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NABH Digital Health Standards will act as a catalyst in the faster adoption telemedicine and Telehealth

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The NABH Digital Health Standards aims to consider all relevant aspects of the application of patient interfacing technologies across the continuum of care applicable for outpatient, inpatient, and remote patient monitoring. The focus will be on keeping the personal data confidential to ensure the safety of the patients’ healthcare records, informs Dr Rishi Bhatnagar, Member, NABH and President, Aeris Communications to Akanki Sharma in an exclusive interaction

How successful can telemedicine be in India as compared to other developing/developed countries? Do you think it can be implemented flawlessly in a country like ours? 

For India, telemedicine and telehealth may turn out to be the cheapest, as well as the fastest way to not only bridge the rural-urban health divide but also manage the COVID-19 crisis. Telemedicine is a safety valve for our strained healthcare system.

It is already playing a great role in critical care monitoring and timely interventions are helping in reducing the burden on poor patients to travel miles for getting medical attention and diagnostics while also ensuring that only those patients are hospitalised, who need critical care. Telemedicine is already providing a proactive approach to help patients in rural and remote areas, especially in the government-run programmes. Hundreds of thousands of SMSes are sent every day by government health departments, NGOs and the private sector – all are ensuring better adherence and compliance – be it for immunisation, vaccination, ante-natal counselling or blood sugar evaluation. Medical call centres are providing authenticated validated health information through mobile phones. Thousands of health “apps” can now be downloaded.

The telemedicine market in India is expected to reach US$5.4 billion by 2025 with a CAGR of 31 per cent. Its future will not be limited to remote consulting, but it has a variety of applications in patient care, education, research, administration and public health. We now have the political will and resources to expand the benefits of digital healthcare pan-India. The government’s National Health Policy (NHP) 2017 had defined the vision of ‘health and wellbeing for all at all ages’. Continuum of care is a  concept strongly advocated by the policy. Citizen‐centricity,  quality of care,  better access,  universal health coverage and inclusiveness are some of the key principles on which the  NHP  is founded.  All these aspirations can be realised principally by leveraging the power of digital technologies.

The telemedicine guidelines released by the Ministry of Health and Family Welfare (MoHFW) say, “Since there is a possibility of abuse/misuse, ensuring the privacy of patients in video consults is extremely important (on few platforms).” How will the Registered Medical Practitioners (RMPs) achieve this? Can you give some examples?

Very clear telemedicine practise guidelines have been issued for enabling Registered Medical Practitioners (RMPs) to provide healthcare using telemedicine in India. ‘While using video in telemedicine facility, apps, video on chat platforms, facetime, etc provide easier patient identification, in-person consultation with real-time interaction with the patient and discussion with the caregiver; there is a possibility of abuse/misuse to the privacy of the patient as well. To this effect, every RMP shall display the registration number accorded to him/her by the State Medical Council of India (MCI), on prescriptions, website, electronic communication (WhatsApp/email, etc.) and receipts, etc. given to his/her patients.’ The guidelines clearly mention that the RMP should ensure that there is a mechanism for a patient to verify the credentials and contact details of the RMP. Moreover, it is specifically noted that in addition to all general requirements under the MCI Act for professional conduct, ethics, etc, while using telemedicine, all actions that wilfully compromise patient care or privacy and confidentiality, or violate any prevailing law are explicitly not permissible.

Moreover, technology platforms (mobile apps, websites, etc.) providing telemedicine services to consumers shall be obligated to ensure that the consumers are consulting with RMPs duly registered with national medical councils or respective state medical council and comply with relevant provisions. Technology platforms shall conduct their due diligence before listing any RMP on its online portal. The platform must provide the name, qualification and registration number, contact details of every RMP listed on the platform. In addition, to enable all those RMPs who would want to practice telemedicine and get familiar with these guidelines as well as with the process and limitations of telemedicine practice, MoHFW plans to:

  • develop an online programme and make it available by the Board of Governors in supersession of MCI.
  • make it compulsory for all RMPs to complete a mandatory online course within three years of its notification intending to provide online consultation need.

