Role of Telemedicine and Digital Technologies

Future of emergency care services in India

India is the second most populous country and the largest democracy in the world. Despite that, emergency care in India is still fragmented with emergency medical services (EMS) not accessible in different parts of the country. According to the Ministry of Road Transport & Highways data of 2016, nearly four hundred deaths occur on Indian roads every day. Additionally, it is being reported that out of every 1 million people, 42,800 suffer from sudden cardiac arrest every year. These figures clearly indicate the need for efficient emergency care services in the country that should be accessible at all places. While the government has been playing its part to improve the condition of EMS in India by collaborating with different organisations and setting up autonomous like the Centralised Accidents and Trauma Services (CATS), the existing emergency care in India fails to meet the public demand. However, with the disruptions caused by the COVID-19 pandemic, digital solutions have come to the fore to enable easy and timely access to care without the need to be physically present at the doctor’s office. Telemedicine services are transforming the approach to care by not only preventing overcrowding at EMSs, but also ensuring proper safety and wellbeing of medical professionals in emergency care settings.

Vikram Thaploo, CEO, Apollo Telehealth

Telemedicine to the aid of emergency care

Emergency care services have been designed to provide timely and immediate care to time-sensitive conditions. In any sort of medical emergency, EMS act as the sole point of contact for patients suffering from stroke, trauma and other emergency medical conditions. However, due to the shortage of staff, overcrowding and lack of necessary resources, emergency medical services in the country often fail to meet up to the needs and expectations of the public. That’s where the power of technology comes into play. Patients can be pre-screened from the comfort of their homes, during hospital transport or after arrival in the emergency department with the help of telemedicine services. This can significantly reduce the time required to provide immediate care to emergency patients.

In the case of rural emergency medicine, the role of telehealth can never be undermined. With the help of a single specialist, telemedicine is allowing care to be provided to different sites simultaneously. Different patient-care

sites may also connect with a centralised hub using telemedicine services while helping to foster more regionalised care. Telemedicine services are already making a difference in the remote, mountainous regions of Himachal Pradesh. Apollo Telehealth has established the world’s highest telemedicine centre at an elevation of 14,000 feet above sea level. The health services provided at this telemedicine include medical assistance in case of emergencies as well as primary and specialist tele-consultations, saving lives by using technology.

One of the significant challenges of rural emergency sites in India is the lack of trained, skilled professionals. Also, with high variability of staffing, there comes the issue of variation in skills, experience and education. Through provider-to-provider models, telemedicine can facilitate experience sharing and fill education gaps by giving cognitive support to non-emergency clinicians who lack the experience and/ or training in an emergency department.

It is being estimated that every year almost 1.8 million people in the country suffer from stroke and early treatment is the only way through which the incidences of morbidity and mortality cam be reduced.When a person suffers a stroke, he/she loses almost 2 million brain cells every minute when a blood blockage or rupture prevents oxygen from reaching the brain. It is nearly impossible to know whether the patient has a block or bleed, and giving the wrong treatment can prove fatal.With telestroke programmes, it is increasingly possible to connect hospitals with a neurologist so as to evaluate a CT scan image and discuss with the on-site doctor about the best course of action. Telestroke programmes decrease the door-to-treatment time helping improve patient outcomes.

Game changing technological advancements for EMS

For an ageing and rapidly increasing population, technology can be the best answer to some of the prevalent and complex problems in EMS. The digital revolution in recent years has completely changed the way information is stored, processed and communicated. On top of that, the inception of robust wireless broadband networks, powerful mobile computing and deep data analytics can play an important role in defining how emergency medical services will be conceptualised and provided to the citizens of India in the future.

Here are some of the ways technology is making a difference:

Connected ambulance service

Though this is not a new technology but its adoption in India has been very slow. The connected ambulance service allows a new way of connecting patients, remote medical experts and ambulance workers in real-time.Connected with GPS and cameras along with portable ECG machines, these ambulances are able to relay critical information to physicians and emergency departments before the patient reaches the hospital. Studies reveal that every minute of delay in starting emergency treatment lessens the chances of survival by 7 per cent-10 per cent.

An integrated and connected system for health records

A connected database management system provides the opportunity for emergency medical services to share a patient’s medical record with the ED which can significantly improve the chances of saving someone’s life in times of emergency. With the shared information, ED personnel can make informed decisions and attain good health outcomes. Presently, paramedics and ambulance crew have no access to patient medical data which limits their understanding about the health conditions of a patient. In India especially, where paramedic care training is not yet standardised, scarcity of information can detrimentally affect the way any diagnosis is carried out. In some

cases where the emergency staff arrives in advanced life support (ALS) ambulances and are aware of how to take action, plenty depends on the patient’s medical history.

Predictive analytics

Predictive analytics can be utilised to enhance the pace and manage patient flows effectively. This data-driven solution allows the monitoring of admission and discharges in hospitals, notifying on-site paramedics regarding the availability of beds and connecting to emergency medical services systems as emergency department staff, doctors and healthcare organisations can reduce delay rates and enhance health outcomes. By using predictive analytics, healthcare providers can also learn about potential areas to place ambulances based on past data. This can reduce ambulance dispatch time and response time and allows hospitals or healthcare providers to manage their resources efficiently, smartly and reduce the admission and wait time.

A government-led push towards digitisation in healthcare

The Indian government has been actively promoting digitisation in the healthcare sector. With the introduction of the Ayushman Bharat Scheme, the government has come up with the Information and Communication Technology (ICT) scheme, which focused on the development of the health sector. The said scheme includes telehealth development ideology to make it effective, safe, efficient and patient-centric. The National Digital Health Mission (NDHM) launched by the government is another step to building the foundation for digital healthcare infrastructure in the country. The primary aim of the initiative is to make India self-reliant by providing universal health coverage to all the citizens in the country.Similar to an Aadhar ID, the introduction of a unique health ID aims to recognise and becomes more responsive and innovative, enhancing the adoption rate among patients and providers, para-medicine services will become critical and undergo massive change and emergency treatments will be offered at much lower costs than the emergency department.

The latest technologies are capable of doing numerous things we want them to do and assure to improve accessibility to emergency healthcare services and reduce the huge amount of money lost in unnecessary patient transports and emergency department visits. When done the right way, technology can be the golden thread uniting patients and providers and catering to the needs of patients even from the comfort of their homes.

authenticate a person depending on previous health records.

In the recent Union Budget 202223, the finance minister of India declared that the government will launch an open platform to connect India's digital health ecosystem under the Ayushman Bharat Digital Health Mission (ABDM).

Way forward

Over the coming years, technological advancements will lead to increased acceptance by both patients and doctors and telemedicine usage will witness unprecedented growth. The increased acceptance will also allow the growth of other fields like Tele-ICU, TeleOphthalmology, Tele-Dermatology and Tele-radiology.

Technological innovations remain the key to navigating the challenging EMS landscape in India. As telemedicine References are available at www.asianhhm.com

AUTHOR BIO

VIKRAM THAPLOO is the CEO - Telehealth at Apollo Hospitals Group. After completing his Healthcare Management Programme from the Indian School of Business (ISB) and PGDBM from Symbiosis, Pune, he briefly worked for the hospitality industry before moving on to retail, crowing his eventful journey with his current stint in healthcare. A proactive leader, his mandate as the CEO of Apollo TeleHealth include a larger-than-life duty that comes with the express goal of turning healthcare affordable using the convergence of Technology, Telecom, Medtech ecosystem, and Healthcare.