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This viewpoint summarizes the discussion that occurred during the “Translating Policy to Practice in Telehealth–Lessons from Global Implementation Experiences” panel that was held virtually at Telemedicon2020, December 18-20, 2020. This panel brought together policy and implementation experts from some countries of South Asia, Kuwait, and the European Union to share their experiences in the development and implementation of telehealth standards and of the scale up of telehealth interventions within health systems. Several common themes arose from the discussion, including the significant role of people; encouragement by respective government policymakers; addressing concerns, particularly related to privacy, confidentiality, and security; and capacity building of human resources. These are discussed in turn, along with the future directions identified by the panelists, which emphasized the need for active encouragement toward the adoption and diffusion of digital health in general and of telehealth in particular. All stakeholders, ranging from governmental policymakers to common citizens, need to come together to build trusting partnerships to realize the advantages offered by telehealth.
This paper summarize the discussion that occurred during the “Translating Policy to Practice in Telehealth–Lessons from Global Implementation Experiences” panel held virtually at Telemedicon2020 [
The COVID-19 pandemic has accelerated the role of various digital health interventions, including telehealth, in supporting health services delivery [
The delivery of health care services, where distance is a critical factor, by all health-care professionals using information and communications technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and the continuing education of health care workers, with the aim of advancing the health of individuals and communities.
The GSDH 2020-2025 generally defines digital health as “the field of knowledge and practice associated with the development and use of digital technologies to improve health” [
This definition encompasses eHealth, in line with that in document EB142/20 on mHealth, noted by the Executive Board at its 142nd session (see document EB142/2017/REC/2, summary records of thirteenth meeting, section 2), which stated that “Today the term digital health is often used as a broad umbrella term encompassing eHealth as well as developing areas such as the use of advanced computing sciences (in the fields of big data, genomics and artificial intelligence, for example)”
Although several countries have launched interim guidance on telemedicine, a sustainable telehealth ecosystem would need to take into consideration standards, interoperability, and regulatory frameworks (see [
In the subsequent sections, we provide a brief historical overview of telemedicine, with respect to the periods prior to and during the COVID-19 pandemic, in some of the participating countries, particularly India. We then discuss the current status, with respect to both policy frameworks and actual practice in some of the countries represented herein. We further elaborate on the perspectives, as described by different panelists, and suggest the way forward for the adequate adoption and diffusion of telehealth in countries of South Asia and beyond.
Panelists and their affiliations.
Name and role | Country | Affiliation |
Ashvini Goel (Chair) | India | Telemedicine Society of India (TSI), Lucknow |
Alexander Thomas (Cochair) | India | Association of Healthcare Providers India (AHPI), New Delhi |
Oommen John (Moderator-1) | India | George Institute for Global Health, University of New South Wales, New Delhi, and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal |
A Thanga Prabhu (Moderator-2) | India | St Johns Health Innovation Foundation, Bengaluru |
Sunil Shroff (Panelist) | India | Madras Medical Mission, Chennai |
Fazilah Allaudin (Panelist) | Malaysia | Planning Division, Ministry of Health |
Chaminda Weerbaaddana (Panelist) | Sri Lanka | Ministry of Health |
Dari Alhuwail (Panelist) | Kuwait | Information Science Department, Kuwait University, and Health Informatics Unit, Dasman Diabetes Institute |
Udaya Koirala (Panelist) | Nepal | Telemedicine Society of Nepal, Kathmandu |
JA Jayalal (Panelist) | India | Indian Medical Association, New Delhi |
Patricia Codyre (Panelist) | SEAROa, World Health Organization | Digital Health and Innovation, SEARO, New Delhi |
Andy Bleaden (Panelist) | European Union | European Connected Health Alliance (ECHAlliance), United Kingdom |
SN Sarbadhikari (Panelist) | India | George Institute for Global Health, New Delhi |
Shubnum Singh (Panelist) | India | Confederation of Indian Industries, National Healthcare Council, New Delhi |
Shuchin Bajaj (Panelist) | India | Ujala Cygnus Healthcare Services, New Delhi |
aSEARO: World Health Organization Regional Office for South-East Asia.
