After coronavirus, telemedicine is here to stay


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A nutritionist consults with a patient of Clinicas del Azucar in Mexico, which specializes in diabetes care.
A nutritionist consults with a patient of Clinicas del Azucar in Mexico, which specializes in diabetes care.

The COVID-19 pandemic is accelerating the long-anticipated surge in telemedicine services worldwide. Consulting a health care provider over phone, video or text has become the new normal for many non-urgent medical needs, while the crisis has sparked renewed interest in digital tools that can test and monitor at-risk patients safely in their homes.

Generally defined as an exchange of medical information using telecommunications, the industry has evolved to encompass technologies that link health providers with home-based tools to track patient biometrics, such as digital stethoscopes and otoscopes. Many conditions can now be monitored remotely – ranging from chronic diseases to mental health – with app-based solutions that connect patients to their providers.

Before the pandemic, the global telemedicine industry was already expected to grow at an estimated 15% a year by mid-decade, but some analysts believe it will now accelerate to 19.3% and forecast a projected value of $175.5 billion over the same period. Much of that growth is linked to emerging markets, which are quickly adopting telemedicine to provide health care to underserved populations. The private diabetes health care chain Clinicas del Azucar, for example, is expanding into remote areas of Mexico with an app that will allow patients to test their glucose levels at home and transmit the results to the clinic’s providers.

Until now, telemedicine has faced considerable barriers from policy makers, payers and professional organizations concerned about patient safety, with some policies designed to protect incumbent businesses as well. Those restrictions were easing before the COVID-19 crisis, and now they are being lifted further in many parts of the world, as the pandemic sheds light on the benefits of safe, remote testing and monitoring.

IFC’s venture capital team has invested in several health tech companies that can help answer key questions on the viability of expanding telemedicine in emerging markets.


Is telemedicine right for every health care business?

The short answer: at this point, telemedicine is not an absolute game changer for everyone. While technology is expanding virtual diagnoses and delivery, health providers still need to see many patients in person. For example, the Mexican ophthalmology chain Salauno responded to the COVID-19 quarantine by offering tele-consultations, but co-founder Carlos Orellana says while these are a great way to facilitate initial contact with patients, they cannot substitute for the chain’s core business of in-person eye examinations and surgeries. However, India’s integrated health platform 1mg has a much different business model and is experiencing a surge of business linked to the pandemic. The company provides an online pharmacy, at-home sample collection for lab tests and online doctor consultations.


What services can telemedicine provide, now and in the future?

During the pandemic, telemedicine has helped health workers triage some patients through virtual consultations, using new technologies to protect patient privacy. Screening patients before they arrive at a clinic or emergency room improves efficiency and safety, since pre-screened patients generally spend less time waiting for care and providers have a better idea of what services will be needed.

Telemedicine can also offer at-risk patients timely guidance. For example, “In Brazil, one of our portfolio companies, TNH Health, is now freely rolling out AI chatbots to facilitate COVID-19 education,” Michael Nicklas, managing partner of the country’s Valor Capitol Group, told IFC.

In the future, it’s likely that tele-screenings will continue to grow in popularity. Rajat Goel, co-founder of Eye-Q, which operates 37 private care eye clinics throughout India, says that moving forward his company wants to screen patients remotely before consultations and procedures. “It will make our hospitals more efficient,” he says.

The use of remote diagnostic tools is also expected to increase, especially in remote and underserved communities. Emerging technologies, such as portable cardiac and lung monitors, will be able to record patient data in real time, allowing physicians to assess and treat more patients across much wider areas.


How will policy shifts impact telemedicine technologies?

Before the pandemic, few insurance companies would reimburse for teleconsultations or for home-based medical tests and diagnostics. Governments also imposed regulatory restrictions, due to concerns about patient safety and privacy, as well as the potential for fraud.

Those concerns are still valid, but as restrictions temporarily ease for the pandemic – and the benefits of telemedicine are more readily apparent – there is a fresh call for collaboration and policy reform.

Valor Capital’s Nicklas is confident that a temporary easing of telemedicine regulations in Brazil will become permanent. “What’s out of the box will be hard to put back in again,” he says.

“There were a lot of skeptics around telemedicine,” says Tandon of 1mg. Now, he says, policy makers are seeing that telemedicine reduces risk while improving efficiency and that it’s perhaps the most appropriate medium to connect the underserved (typically in the countryside) with access to quality care (typically in urban centers). He believes the industry has a significant opportunity to bring about change. 

Of course, there are more questions about the viability of telemedicine that still need answers. There are issues of privacy, liability and access that need to be addressed before telemedicine becomes a reliable and universal service.

But COVID-19 is challenging the industry to explore new ways of improving care and saving lives. It has thrown a spotlight on the need for disruptive technologies that take advantage of the widening access to telecommunications and internet connectivity across the globe.

The world’s emerging economies have consistently proven they are open to radical change in how they deliver products and services. The rise of telemedicine may help shape global economic recovery in a post-pandemic world, with the potential to provide safe, efficient and cost-saving health care to remote and underserved populations.


