hospitals unless there was an emergency.
Over time, the use of telemedicine has led to people appreciating its benefits.
And many of those, who have been benefited, will be choosing telemedicine over in-person visits to doctors to avoid inconveniences like long journey and other associated costs.
An analysis of the calls that Doctor Dekhao, a tele-health platform, has been receiving over the last two-three months showed that 90% to 95% of those were not related to Covid-19. In the April-June period, the trend reversed, said Dr Mohammad Nayem, head of operations of Doctor Dekhao.
"We are getting fewer calls now but more of them are concerning regular healthcare problems," he added.
That indicates an increasing trend in the use of telemedicine, which service providers predict to continue in the year to come and beyond.
A telehealth programme on diabetic patients revealed that regular follow-ups on their health conditions and counselling helped keep diabetes under control in 72% cases. The figure was only 23% six months before when Digital Healthcare Solutions launched the programme along with the Bangladesh Diabetic Association.
Likewise, patients suffering from any chronic disease can be benefited from telemedicine.
"Telemedicine can never replace emergency medical care," Nayem said. But it can complement the healthcare system by increasing people's accessibility of primary healthcare and putting in place a referral mechanism.
For example, if one suffers from a chest pain in a remote corner, miles away from a healthcare facility, they can quickly consult a doctor through phone calls, video calls or chat and can learn what they need to do.
They may need immediate medical attention if the pain is induced by a heart attack. Otherwise, over-the-counter medicines may alleviate the pain. The patient must know which of the two is their case and telemedicine can save their life or save them from a long, arduous journey at an odd hour of the day.
In an emailed response, the CEO of Praava Health said 70% of the primary care needed could be given by telemedicine, which would reduce the burden on the already understaffed hospitals "by triaging patients as the first line of defence". The remaining 30% patients requiring admission to hospitals can be promptly referred.
Above all, that remote medicine can bring down the unnecessary use of drugs, including antibiotics, and remove the chances of maltreatment by quack doctors.
Riding on the newly found popularity, telemedicine service providers are also incorporating specialised care.
Praava started video consultations similar to in-person visits through apps like Hangouts and WhatsApp, allotting at least 15 minutes for each patient. It also collects samples from home in the capital if any lab tests are prescribed. Reports are delivered digitally.
Doctor Dekhao is focusing on providing solutions to gynaecological, paediatric, cardiac and skin problems as its data shows an increasing concentration of patients in these areas.
Digital Healthcare offers monthly and yearly membership packages, with which people can enjoy direct access to general practitioners and specialised doctors whenever any health issue arises.
But it is to be kept in mind that technology should not get more control over healthcare than the human connection between doctors and patients, said Prof Nezamuddin Ahmad, former head of the palliative department at Bangabandhu Sheikh Mujib Medical University.
"Many of the health problems are connected to our minds," he said.
Doctors observe patients with the help of their five senses and weigh their economic and social status while making judgments and prescribing treatment. That is a long-established practice.
"Telemedicine might make more advances, with innovation of newer technologies, but human touch should always be part of healthcare as it is humans we deal with," Nezamuddin said.