In the interim period, the principles mentioned in these guidelines need to be followed. Thereafter, undergoing and qualifying such a course, as prescribed, will be essential prior to the practice of telemedicine.

What measures is NABH bringing to establish the true identity of RMPs as well as the patients?

A lot of work has already been initiated for ensuring safety and security in digital healthcare in the National Health Policy 2017 itself. The key principles of NHP 2017 include universality, citizen‐centricity, quality of care and accountability for performance. The policy lays significant emphasis on leveraging digital technologies for enhancing the efficiency and effectiveness of delivery of all the healthcare services. Against the above background,  the committee constituted by the  Ministry of Health to lays down an implementation framework for the National Health Stack (NHS) proposed by NITI Aayog, has come up with the  National  Digital  Health  Blueprint. The key features of the blueprint include a federated architecture, a set of architectural principles, a  five‐layered system of architectural building blocks,  Unique  Health  Identifier  (UHID),  privacy and consent management,  national portability,  EHR,  applicable standards and regulations,  health analytics,  and above all, multiple access channels like call centres,  India  Digital  Health portal and  MyHealth App.

With telemedicine coming into place, what crucial steps is NABH taking to keep the medical records and patient history confidential? What kinds of harm can such a data leak cause?

The Digital Health Standards of NABH’s objective are to study all essential details of applying patient-interfacing technologies across the continuum of care applicable for outpatient, inpatient and remote patient monitoring. The focus will be on keeping the personal data confidential to ensure the safety of the patients’ healthcare records. Digital Health Standards may also consider guidelines regarding legal obligations, interoperability and communication standards, data security, remote monitoring and mobile apps.

How significant is the issue of physician burnout in the context of telemedicine? Do you think that telemedicine, especially in these times can cause burnout or can it be helpful to physicians? 

India has a shortage of around 600K doctors and two million nurses. RMP accessibility, as per the WHO standards, has been a persistent problem for the Indian healthcare sector. The country has a basic need for an increased number of qualified medical doctors with only one government doctor for every 10,189 people. It also needs an additional 18.8 million ancillary workers like nurses and technicians for the operation theatre, radiology and dialysis to meet the growing demand for accessible healthcare. So, yes physician burnout is real in our country. The diminished enthusiasm for their work can lead to poor performance, potentially leading to errors and misdiagnosis and ultimately, damaged relationships between doctors and patients.

However, telemedicine helps physicians save time and also help provide doctors with a feeling of control and independence. Most doctors’ schedules are overwhelming and unmanageable. The convenience and ease of telemedicine visits can lead to fewer missed appointments and can allow providers to work more effectively. By handling some routine health issues remotely, they can better manage their work schedule and call hours. Patients also appreciate it more when they don’t have to commute, worry about finding child care or have to sit in a waiting room surrounded by other sick patients. Telemedicine is healing patients and doctors alike and therefore, is set to have a hugely positive impact on our healthcare system.

Since you are also the President for Aeris Communications, tell us how is your company contributing to transform small-to-large healthcare businesses with IoT and connected technology?

With global support of major cellular technology standards, such as GSM, CDMA and LTE, we can empower our healthcare partners to offer their clients and users’ flexibility and growth throughout the world. We provide the best connectivity for Telemedicine IoT cellular connectivity (outside India and China) that enables medical device manufacturers and healthcare providers to achieve the highest levels of patient engagement and medicinal adherence. With our new and enhanced Aeris Fusion IoT Network, frontline warriors can access advanced connectivity and monitor solutions that can improve the quality of health.

How is Aeris going to include solutions and learnings from NABH’s initiative towards telemedicine?

The healthcare industry is one of the most exciting areas for emerging technologies. With the emergence of 5G, IoT services and its applications, the healthcare industry is ready to become more connected and readily available. NABH’s vision is to reach out to more population with telehealth solutions. We know that telemedicine is one solution that will bridge this gap of rural and urban to a certain level and decrease the time of medical staff consumed in travel to address patient needs. Aeris will learn from NABH guidelines, and we will incorporate them in the best way possible. We are solution providers, so with our portfolio of IoT solutions and services, we would also be in a position to help achieve NABH goals.

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