Apollo Group has been the pioneer of telemedicine in India by first linking its hospital in Chennai with the Apollo rural hospital at Aragonda village in Chittoor, Andhra Pradesh, with the help of Indian Space Research Organisation (ISRO) in 2000. But it was under the leadership of Vikram Thaploo, Founder CEO of Apollo TeleHealth, that a major initiative called the ‘Rural Connect’ was started, aimed at providing primary and specialty services in far-flung areas across the country. Through this initiative, the group has partnered with many state governments, and also operates telehealth services privately in various states. At present, the group is connected to 300 million people in India remotely. In this chat with Moneycontrol, Thaploo speaks about the power of telemedicine in today’s technology-driven world, its usefulness in India’s context, and access barriers to telehealth in states. Edited excerpts:
How do you think has been the journey of telemedicine in India so far, and what role has the Apollo group played in it?
Telemedicine has been around for the last few decades now. It was in March 2000 that we launched the telemedicine program, by the then visiting President of the US, Bill Clinton. And it was launched from Aragonda village, which is where our chairman (Prathap Reddy) is born. So, it’s been around for a while. But COVID-19 became a catalyst. The pandemic catalysed the entire adoption of telehealth -- from the doctors’ side as well as the patients’ side. Earlier, we had to convince a patient to take (telemedicine) services and convince a doctor to give telemedicine (services), but now, that’s not the case. Contrary to popular belief, globally, rural areas have adopted telemedicine much earlier, because they did not have the luxury of choosing. So, the adoption was much higher, but the penetration was less.
On the other hand, in urban areas penetration was more, but adoption was less. So, this equilibrium has now become a little better over the years, and I think, with COVID-19 it became much more accessible, affordable.
The telemedicine market grew very sharply to $1.3 billion last year at a CAGR of 40 percent, and is expected to cross $5.5 billion by 2025. So, that’s the size of the telemedicine market now.
In a country like India where access and affordability of healthcare are major concerns, can telemedicine be a replacement for the regular healthcare and primary care?
Technically, it cannot be a replacement; in fact, it’s a model, a modus operandi or a mode of providing services. It’s a force multiplier. So, when you look at an ICU set-up, a doctor would probably be able to see 15 to 20 patients at one go. But when we use the same services of the same doctor through our tele-ICU set-up, we are able to go up to 100 patients.
It was thought that telemedicine can be used to aid the void created by the shortage of specialists, but it turns out that it has started augmenting even the lack of physicians.
For instance, we have a model in Jharkhand, where the primary health centres are run by paramedics and we have 100s of them with the government of Jharkhand. So, it’s basically argumentation of primary care. In such cases, GPs (general physicians) through telemedicine can guide patients.
So, it takes care of the dearth of primary care physicians, specifically in this kind of a scenario. But when you look at another model where specialists operate through telemedicine, it takes care of the dearth of specialists in rural as well as semi-urban and even urban areas too. This model was earlier used only in emergency (situations). But now we look to it for providing longitudinal services and for taking care of even chronic ailments.
What do you think are the critical gaps in healthcare delivery that can be filled through telemedicine?
In India, 70 percent population live in rural area, but only 30 percent doctors are available for them. The situation is reverse in urban areas. So, in that case, say at a sub-centre level and at the primary health care centre level, providing telemedicine services have helped many states, mainly the progressive ones, which have thought of these models.
In urban and semi-urban areas, on the other hand, the concern is the lack of specialists because they are largely concentrated in tier I or metropolitan cities. Providing services from here to those places where a specialist is needed is also very important and telemedicine is bridging the gap. Now, if you look at telemedicine in a little more holistic way, it’s a digital environment which it is enabling. But if we look at what else it does, it provides longitudinal data, provides support in doing chronic disease management, provides support in mental health management because people are able to connect to a doctor without any inhibitions. So, we are seeing a lot of rise in mental health support by the use of telemedicine.
And then we go forward and we look at the newer models of telehealth, which we do in Apollo as well. These include use of drones and ambulance services. For example, when a patient gets picked up from a site by an ambulance, from that minute onwards the emergency response (ER) department receives the data. So, by the time the patient reaches the ER department, the data is already there and the patient can be immediately taken care of.
Then there can be connected rooms or connected beds where a patient is lying on the bed, and you don’t need to disturb the patient. You can use the connected devices and contactless devices and measure parameters like blood pressure; that way a patient does not need to be woken up at 12 at midnight for the BP reading to be taken. It’s called continuous monitoring; without even wearing the probes sometimes, many of these happen through sensors. So, all this is part of telemedicine. I believe this is the way to go, and remote monitoring where we are able to convert multiple beds at multiple layers into stepdown treatment is very useful.
What the COVID-19 pandemic showed us is that physical infrastructure was not enough to take care of what we were thrown into. But with these kind of set-ups where telemedicine and remote healthcare systems are in place, they would probably take care of such pandemics as well, such huge rush of patients into the hospital because all beds will have technology-enabled healthcare support.
For popularising and making telehealth accessible, what can be the role of governments and the private sector?
The role of the private sector has to increase even though it has been proactive in adoption of such technologies. Every hospital system has to understand that going forward patients would not want to come to a hospital for any primary care support; they would want to come to a hospital only when intervention is required. So, in that scenario, all private hospitals have to jack up their efforts and make sure that they are able to provide support to the patient if they want to retain a consumer over a longer period of time.
The government has multiple roles to play as it considers the primary healthcare provider specifically for the masses. Therefore, for augmenting the primary health care delivery and making the secondary and tertiary care delivery more robust, government needs to adopt all technologies.
A number of schemes which are being implemented now from the Centre do support digital transformation in healthcare. Secondly, the government did play a role in releasing guidelines on telemedicine, but then it has to do more. People are using these services more easily without the fear of going wrong on anything and providing these services.
The government, in fact, has a regulatory role and the job scale-up will happen only if it is involved. I think, the current governments are giving due consideration to it, but adoption has to increase a little more.
Apollo has been a leading force in the telemedicine sector in states like Tamil Nadu and Karnataka, but are you also planning to expand?
We are already in Himachal Pradesh, where we are providing tele-emergency services; we are also providing tele-radiology services in Uttar Pradesh. We are doing much work in north-east -- in Arunachal Pradesh, Meghalaya and Assam. Our services are also there in Jharkhand and Andhra Pradesh. In fact, there are only few states which remain out of the ambit of (these) services.
But since in India health care is a state subject, it needs more support from state governments. But privately, we do a lot of work in almost all parts of the country.
What specific support do you need from states to expand your services?
Services, such as healthcare, that touch a large number of people, are executed through projects that go under tender. And then in tender, governments usually focus on the lowest rate or L1. So quality suffers, and then anyone and everyone can jump into providing health care, quoting the lowest rate. But that does not address the problem of providing quality health care.