INTRODUCTION:

Like many industrial engineering concepts telemedicine technique was applied in healthcare to improve overall efficiency¹. World Health Organization (WHO) has given importance to telemedicine for a long ago. India shares a green signal only during the Corona Virus Disease (COVID-19) pandemic, specifically in India, where access to affordable healthcare services is an issue today; telemedicine will benefit the public immensely². Telemedicine was considered futuristic and experimental some years ago, but now it is a reality by the grace of COVID-19.

Telemedicine is considered a tool to be used for the remote diagnosis and treatment of patients using telecommunications technology, thereby providing substantial healthcare to low-income regions. The earliest published telemedicine record was in the first half of the 20^th century when Electroencephalography (ECG) was transmitted over telephone lines³. During COVID, it plays a vital role, but some believe it cannot replace consultation in person or emergency⁴. Even before COVID came to India, telemedicine was functional. Telemedicine allows better healthcare choices, increases emergency service quality and performance, reduces time in making a diagnosis, and saves costs for both doctors and patients by optimizing clinical procedures and reducing travel expenses to hospitals^5,6,7.

The technological intervention in health care has made patients dynamic participants in the patient care delivery process⁸. The current study was completed in 2010 in a tertiary care super specialty hospital. The need of this study is to find the use pattern of the telemedicine facility and the opinion of the telemedicine users in the study setting.

MATERIALS AND METHODS:

The survey interview method study was performed during the year 2010 from March to May at a tertiary care hospital as a nodal centre for telemedicine with five telemedicine centres. Thirty patients and 20 doctors were interviewed using the judgemental sampling method with a pre-tested questionnaire. Doctors were interviewed face-to-face, but patients were interviewed over the telephone due to distance issues. Doctors were examined with ten questions, of which three were about the number of telemedicine uses, and the other seven were about their experiences with telemedicine. Patients were examined with two demographic questions and eight (total ten) use of telemedicine experiences. A two to five Likert scale was used to record the opinions. Previous records and various other data sources were collected as secondary data sources. The Data were collected and analysed using MS Excel using simple statistical tools.

RESULT:

Out of 20 doctors, all have used the telemedicine facility for various purposes like teleconsultation and tele-education (figure 1).

Figure 1. Number of teleconsultation and Tele-education sessions by doctors’ group.

Regarding the various quality parameters of the telemedicine facility, like the quality of image, video, audio, and transmission, along with the usefulness, behavior of staff, and overall facility and interaction with patients and staff, a five-point Likert scale was used (figure 2).

Figure 2. Five-point Likert scale of Doctor's opinion on the quality parameter of telemedicine.

Out of 30 patients, 60% were male, 40% were female, and were of different age categories from below 20 to more than 40 years of age (<20 years 26.6%, 20-40 years 36.7%, and >40 years 36.7%).

For teleconsultation, the patients are consulted from different hospital levels, from primary to Taluk level to district and medical college hospitals (figure 3).

Figure 3. Level of hospitals from where teleconsultation was asked.

It is found that the reason for taking telemedicine treatment was economic (40%), as per instruction of a doctor (40%), and avoiding travel (20%). The reason for taking telemedicine in the study setting was 70% for its name and fame and 30% for expert consultation. A mixed response was found regarding why telemedicine is convenient for the patient (figure 4).

Figure 4. How telemedicine is convenient for patients – patients’ response.

All patients responded that they all (100%) got the proper Telemedicine consultation. Of 30 patients, 34% consulted for Neurosurgery, 31% for Neurology, 21% for Cardiac surgery, and 14% for Cardiology.

All the patients responded that they all had a change in their treatment and overall satisfactory telemedicine services from the study setting.

DISCUSSION:

It was found that the study setting telemedicine usage for the last five years is very effective. The primary purposes of the modality used are teleconsultation (majority), tele-education, live workshops on surgeries and procedures, virtual classroom teaching, and telecasting seminars. In the Doctors group, it was found that the majority, 75% of the doctors, use the facility for teleconsultation 5 to 10 times, and for Tele-education, 55% of doctors used for less than five times. It is concluded that teleconsultation followed by tele-education is most of the study setting telemedicine facilities. Study shows that with proper training there are significant changes for nurse practitioner in the delivery of care using telehealth^9,10.

