Will telemedicine be the new norm after the coronavirus crisis?

When Dr Mythili Krishnamurthy, an obstetrician/gynaecologist in the Indian state of Tamil Nadu, got her patient’s message on WhatsApp about breast pain and a fever, she was confined to her home, like the rest of India, which had been on lockdown since March 25 due to the coronavirus pandemic. But the lockdown did not stop her from managing the patient’s care.

Doctors, like Krishnamurthy, are doing “house calls” again – but now, they are in the form of telemedicine visits. Telemedicine refers to remote care, including real-time video and app-based visits. Because of the public health crisis, a profession wary of accepting telemedicine has turned to it overnight.

Media touts telemedicine’s value as a way to triage suspected COVID-19 patients, but telemedicine is not just a useful temporary stopgap, healthcare professionals say. It allows doctors to see patients with a range of problems and can improve patient care. Once doctors and patients use it, it is unlikely they will stop.
Poor technological infrastructure and low overall computer literacy in Tiruchirappalli, Dr Krishanmurthy’s city, made her look for a simple platform to conduct telemedicine. She chose WhatsApp, a mobile app not specifically intended for healthcare.

“Our health system is low-resource. Few people have insurance coverage. All payments are out of pocket. I could not pass the cost of an electronic medical record or video conferencing to the patient,” she told Al Jazeera. At her hospital, Sri Dhanvanthri Nursing Home, all records are still on paper.

Text communication promoted timely, secure and affordable care.

“Initially, calls were infrequent, but now patients almost all have smartphones so they can talk to me and it saves a lot of time and travel. If they travel 60 or 70 kilometres (47-43 miles) in the night to see me, it makes sense.”

But she acknowledged using WhatsApp and other technologies do come with disadvantages: Texting requires a basic literacy and doctors and patients can also miss nonverbal cues such as facial or physical expressions when they text.

“Using WhatsApp requires an individual rapport between doctor and patient,” said Dr Krishnamurthy.

Until recently, official telemedicine guidelines in India were vague. But on the first day of the lockdown on March 25, the Medical Council of India introduced telemedicine practice guidelines, making WhatsApp an approved platform.
New ‘believers’

Although telemedicine has been available in many countries for years, with some places even setting up telemedicine centres, it did not have wide acceptance in many places. Many patients, especially in rural areas, were not aware it was an option and many patients, physicians, and healthcare systems resisted accepting it as legitimate patient care.

Barriers to implementing telemedicine have included cost, liability, security, lack of technological infrastructure, and poor computer literacy among patients and doctors.

Despite these barriers, telemedicine has its advantages, experts say, as it increases access to primary and specialist medical care. During the COVID-19 pandemic, access to healthcare has decreased because non-urgent in-person visits are discouraged.
Aside from improving access and decreasing patients’ financial and travel burden, telemedicine can also improve care compared with in-person visits.

“I hadn’t realised how much our exam rooms give us a flat view of our patients. Now it’s like being surprised by a pop-up book when I turn on the screen,” said Dr Su Wang, a medical director at Saint Barnabas Medical Center, in New Jersey.

Dr Wang is a recent convert to telemedicine. Because of the COVID-19 pandemic, her clinic switched to mostly online visits out of necessity. Previously, she assumed telemedicine was “subpar” care. She scoffed at video physical exams. But after just one week of telemedicine visits, she is a believer. Real-time video visits gave her a more intimate, and ultimately more comprehensive view of her patients, she said.