TELEMEDICINE : A Discourse on its Sustainability

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TELEMEDICINE : A Discourse on its Sustainability

The rise of telehealth -- a delivery of medical services through electronic means of communication -- has been one of the most remarkable spillover effects of the COVID-19 pandemic.


Global Context
In the US, the Centre for Disease Prevention and Control (CDC) specifically recommended that healthcare facilities and providers offer clinical services through virtual means such as telehealth. As a result, its usage peaked during April 2020 but has since stabilised at 38 times higher than pre-COVID time. Needless to say, the US was amongst the first adopters of telehealth and has also been a mature user of tele-ICU services with an estimated 11% of American ICU beds under telemonitoring.

Telemedicine adoption, which was once tepid in Latin America (Chile, Argentina, Costa Rica, Mexico, Peru, and Columbia) due to insufficient communication infrastructure and status quo biases plus regulation deficiencies, witnessed a breakthrough during the pandemic, thus making the virtues of telemedicine apparent. Argentina passed legislation to validate electronic prescriptions and launched TeleCovid -- a public telemedicine provider.
In the Asia Pacific region, the governments of Australia, Singapore, Indonesia, and the Philippines made consistent efforts to increase the use of telehealth through subsidies, funding, and relaxation of certain health regulations during the pandemic.

In the developed countries, the increasing rate of telehealth adoption was enabled by three factors. First one is increased consumer willingness to use telehealth, second is increased provider willingness to use telehealth and finally, regulatory changes enabling greater access and reimbursements.

Key Questions
While it is evident that government interventions and public sector support have been the key to creating favourable business environments for telehealth in those regions, Nepal seemingly is standing out from the crowd. As the country reels under the third wave of COVID, many start-ups and corporates have been spotted providing telemedicine and digital health services to meet the growing needs of the mass market. But, will the surge in telemedicine services be sustainable in the post-pandemic period or will it retreat? This may be a fruitful discourse for telehealth businesses in Nepal, and this article aims to shed some light on it.

Focus of Care
In Nepal, the majority of dispensaries, hospitals, and doctors are located in urban areas where only 21 percent of the population resides. Most of the medical practitioners are concentrated in metros, especially in prosperous areas. Rural, sub-urban, and urban slums lack adequate access to quality primary healthcare. Much of the care delivered in underserved areas is through private unlicensed providers commonly called Health Assistants (HA) or "quacks" or through public sector primary or community health centres. Though health tech start-ups and firms have made a successful market entry (i.e. timing) at the height of the pandemic the result of which led to an exponential boom in online consultations via apps, medicine delivery, and even health service at the patients' door, those quick wins should not serve as a precursor to reverse the focus of care, i.e., enabling access to specialist and super-specialist care to the untapped population. As the government's telemedicine strategy in 25 of the remote districts in Nepal has already proven defunct due to financial and operational constraints, the creation of strategic choices and the way those choices cascade to the bottom of pyramid (BoP) markets will determine the sustainability of health tech start-ups and corporates looking to gain a foothold in the challenging healthcare market.

Integrated Healthcare System
During the COVID-19 pandemic, telehealth companies recorded an average growth of 70 percent in basic telemedicine demand as compared to 2020. As promising as it sounds, online consultations on their own may not be enough for it to thrive post-pandemic era. It has to be integrated into other services like home healthcare where physicians go to the patients' home to provide the needed medical services including routine check-ups, administering medication and collection of medical samples for diagnostic purposes. Fully integrated patient record allows clinicians to serve the patients best, no matter whether they are present physically or remotely. Home delivery of prescribed medications adds to the safety and convenience of patients. Another emerging trend in the industry is modern healthcare subscriptions which may help expand the service offerings through mobile applications and make services financially accessible to patients.

Continuous Process Improvements and Product Enhancements/Optimizations
Built on proprietary technology, telehealth apps are seen to be the core products of telehealth companies in Nepal. Through these apps, patients or their dependents are able to avail services of online video consultations, book hospital appointments, or even order medicines online. As this may be considered a good enough product 'app' for a nascent telehealth industry, acquiring and retaining customers may be challenging due to changing customer needs and preferences in the long run. It is for this reason that companies have to offer more than the basics, thus giving rise to better user engagement and experience imperatives. Such imperatives must undergo a great amount of business analysis and planning exercises, phase-wise implementation, regular updates, and zero errors leading to faster processing of information and lower latency.

As per WHO, telemedicine is defined as the delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of healthcare providers, all in the interest of advancing the health of individuals and their communities. Globally, telemedicine has the potential to revolutionise healthcare by bringing down the cost of both provider and patient as well as improving the accessibility to quality medical professionals. In Nepal, it would be naïve to say that the government’s stay at home orders and the risk of COVID-19 transmissions at healthcare facilities were policy-level changes for boosting telemedicine service. Unless the need for virtual healthcare comes from the 'horse's mouth', the state of public health infrastructure and services would never see an overhaul for digitised healthcare services delivery. Due to its uncertainty in the future, efforts of the private sector to bring innovation and improvements towards digitisation of the healthcare ecosystem in Nepal shall always become a precursor for the country's healthcare transformation. Thus, the sustainability of telehealth companies is something that must be reviewed time and time again.

(Mr. Paudyal is a Chartered Accountant and holds an MBA from AIT, Bangkok.)

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