The various quality parameters of the telemedicine facility and the Doctor's opinions give a mixed response. 50% of the idea of Very good image quality, 10% said excellent, whereas 40% said only good. Regarding video and audio quality, 85% believe very good, and 105 say excellent. 45% responded with very good and 15% with excellent transmission speed. 45% excellent, and 50% say very good on the usefulness of telemedicine. The doctor group on the staff behavior gave 30% excellent and 65% very good rating. 55% say excellent, and 40% say the very good interaction experience between patient and staff. Overall, 30% opine excellent, and 55% very good rating of the telemedicine facility.

In the patient group, the majority (60%) are male, and the age is between 20 to 40 years (36.7%). From the different levels of hospitals, Taluk level hospitals are seeking more teleconsultation (40%), followed by District level and equally from medical college and primary level healthcare. Most patients (40%) believe it is economical to have telemedicine consultation, and 20% say it avoids traveling similar to the study of Shivappriya et al.¹¹ However, 40% of patients seek telemedicine by the instruction of doctors, which is also a good reason or impact for the use of telemedicine. Here in this study setting, it was found that the name and fame of the institution is the major reason for taking telemedicine the patients (70%). 60% say that of the sudden response, and it is very convenient for them to have telemedicine. Major consultation from the Department of Neurosurgery (34%) followed by Neurology (31%). All the patients think that they had a perfect and proper telemedicine consultation and had got a change in their treatment. All of them were very satisfied with the telemedicine services.

It is found that telemedicine is an excellent tool, especially for rural India, where more than 50% of healthcare practitioners in rural India still need formal training. With poor access to traditional healthcare facilities in rural India, quackery remains a significant issue in health. The skewed workforce distribution in India, where 60% of the force caters to 30% of the population living in urban India, with an urban-to-rural doctors’ ratio of 3.8:1, can be mitigated by effective and accessible telemedicine programs¹². Healthcare sector should leverage information technology to improve quality of life ¹³.

Though the National Medical Commission issued a guideline for telemedicine uses, many ethical issues still need to be solved; gaps emerged between current legislation, legislators, service providers, different medical services, and most importantly, patient interaction with their data and the use of that data¹⁴.

The limitations of this study are the very few study participants, and the patients who underwent telemedicine treatment were interviewed only by telephonic means due to far away distance. Telemedicine has become a key player in the healthcare system, especially in underserved areas. Despite having the utmost potential, it still has not been able to attain the "boom" that it was meant to create. The use of telemedicine and technology has a significant impact on the rural population, especially in hilly and remote areas of rural India, which can offer both cost-effective as well as good-quality care^15,16. This may be as simple as using smartphone as done in Indonesia¹⁷.

CONCLUSION:

Telemedicine is now a booming technology during and after the pandemic. But India also used it before the pandemic, which started long before. The current study shows the telemedicine facility of a tertiary care hospital that has been providing a very effective telemedicine service for the last five years in South India. Telemedicine is underused due to a need for more awareness among users. The study setting has a good user experience in terms of image, video, audio quality, and transmission speed. The patients are also delighted with the services in terms of change in treatment and quality of services. Awareness among patients is less for telemedicine. Open webinars to the public are required for a good impression of telehealth in daily life¹⁸ break the transmission chain of communicable diseases ¹⁹ as social factors have much impact on health and disease of the community²⁰. Exhaustive telemedicine practice guidelines must focus on critical parameters for convenient, accessible, and cost-effective patient care.

CONFLICT OF INTEREST:

The authors have no conflicts of interest regarding this study.

REFERENCES:

1. Sweta Bhattacharya. A Review of the Application of Automation Technologies in Healthcare Domain. Research J. Pharm. and Tech. 2016; 9(12):2343-2348.

2. Ateriya N, Saraf A, Meshram VP, Setia P. Telemedicine and virtual consultation: The Indian perspective. Natl Med J India. 2018; 31(4): 215-218. doi: 10.4103/0970-258X.258220.

3. Chellaiyan VG, Nirupama AY, Taneja N. Telemedicine in India: Where do we stand? J Family Med Prim Care. 2019; 8(6): 1872-1876. doi: 10.4103/jfmpc.jfmpc_264_19.

4. Agarwal N, Jain P, Pathak R, Gupta R. Telemedicine in India: A tool for transforming health care in the era of COVID-19 pandemic. J Educ Health Promot. 2020; 28(9): 190. doi: 10.4103/jehp.jehp_472_20.