Monique Mrazek

Health Tech Lead Disruptive Technologies and Senior Investment Officer, International Finance Corporation (IFC)

Ruchira Shukla

South Asia Regional Lead for Disruptive Technology Investments, International Finance Corporation (IFC)

Ramesh Kumar Nanjundaiya
November 22, 2021

Current digitized healthcare sector in India and new tools decoded

One does not fail to notice that the entire medical services sector and hospitals in India are undergoing a major transformation in delivery of services, monitoring and patient care. New hospital are springing up as super speciality hospitals in tier 2 and tier 3 towns across India at a rapid pace.
While this sector has been in the growth traction for over a decade now with super speciality hospitals springing up all over India, what has catapulted this to still higher levels in the last 12 months is the noticeable ongoing technology support and digital transformation for the healthcare sector. This is exuberated mainly due to the aftermath of the covid 19 pandemic and its tracing mechanism.

Government of India's top priority is to ensure, facilitate and encourage timely manufacture and delivery of covid 19 vaccines to the local population as well as undertake exports to about 50+ countries across the globe. Some of the exports are pure commercial while some free donation supply to various countries appropriately termed vaccination diplomacy.
While one does notice very positive efforts in developing covid 19 vaccinations, challenges have also come in hand- in-hand including manufacturing delays, raw material shortages, manufacturing capacity constraints, balancing demands, staggering rollout mechanisms, transportation and logistics. Suppliers are ensuring that proper safeguards are in place via the use of digital tools and telecommunication, data storage and standards, hospital listing, data protection frameworks, encryptions and identification systems.
For the delivery of vaccinations from the manufacturing site to the patient involves a huge supply chain management service. The country urgently needs technology support to ramp up the vaccination activity to double from the present 3 million /day to at least 6 million/day. For this to happen, one needs strong access to digital technologies, mobile devices to expand capacity via secured cloud based services for such a huge vaccination campaign across India.
Digital technologies is playing a critical role to support the production, planning, monitoring, delivery and management of vaccination programs on a pan India basis by successfully using digital logistics application via electronic communication, mobile networks and special app to reach the nook and corner of India. The digital vaccination recording and follow-up systems has started working well lately by using standard (Pan and Aadhar) ID systems to determine eligibility and track patients between doses.
Most of us have heard about the Aarogya Setu app. An Indian COVID–19 contact tracing, mapping and self-assessment digital service. It is primarily a user friendly mobile app, developed by the National Informatics Centre under the Ministry of Electronics and Information Technology (MeitY).
Statistics indicate that by September 2020, the Aarogya Setu app, has more than 15.7 crore registered users and is growing month on month . This in itself is a success story. It was widely clarified in the media that the app's data is fully secured to protect confidentiality and encrypted in transit as well as at rest. Fully encrypted personal information is stored with necessary firewalls and protocols and transparency as appropriate. The World Health Organization has lauded the Aarogya Setu mobile application for helping healthcare sector and departments in a vast country as India to identify COVID-19 clusters. This clearly shows that the healthcare industry has seen a massive shift in its dependency on technology.
Today in India, the digital transformation efforts and its adaptability in this sector has moved forward in leaps and bounds which about a decade ago was starting with just using computers in hospitals for billing, appointments and scheduling.
In addition, technically savvy hospitals in the metros not only have high sophisticated medical devices, mri machines but also fully interactive websites and online platforms. Technology and digitizations is enabling error free online appointments, consulting, video consulting and conferences and telemedicine. Apart from these, the highly sophisticated medical devices that modern hospitals across the country use for detection and curing means that hospitals have up skilled themselves via integration of medical knowledge with Al-enabled medical devices and electronic health records.
In a nutshell, what this tells us is that the whole doctor-patient relationship and communication is undergoing a huge transformation via timely decision making regarding planning treatments schedules, operation theatres optimal use, data sharing and outcomes to bring in the "patient is the king" mindset.
Thus data integration is being actively used in extending medical services and for the increase in data aggregation that can assist in the activity of preventive care, proper staff allocation and monitoring and reduction of medical errors so as to provide a high level of care. Of course, the medical expenses have also increased with inflation. Today the focus of the hospital management is to build loyal patients. To this end, hospitals are using technology to arrive at patients predictive analytics via medical records data, family history, health insurance cover via cashless treatments.
When applying predictive analytics to the data generated by each patient and combining this data with those points collected from medical health records, healthcare providers will be able to build loyalty with their patients. What is needed is to address challenges and rectification via use of technology.
Today in view of increasing costs, covid restrictions, patients, more so in the urban area seem to equip themselves to the use of digital technology with self monitoring of BP and sugar and oximeters and temperature monitoring, house visit for blood sample collection. Patients want to increasingly make use of digital devices for their self care. All these is to ensure that they receive continuing healthcare facility at their homes due to shortage of hospital beds and increasing expenses. This has given rise to telemonitoring devices and virtual consultations.
The object therefore will be for hospitals and medical practisers to integrate digital technology in up skilling and installing health records and information systems. This will help in real time monitoring and remote diagnostics or tele home care. The technology that are used includes telemedicine and diagnostics, mobile device healthcare, RPM sensors, using webcams, video-conferencing, videophones and WebPages for monitoring of patients.
Another area coming up fast are the Wearable's for recording heartbeat, pulse rate, blood pressure, blood sugar etc.
In conclusion the foregoing indicates that digital Healthcare holds tremendous promise and opportunities and will be cost effective in the long run.

Ramesh Kumar Nanjundaiya