Date: 26/08/2022

Relevance: GS-2 Issues relating to Health; e-governance- applications, models, successes, limitations, and potential

Key Phrases: eSanjeevani Health and Wellness Centre, National Telemedicine Portal, National Medical College Network, National Digital Health Authority of India (NDHAI)/National e-Health Authority (NeHA), Open Digital Telehealth Initiative

Context:

• Telehealth has seen good advancement in India in recent years, but much potential can be unlocked through platform thinking, as it can help achieve better citizen health and faster responses to adverse health events like the pandemic.

Scale and Scope of Telehealth Services in India:

• The Indian telehealth sector has private sector players like Apollo Telehealth services and Practo Technologies, and public sector services like eSanjeevani.
• eSanjeevani Health and Wellness Centre (HWC) is operational at around 80,000 HWCs and has registered more than three crore teleconsultations by March 2022.
• It not only provides consultation services linking patients with doctors (eSanjeevani OPD), but also links doctors to other doctors (eSanjeevani Ayushman Bharat-Health and Wellness Centre).
• On the other hand, Practo Technologies has expanded to services like appointment booking and end-to-end surgeries, and have served around 17 crore patients in 2021.
• While the telehealth market has expanded, it is quite segmented wherein the private players mainly cater to the economically well-off, while eSanjeevani serves the poorer sections.
• This is true for doctors as well, with eSanjeevani having only government doctors and private sector players having private practitioners.
• Additionally, eSanjeevani has also imposed ‘state boundaries’ on the digital platform, with residents of a state only being connected to government doctors of that state.

The Potential for an Open Digital Telehealth Initiative:

• An Open Digital Telehealth Initiative (ODTI) links private and public healthcare institutions, doctors, and citizens in the country to enable connectivity, service delivery, and commerce within this ecosystem.
• It reimagines the scope of ‘eSanjeevani’ and envisages a much larger canvas to play with, with a wider range of actors and services, using a mix of protocol and platforms.

Salient features of the proposed ODTI are:

• Connectivity across the actors to break the segmented markets created by different platforms.
• All will be connected into a single market through the use of standard protocols, that will then onboard both government and private sectors’ doctors and institutions, as well as patients across the economic spectrum.
• It will integrate payment and aspects of video-audio communication within the platform.
• Private players can build their customised apps on top of the protocols, as done in Unified Payments Interface (UPI).
• Their marketing efforts will lead to higher patient penetration, and they can leverage the pan-India doctor network.
• Authentication of doctors and healthcare institutions can ensure that only state-registered doctors are onboarded by using a government-approved closed registry.

Why does the Open Digital Telehealth Initiative Matter?

1. Help address geographical inefficiencies:
   • India has huge regional disparities when it comes to the number of doctors, whether it is the urban-rural differential or between states.
   • For example, Tamil Nadu has more doctors per capita than the World Health Organization’s recommended norm. This scenario is alien to most other states.
   • A unified Indian telehealth market will enable a doctor to serve patients, regardless of their location and thereby, utilise the ‘excess doctors’ in one area to service patients in other geographies.
2. Create a unified telehealth market:
   • With this, the telehealth ecosystem will change to a unified pan-India one across patients, doctors, and institutions, and eliminate segmentations of state-boundaries or private and public.
   • For private doctors and healthcare institutions, this will expand the market beyond their physical location and provide them access to patients across India.
   • Patients will be able to compare prices across doctors, before selecting one that they are comfortable with.
   • This will also pressurise the expensive doctors to offer better quality services or lower their fees.
3. Addressing other health inequities:
   • This platform can help address inequities based on community and economic status.
   • For example, tribal communities susceptible to hypertension can be provided with targeted subsidies for cardiac care.
   • This can be enabled through e-RUPI, which allows for initiative-specific spending.
   • Similarly, migrants often face difficulties in communication, thereby reducing their accessibility to the healthcare system.
   • A language-based filter can allow them to select and consult doctors conversant in their own language.
4. An early warning system for adverse health events:
   • The data amassed by the private telehealth companies is not easily accessible for public health work.
   • This platform can help aggregate and build a source of near real-time pan-India public health data.
   • Access to this data will enable the monitoring of symptoms and disease surveillance across national, state, and local scales.
   • Breakthroughs can be created in syndromic surveillance, whether it is understanding the shifting patterns of diseases, or creating an early warning system for epidemics and adverse health events.
   • The access to data will allow better epidemic and pandemic intelligence and help improve the prevention, control, and diagnosis of diseases.
   • This data can also be used to create a health profile for all regions and thereby, formulate the right local health policies.
5. Data for other public health goals:
   • The standardised protocols of ODTI will help access a larger scope of data as well, such as medications being prescribed.
   • An important indicator, changes in antibiotic prescriptions can be an early sign of antibiotic resistance.
   • The digital repository of medical records will allow patients to share their medical documents and track whether proper guidelines for prescriptions and diagnosis are being followed by healthcare professionals.
6. Integrating neighbouring countries:
   • Telehealth services can be expanded to other countries just like UPI.
   • India had close to seven lakh medical tourists in 2019, primarily from neighbouring countries wherein Bangladesh alone accounted for 57.5 percent medical tourists in India.
   • Thus, ODTI can potentially enable cross-border healthcare services to other countries.
   • Along with boosting the economy, it will also help India become the telehealth centre of the world.
7. Privacy and other concerns:
   • As ODTI will capture sensitive personal information, strong measures to ensure privacy and data security are critical.
   • In addition, minimising instances of harassment and misconduct will need to be implemented to ensure a safe atmosphere for both patients and doctors.
   • The National Medical Commission’s drafted guidelines can be implemented robustly, by integrating it within the architecture and processes of the platform.

Conclusion:

• For a country that has consistently faced the barrier of access to quality health care, technology and innovation in health have the power to bring lasting solutions to the changing health needs of our people and improve patient experience and outcomes.
• Creating and deploying ODTI will be a huge improvement in telehealth services and aid in achieving the National Digital Health Mission’s aim of providing accessible and affordable healthcare services for all.
• This will not only aid the pace of growth of healthcare services across the country but will also help deliver a wide set of public health goals.
• India is standing at the cusp of a digital health transformation, which can propel the country's economic growth and set an example for emerging economies if managed well.

Source: ORF-Online

Mains Question:

Q. Telehealth has seen good advancement in India in recent years, but much potential can be unlocked through platform thinking, as it can help achieve better citizen health and faster responses to adverse health events like the pandemic. Examine. (250 words).