5. Weinstein R.S., Lopez A.M., Joseph B.A., Erps K.A., Holcomb M., Barker G.P., Krupinski E.A. Telemedicine, telehealth, and mobile health applications that work: opportunities and barriers. Am. J. Med. 2014; 127(3): 183–187.

6. Parimbelli E., Bottalico B., Losiouk E., Tomasi M., Santosuosso A., Lanzola G., Quaglini S., Bellazzi R. Trusting telemedicine: a discussion on risks, safety, legal implications and liability of involved stakeholders. Int. J. Med. Inf. 2018; 112: 90–9.

7. Haleem A, Javaid M, Singh RP, Suman R. Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sens Int. 2021; 2: 100117. doi: 10.1016/j.sintl.2021.100117. Epub 2021 Jul 24. PMID: 34806053; PMCID: PMC8590973.

8. R. Nalini, R. Alamelu, R. Amudha, V. Badrinath, D. Ganesh Kumar. E-detailing –Empowering doctors in Digital Era. Research J. Pharm. and Tech. 2017; 10(8): 2663-2667.

9. Preeti Manoj Bagul, Archana Gunjal. A Study to assess the effectiveness of Planned Teaching Programme on knowledge regarding Telemedicine among nursing students in a selected college in Mumbai. Asian Journal of Nursing Education and Research. 2022; 12(1):102-4.

10. V. Indra, S. Urmela, N. Naveen. Nursing Perspective towards Tele Health and eHealth Efficacy for Quality Health Care. Int. J. Nur. Edu. and Research. 2019; 7(4): 598-600.

11. S. N. Shivappriya, R. Dhivyapraba, A. Kalaiselvi, M. Alagumeenakshi. Telemedicine Approach for Patient Monitoring System using IOT. Research J. Engineering and Tech. 2017; 8(3): 233-236.

12. Pulla, P. Are India’s quacks the answer to its shortage of doctors? BMJ. 2016; 352: i291. doi: 10.1136/bmj. i291.

13. R. Amudha, R. Nalini, D R. Alamelu, V. Badrinath, M. Naveen Sharma. Telehealth and Telenursing – Progression in Healthcare Practice. Research J. Pharm. and Tech. 2017; 10(8): 2797-2800.

14. Dash S, Aarthy R, Mohan V. Telemedicine during COVID-19 in India-a new policy and its challenges. J Public Health Policy. 2021; 42(3): 501-509. doi: 10.1057/s41271-021-00287-w.

15. Nittari G, Khuman R, Baldoni S, Pallotta G, Battineni G, Sirignano A, Amenta F, Ricci G. Telemedicine Practice: Review of the Current Ethical and Legal Challenges. Telemed J E Health. 2020; 26(12): 1427-1437. doi: 10.1089/tmj.2019.0158.

16. Perdani Adnin Maiisyah, Zullies Ikawati, Zainol Akbar Zainal. Smartphone Application for Diabetes in Indonesia: A Narrative Review. Research Journal of Pharmacy and Technology. 2021; 14(7): 3955-0.

17. Kaeley N, Choudhary S, Mahala P, Nagasubramanyam V. Current scenario, future possibilities and applicability of telemedicine in hilly and remote areas in India: A review protocol. J Family Med Prim Care 2021; 10(1): 77-83. doi: 10.4103/jfmpc.jfmpc_1085.

18. Premala Krishnan, Kamala Krishnan, Chua Bee Qing. Knowledge and Perception of Telemedicine and Telerehabilitation on patient data sharing during COVID-19. Research Journal of Pharmacy and Technology. 2023; 16(7): 3109-4.

19. S. Ramasamy, Keerti Sharma, Preeti Mishra, Reena Gupta, Jitendra Gupta, Amit Kumar Verma. Practicing Telemedicines in India. Research Journal of Pharmacy and Technology. 2022; 15(12): 5909-8.

20. Rathi, HB., Viswnadham KK, John Masih. An Analytical Study of Social Determents of Health. Research J. Pharmacology and Pharmacodynamics. 2012; 4(5): 267-271.

Received on 31.10.2023 Revised on 24.06.2024

Accepted on 01.11.2024 Published on 06.12.2024

Available online on December 31, 2024

Asian Journal of Management. 2024;15(4):329-332.

DOI: 10.52711/2321-5763.2024.00051