Telemedicine has been helping family physicians by giving them easy access to specialized physicians and helping them in the close monitoring of patients. Various types of telemedicine services such as store and forward, and real-time, remote, and self-monitoring provide various educational, health care delivery and management, disease screening, and disaster management services across South Asian countries. In India, telemedicine had been traditionally led by some like-minded and passionate health care experts from diverse backgrounds and organizations, who, in their quest to bridge the humongous “health care divide” in India, decided to utilize communication technology for the provision of quality health care to care-seekers in underserved and difficult-to-reach areas of the country. They were ably facilitated by the Indian Space Research Organization with offer of their satellites for the purpose, since 2001. In India, several public and private telemedicine projects have already been in place, although fragmented and at small scales [
In Nepal, rural and remote health centers have been connected through a telemedicine network for specialist consultation, although issues such as electricity connection and network connectivity have hindered the widespread adoption and diffusion [
Sri Lanka has been promoting teleconsultations in response to emergency situations following the tsunami in 2004 [
The Indian government released telemedicine practice guidelines [
There is compelling evidence [
Telemedicine adoption had accelerated because of COVID-19. From March 2020 onward as the number of cases increased, a WhatsApp group was first used to help prevent the spread of disease. A small telemedicine platform was used to reach more patients. State government accommodations though legal cover came much later. Within 6-7 months, 10,000 volunteers came forward to help without salary or recognition. Real-time triaging of COVID-19 cases has been accomplished in 16 states. Teletriaging has been performed to avoid panic. Fake news and the spread of misinformation (infodemic) also need to be addressed [
Experts also stressed the importance in addressing interoperability needs beyond technological aspects. Interoperabilities for human and institutional factors such as culture, governance, and policy also need to be kept in mind. For addressing these issues, changes in management principles have to be applied judiciously and continuously. The National Digital Health Mission and the Swasth alliance have come together to help manage COVID-19. The novel coronavirus (SARS-Cov-2) has globally acted as the chief transformation officer, causing massive digital disruption, especially for the health and education sectors. Learning from each other, we should be able to address the bigger problem. Digital health literacy is also badly needed. Digital determinants of health should be addressed [
In Nepal, the government actively promoted the use of information and communications technology during the pandemic by offering several online consultation apps, and telemedicine practice guidelines were released [
In Sri Lanka, a robust primary health care delivery model along with a strong telecommunication network supported health care delivery during COVID-19 [
In India, the Telemedicine Practice Guidelines 2020 were formally notified in May 2020 [
The oil-rich Gulf Region, including the state of Kuwait, has made huge strides in the adoption of digital health solutions, including telehealth, electronic health records, laboratory information systems, picture archiving and communications systems, radiology information systems, and health information exchange in some countries [
Experts from Malaysia [
In Sri Lanka, physicians are trained at University of Colombo with an MSc in health informatics, which has given rise to a talent pool that has been very useful to deploy telemedicine. Training of health care workers [
Sri Lankans have access to a primary health care organization within a very short distance irrespective of their geographical location of residence. As such, before the pandemic, provider to client telehealth was not seen as a priority. Despite lack of need for telehealth services due to geographical reasons, there was a demand for such services due to diseases associated with stigma, where people would prefer to maintain anonymity when seeking services.
Legal cover is essential to practice telemedicine. Guidelines have already been put in place by the Ministry of Health. More than 200 physicians have been trained in telemedicine. Two vendors have been identified and services are offered free to the public. Training was conducted online. Thus, Sri Lanka has proven that health care can be delivered via telemedicine, as has been done for COVID-19. Training care providers along with private players, especially with respect to ethics and security issues, is being undertaken.
Although Kuwait [
Telemedicine should be integrated with national health strategies and those investments need to be made not only in equipment, but in training the workforce and ensuring continuing support. All digital health solutions need to be humanized and a dialogue amongst all stakeholders to tailor the solutions to serve them all is essential.
It was also suggested that digital health should be part of medical and health sciences educational curricula, and potentially even in the general and higher education systems where consumers of health services can understand how to best leverage these tools and play a more active role in their own health care.
In Nepal, new technology has to be adopted. The human factor may be one of the major barriers for the speedy development and use of telemedicine. Doctor-to-doctor and doctor-to-patient consultations are quite different. Based on a surgeon’s experience, it was stated that cameras that are used to cover remote surgery have been found to be useful. Demystification of telemedicine technology should be obtained through vigorous training for all levels of human resources involved. A structured telemedicine curriculum should be introduced to formal medical and information technology education at different levels. Continued technical support at remote sites is necessary for continued service and to avoid unnecessary frustration.
