Dr. Shyam P Lohani

Current medical practices have not changed much since the time of Hippocrates. When a patient becomes sick, s/he either has to come to a clinic, emergency room, or hospital. In spite of the internet transforming every aspect of our lives, from how we gather information to how we purchase groceries, the way medical care is delivered has relatively remained unchanged.
However, the ongoing coronavirus pandemic has rather transformed our healthcare delivery. The incorporation of telemedicine into routine medical care has been increasing worldwide. Using the existing internet technology and devices that most people have in their homes, medical consultation over the internet can result in faster diagnoses and treatments, increase the efficiency of care and reduce patients’ stress in terms of both travel time and waiting period.

Growing demand
A rapid demand for affordable and quality health care has been increasing throughout the world over the past few decades. Being home to more than 23 per cent of the world population, South Asia has created more demand for health care. It has a double burden of communicable and non-communicable diseases (NCDs).
Telemedicine is the exchange of medical information from one site to another through the use of Information and communications technologies (ICTs). Telemedicine brings the situation in which a patient does not need to travel to a clinic in person. Patients can have many ailments shared on a computer, tablet, or smartphone and seen by a health care practitioner and have treatment prescribed as needed.
People in developing countries have poor access to healthcare and marginalised people in those countries have even less access to healthcare services within the country. In developing countries, issues related to accessing the appropriate healthcare and improving the quality of care has been critical. Many times, the quality of public health care in developing countries has been compromised due to overstretched healthcare capacity.
The cost of healthcare in developing countries is also a crucial issue. Out of pocket expenditure on healthcare has increased many folds in recent times. Catastrophic health is posing a serious threat to a financial ability of a household to maintain its basic needs. Many barriers like geographical access, availability, affordability, and acceptability to access healthcare are unique to developing countries. These barriers become more problematic to the already neglected section of the population such as women, children, elderly, and physically disadvantaged. In order to support accessible, cost-effective, and quality care, ICTs have great potential. Telemedicine uses ICTs to tackle geographical barriers and increases access to healthcare services. Telemedicine is particularly useful for rural and underserved communities in developing countries.
Telemedicine is an innovative solution that links the health facilities of developing world to the technological and human resources of the developed world. In rural or underprivileged areas of the world, where the disease is prevalent, healthcare providers are scarce, and healthcare infrastructure is inadequate, importance of telemedicine becomes more prominent.
For areas or regions with inadequate healthcare infrastructure, the possibilities of telemedicine are great as it enables effective medical care despite understaffed health facilities and undertrained providers. On the other hand, basic telemedicine services can be established with low start-up costs and operated by nurses and health assistants.
There is a constant paradigm shift of healthcare needs and services all over the world. Now, technology plays a vital role in healthcare. As there is a constant search for better ways to treat people, technology has brought numerous great advances to the healthcare domain. With the technological advancements such as telemedicine, we can now obtain access to medical services or information that might normally be unavailable. Telemedicine in developing countries has tremendous potential to expand. It not only solves logistical constraints but also provides support to weak public health systems and connects to global networks of healthcare professionals.
It is expected that telemedicine will reduce the burden of hospitals, the suffering of patients, out-of-pocket expenditure, the need for transport, hospital fear, and save the time and money of the general public. It is also expected that it will increase the quality of care and will develop trust among patients toward telemedicine. We cannot deny the partial development of telemedicine and few success stories in many parts of the world but the benefits that are expected from telemedicine is still lacking. It is, therefore, important to answer two important questions such as why telemedicine is not picking the pace and why it is not becoming popular among service providers as well among the patients.

Accreditation
Owing to a lack of computers and smartphones in resource-poor areas, the potential mass benefits of telemedicine in the region have not yet been reached. Critical technology needed to establish telemedicine services is still missing to advance telemedicine, the underserved region in our part of the world has vast potential and is expected to scaling up for telemedicine by strengthening health systems and health infrastructure.
There is no specificity and standardisation in the practice of telemedicine throughout the world which poses a critical accreditation issue. There is a need for accreditation of telemedicine facilities which will help clear fear among the users as well as providers. Thus, the establishment of accreditation councils and regulatory bodies will help expand telemedicine. It is called upon health councils to come forward and formulate a policy to take the lead role and responsibility to regulate the practice and procedures of telemedicine.

(Professor Lohani is the founder and academic director at Nobel College. lohanis@gmail.com)