By Professor Nathan Grills, Academic Fellow, Australia India Institute
When I entered medicine in 1994, I remember flouting the importance of telehealth in the selection interviews. It was even more relevant for me for two reasons: Firstly, I am from rural Victoria where lack of access to specialist rheumatology services as a child has left me with a long-term disability. If telehealth was around in the 1980s could I have accessed better care? And secondly, I was entering medical school under an Australian Navy Scholarship. The Navy increasingly seeks to utilise telehealth, given remote deployments and potential for injuries. Indeed, telehealth has been touted as ‘the future of healthcare’ to increase access for those in rural and remote settings – as we have in Australia and India.
Unfortunately, it has been slow to develop outside the high-resource, highly publicised settings like Antarctica! Prior to 2020, the use of telehealth was limited, especially in low and middle-income countries (LMICs) like India. There has been plenty of research and technological development demonstrating its efficacy. However, despite India increasingly acquiring a reputation for being the world’s IT hub, developing a system of safe, reliable and affordable telehealth in LMICs has often been unattainable. Among the challenges have been limited internet access, inconsistent electricity, inadequate devices and poor bandwidth. And from a system perspective, there were medico-legal issues, regulatory barriers and difficulties in assuring quality healthcare. There has also been a digital divide along the lines of age, poverty status and education.
Enter COVID-19. Necessity is the mother of innovation, they say. When the pandemic arrived in 2020, social distancing restrictions and lockdowns limited (or scared) many of us from seeking face-to-face healthcare. Government restrictions limited travel, and accessing healthcare services was seen as a high-risk exercise whereby taking home COVID with your script was a real possibility!
In Australia, healthcare providers and patients generally embraced telehealth or virtual health, as it was a necessity. And Australia’s Medicare was quick to fund virtual health consultations. In parallel, there was a scramble to make telehealth safe, confidential and legally defendable in terms of the medico-legal and regulatory aspects.
As we now move forward post-pandemic (hopefully), it seems clear that virtual care will remain a core aspect of healthcare in Australia.
In India, however, it was not a central feature of the initial 2020 COVID response and many simply delayed or missed out on medical and health treatment in the first wave. Then came the dramatic and horrific Delta wave in April 2021. Telehealth services for management and treatment of patients at home ballooned.
I held numerous phone consults with friends and staff who had contracted COVID. One of my staff was unable to receive an ICU bed, so we essentially established ‘hospital in the home’ for them and provided remote advice on treatment. Similar efforts cropped up across India and globally to help provide virtual COVID care, usually for free.
Likewise, Christian Medical College Vellore, a major research partner for the University of Melbourne, had 1400 COVID patients at any one time (about 1000 inpatients, and 400 being treated via telehealth), and treated close to 1500 patients virtually in the end. This virtual management doubtlessly saved lives and helped limit overload on the health system. Even in many rural parts of India, people adjusted to using virtual health care.
Meanwhile, it has become clear in both Australia and India that people with disability, those in poverty, and those with poor access or knowledge of technology did not benefit equally from telehealth. As so often is the case, inequities were exacerbated by the emergency and the response alike. We explore this in our recent webinar on COVID and ICT health care.
But what now? Telehealth is not going away. According to Solve-Care CEO, “India has the potential to have one of the highest users of telehealth services in the world, making it a natural choice for [us] to make India a focus and important market.”
But moving forward we need a better understanding of how virtual health has evolved in the last two years, and to explore ways to make it inclusive and equitable. To this end, the Nossal Institute for Global Health (University of Melbourne) along with partners including the George Institute, Adelaide University and Infosys have been funded by the Australia India Council to expand accessible virtual care in India and Australia. The project is called VirtuCare.
VirtuCare works with the health and ICT industry, government and healthcare providers, and most importantly people with disability, to co-design a model of care that will address health and rehabilitation needs of people with disability – those who were often excluded in the recent rapid expansion of telehealth. Once we get the model right, we aim to expand the initiative to the national disability and health systems. To achieve this, we partner with e-Sanjiveeni, the government of India’s telehealth platform, to document learning from use of telehealth during the pandemic and to inform future inclusive telehealth models.
This understanding will help inform the development of a virtual health system that is dynamic, effective and accessible, and result in increased health outcomes in both India and Australia, particularly among those who experience disadvantage and poor access to healthcare – in both Australia and India.
The VirtuCare project, announced by Minister Wong on the 15th of August – the same day India celebrated its 75th year of Independence – will be launched in Hyderabad and Delhi in September.
If you would like further information, please contact me at firstname.lastname@example.org