The WHO South East-Asia Regional Office has shared WHO digital health guidelines and specific guidance on telemedicine implementation that have been developed in consultation with member states [
In India, industry bodies such as the Federation of Indian Chamber of Commerce and Industries and Confederation of Indian Industries, in collaboration with the Health Sector Skills Council, could contribute to the mainstreaming of telehealth in India.
The Indian Medical Association (IMA) is in favor of the widespread use of telehealth in India. India has 1,062,398 modern medicine practitioners registered with medical councils as of December 31, 2017 [
Even in Europe, the value of health care ecosystems is now being understood in the context of the vulnerabilities that the pandemic has exposed. Health and social care players are coming together and silos are being broken. With a transforming health care delivery system, new economic opportunities are emerging. The European Connected Health Alliance (ECHAlliance) shared how connecting the dots [
Our ECHAlliance Ecosystems connected the dots in health care during the pandemic taking solutions from one country and adopting them nationwide in another as the NHSNearMe program in Scotland and then offering this adoption back to the Australian health care market who had not seen it implemented at scale.
Privacy and security
Perceived ease of use
Language barriers
Fraud and abuse
Questionable quality of care
Perceived usefulness/preference for face-to-face consultation
Shortage of tech-savvy workforce
Inappropriate behavior by patients
Digital divide
Institutional, cultural, and governance issues
Medical errors
The Personal Data Protection (PDP) Bill, currently tabled in the Parliament, may soon be passed to give robust directions for policy and implementation
Appropriate capacity building for human resources for health and for raising awareness for patients may be undertaken
With the imminent 5G connectivity in India, the digital divide is likely to be reduced
Health data literacy and digital health literacy need to be encouraged across the entire health professional education environment
The National Digital Health Mission is likely to ensure the smoother adoption of digital health
Inadequate training of health care providers
Privacy and security
Ethical issues
Training the care providers along with private players, especially for ethics and security issues, is being undertaken
Huge diversity in the population across socioeconomic status, language, and culture
Inadequate training of health care providers
Lack of user friendliness of digital health solutions
Telemedicine needs to be integrated with national health strategies
Investments need to be made in training the workforce and ensuring continuing support
All digital health solutions need to be humanized and a dialogue among all stakeholders to tailor the solutions to serve them all is essential
People and processes need to come together
Privacy and confidentiality are important
Patients’ and consumers’ digital rights must be respected
The Malaysian Medical Council Advisory on Virtual Consultation (2020) defined the clinical, ethical, legal, technical, and operational aspects of telemedicine for health practitioners
The human factor may be one of the major barriers for the speedy development and use of telemedicine; doctor-to-doctor and doctor-to-patient consultations are different
Regular technological support, particularly at remote sites, is often unavailable
Demystification of the telemedicine technology must be obtained through vigorous training for all levels of human resources involved
A structured telemedicine curriculum should be introduced to formal medical and information technology education at different levels
Continued technical support at remote sites is necessary for continued service and to avoid unnecessary frustration
Underestimating the value of health care ecosystems
Health care and social workers working independently
Doubts regarding scale and economic outcomes
The value of health care ecosystems is now being understood in the context of the vulnerabilities that the pandemic has exposed
Health and social care players are coming together and silos are being broken
With a transforming health care delivery system, new economic opportunities are emerging. The European Connected Health Alliance (ECHAlliance) is connecting the dots to help scale up innovation built in Australia to be rolled out across Scotland, followed by Ireland, and then showcased back to Australia
All panelists emphasized the need for active encouragement toward the adoption and diffusion of digital health in general and of telehealth in particular. All stakeholders, ranging from governmental policymakers to common citizens, have to come together to build trusting partnerships to realize the advantages offered by telehealth. The panelists emphasized the importance of scientific research and evidence-based policy recommendations to improve the use and adoption of effective, efficient, and safe digital health solutions. Various telemedicine applications were referred to, such as those used for diagnosing surgical site infections [
After summarizing the proceedings, the Chair suggested that we can develop appropriate courses for telehealth and introduce them as a part of the curriculum for all health professionals, including physicians, surgeons, dentists, nurses, and allied health care professionals. Like-minded organizations such as the Association of Healthcare Providers of India, TSI, IMA, and reputed academic institutions can come together and influence the regulatory commissions for adopting these recommendations.
European Connected Health Alliance
Global Strategy for Digital Health
Indian Medical Association
registered medical practitioner
sustainable development goal
Telemedicine Society of India
World Health Organization
None declared.