Post Publication Independent Review of
"Virtual health care in the era of COVID-19"
Table of Contents:
Post Publication Independent Review of "Virtual health care in the era of COVID-19"
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Post Publication Independent Review of
Virtual health care in the era of COVID-19
Paul Webster
Published: April 11, 2020 DOI: https://doi.org/10.1016/S0140-6736(20)30818-7
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30818-7/fulltext
Review Comments:
1. Quote "In the face of a surge in cases of coronavirus disease 2019 (COVID-19), physicians and health systems worldwide are racing to adopt virtualised treatment approaches that obviate the need for physical meetings between patients and health providers." End of Quote.
While the industry grapples with the corona virus lockdowns and outbreaks, the authors here are drawing attention to a hitherto much-not-explored vertical, namely, virtualized healthcare.
2. The authors point out two situations, diametrically opposite geographically & demographically
Quote "“I'd estimate that the majority of patient consultations in the United States are now happening virtually”, says Ray Dorsey, director of the Center for Health and Technology at the University of Rochester Medical Center (Rochester, NY, USA). “There has been something like a ten-fold increase in the last couple of weeks. It's as big a transformation as any ever before in the history of US health care." End of Quote.
Quote "In China, patients were advised to seek physicians' help online rather than in person after the pandemic first emerged in Wuhan in December" End of Quote.
3. Quote "China's virtual care transformation was unleashed when the country's national health insurance agency agreed to pay for virtual care consultations because the hospitals and clinics were full" End of Quote
It does require some prompting to overcome barriers whenever a new protocol or process is introduced, and telemedicine also has its own share of acceptance woes.
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Now, that the COVID-19 outbreak has caused a major paradigm shift to telemedicine, it can be expected that both the healthcare service provider and the recipient will be more willing to embrace telemedicine, coz in conventional medical practice, its always the patient who is at the receiving end, and whose clinical conditions may change based on multiple factors, with possible fatality too, while the healthcare provider was at no risk.
The healthcare service conditions have changed rapidly now due to the COVID-19 outbreak, where the healthcare providers' clinical conditions may also possibly change, with fatality not being ruled out.
Consequently, we can expect that both health care providers and receivers will be more cooperative to embrace healthcare, in a better way, than in the past.
When both the healthcare providers and receivers cooperate better with regard to telemedicine, then it certainly opens up more scope for the telemedicine industry as a whole, inclusive of research and academics.
4. Quote "Following China's example, on March 30, at the direction of US President Donald Trump, the Centers for Medicare & Medicaid Services (CMS), which oversees the nation's major public health programmes, issued what it termed “an unprecedented array of temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic”." End of Quote.
This observation by the authors indicates that Policy Decisions may need to be taken at National Level and immediately percolated thorougly, given the threat due to COVID-19 and also a new direction for the various industries related to telemedicine and healthcare, inclusive of academic and research initiatives.
Read together with https://www.businesstoday.in/current/corporate/coronavirus-maruti-noida-firm-get-up-govt-nod-to-supply-10000-ventilators/story/400080.html, when an automobile manufacturer can turnout ventilators, which were hitherto manufactured only by the healthcare industry, then, it implies that any & all industries can immediately jump into the Telemedicine vertical with minor modifications to their processes, which again needs National Level approvals, regulatory nods and waivers.
5. The following observations by the authors helps provide insights that this is not just an Information Technology Enabled Service, but is an Interdisciplinary Technology Enabled Service, drawing from known realms of Medicine, Engineering, and Sciences, with immense potential in hitherto unexplored realms of Medicine, Engineering & Sciences, which implies that there is a tremendous scope and potential for academia, research and industry to work together. Perhaps, this interdisciplinary Telemedicine was the magic potion that the whole world was looking for, as a stimulus or ground breaker to overcome the lag/stagnation in multiple areas caused due to COVID-19.
Quote " “As we confront [COVID-19], we're racing to implement virtual health-care technologies as quickly as we can. The scale and pace of change is unprecedented for Canadian health care.”" End of Quote.
Quote " “It's inexpensive and expedient, but it'll never be the same as a physical examination with all of its human qualities of judgment and communication. But with COVID, this is a trade-off we have to accept.”" End of Quote
Quote "Trisha Greenhalgh, co-director of the Interdisciplinary Research In Health Sciences Unit at Oxford University (Oxford, UK).
“We have a research project that has been tracking the use of video conferencing in Scotland over the past 6 months, and in the space of the last 2 weeks we've seen [a] 1000% increase in use”, said Greenhalgh. “It's incredible. [COVID-19] has done what we couldn't do until now, because, suddenly, it's not just the patient who might die—now it's the doctor who might die. So the doctors are highly motivated. The risk–benefit ratio for virtual health care has massively shifted and all the red tape has suddenly been cut.”" End of Quote.
Quote "In Italy, although all 20 regions had implemented national telemedicine guidelines as of 2018, hospital managers have been largely caught off guard by the explosion in digital demand, says Elena Sini, information officer for GVM Care & Research, a network of nine private hospitals in northern Italy.
Many Italian hospitals lack the necessary hardware and technical resources, she noted in a March 23 webinar. “Burnout is also a concern for IT staff, so set up some psychological support for IT staff”, she advises.
Sini reported a lack of hardware due to broken supply chains and insufficient bandwidth capacities as the demand increased by about 90% on fixed landlines and 40% on mobile networks in Italy. “We have to ramp up telemedicine capabilities, but for most hospitals in Italy this is an issue. We just don't have the capabilities to deliver.”" End of Quote.
Quote "Speaking alongside Sini, Henning Schneider, chief information officer for Asklepios Kliniken, one of Germany's largest private hospital networks, said the COVID-19 pandemic is highlighting a need for intensified IT collaboration between German hospitals. In New Delhi, India, Anurag Agrawal, director of the Council of Scientific and Industrial Research's Institute of Genomics and Integrative Biology, says Indian health-care providers have become similarly preoccupied with virtual health care while the country is in near-total lockdown. “Suddenly, after years of resistance to virtual health care, our physicians keenly want it”, said Agrawal. “[COVID-19] is breaching the barriers to virtual health care faster than anything in history.”" End of Quote.
6. Quote "the Indian Government is copying China's tactics by releasing a set of newly developed applications that use instant messaging platforms, such as WhatsApp, to enable a suite of virtual health-care services, including public messaging about behavioural modifications, epidemiological tracing, and access to virtual health-care providers. " End of Quote.
Perhaps, due to the nature of the emergency caused by COVID-19, it was acceptable to copy another Nation's strategies, but, to sustain in the long run, INDIA needs its own new challenging strategies in Telemedicine, that extends beyond consultation and remote examination of lab results. Perhaps, like the Aadhaar, it is time that the Indian Govt. gives out a new scientific policy regarding Telemedicine based Healthcare and helps enable infrastructure that will completely digitize all healthcare processes and protocols, lab investigations, etc., with multiple distributed cloud based servers, IOT, AI and related services, so that any citizen can avail healthcare service at any Primary Health Care center based on his integrated healthcard.
Policies, and Regulatory Mechanisms need to be put in place for every aspect of Telemedicine based National Healthcare delivery, so that every Govt. Hospital, Private Hospital, Labs, etc. are part of one Giant Pool of the Telemedicine based National Healthcare System.
Further industrial policies and regulatory mechanisms need to be modified so that existing industrial infrastructure can be used to manfacture a new generation of Hospital, Lab and Communication Equipment, Hardwired & integrated Software & Communication Solutions.
7. It is time to think, modify and adapt all academia, industry and research activities towards an integrated interdisciplinary Telemedicine Based Healthcare System post COVID-19, for the world is never going to be the same again and opportunity always comes only as a blessing in disguise.
Quote "“The regulatory barriers that have held virtual health care back for all these decades were never justifiable”, Jadad avers. “[COVID-19] is an opportunity to blow all these barriers away. And the question now is ‘how far are we willing to go?’”" End of Quote.
8. Read together with
Quote "India has tremendous capacity in eradicating coronavirus pandemic: WHO
The executive director of the World Health Organisation (WHO), Michael Ryan, said India, the world's second most populous country, has a tremendous capacity to deal with the coronavirus outbreak as it has the experience of eradicating the small-pox and polio through targeted public intervention. End of Quote
It can be understood that if INDIA has tremendous capacity in eradicating coronavirus pandemic, then it is a natural consequence of the same statement that INDIA has tremendous capacity in handling the situations that arise post the coronavirus pandemic; and the first situation that will arise is integrated interdisciplinary Telemedicine based Healthcare Delivery (not limited to virtual consultation alone, but inclusive of all healthcare delivery protocols, processes and practices).
Consequently, the responsibility now falls on the Academia & Research to show the pathways to the Industry, and together (Academia, Research & Industry) seek required new approvals, regulatory modifications (to pre-existing facilities), and work together in synchronism to establish the next generation integrated interdisciplinary Telemedicine based Healthcare Delivery.
If an automobile manufacturer can manufacture ventilators and provide them on a warfooting, instead of waiting for the healthcare manufacturers to provide the same, it indicates that all that is necessary is a paradigm shift in our thinking & perpectives and to make best use of existing facilities and upscale wherever necessary.
Since India has several Govt., State, Private and Deemed Universities; Research Institutions and Industry Associations, there can always be an avenue for new multiple thronged approaches for the next generation of interdisciplinary Telemedicine Approaches. Whoever is successful, whether it be Academia or Research or Industry or a combination of the three, an eminence tag can be added to them, and Govt. patronage provided maximum to those with the eminence tag, so that India can give to the World, the next generation of Healthcare Processes, Protocols and Delivery based on interdisciplinary Telemedicine based approaches. These new activities have the potential to enrich the existing academic facilities, with scope for new academic courses, accompanied with pathbreaking research initiatives that translate into optimized existing and new industry infrastructure and output, inclusive of all diverse realms of Academia, Research & Industry.
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