BD - Earth day 2024

Technology in Telehealth

K Ganapathy

K Ganapathy

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K Ganapathy Past President, Telemedicine Society of India, Neurological Society of India & Indian Society for Stereotactic & Functional Neurosurgery. Former Secretary General Asian Australasian Society of Neurological Surgery. Hon Distinguished Professor The Tamilnadu Dr MGR Medical University, Chennai Formerly Adjunct Professor IITM and Anna University Chennai, India. Digital Health Expert WHO Director Apollo Telemedicine Networking Foundation & Apollo Tele Health Services, India.

There is an erroneous perception that widespread adoption, upscaling and deployment of Telehealth is a function of technology. ‘Customer delight’ in telehealth interaction will occur only when body language of the Health Care Provider conveys sympathy, understanding and total involvement. This alone will make one ‘hooked on’ to experience virtual remote healthcare.

There is an erroneous perception that widespread adoption, upscaling, and deployment of telehealth is solely related to availability of cost-effective, affordable, accessible, and user friendly technology. There is no doubt that technology acceptance and behavioural modification, which we are witnessing particularly after the onset of Covid-19, has a major role to play. ‘Customer delight’ is what every e-Commerce platform aims for. The Amazons and Flipkarts and Googles of the world package their products in such a way that even octogenarians from rural backgrounds get hooked to the incredible experience. Whom are we selling telehealth to? Who needs to get ‘hooked on’ to experience virtual remote health care? How do you convince a worried or sick patient tens, hundreds thousands of kilometers away that the specialist on the screen can do as good a job or even better than if he is holding your hands directly. How do you excite every individual doctor to evangelise telehealth? This will happen only when his/her patient is convinced that telehealth is as good or better than a face to face consultation 5G, bandwidth of 100 Mbps, a 55” hi -resolution screen, a future ready voice activated EMR where images uploaded with ease at the remote end can be digitally manipulated by the consultant, playing videos, a wide choice of highly secured payment gateways etc etc – the list can be never ending. All this hi-tech no doubt will help, but are we not missing the wood for the trees?

What does a patient using telemedicine even today really want? They want Tender Loving Care (TLC). “Listen, listen, listen, he is telling you the diagnosis” said Sir William Osler 150 years ago. When I give a teleconsult I still listen! Patients do not care how much you know. They want to know how much you care. Healthcare is personal — it is very hard to feel your experience was excellent, when those treating you don’t introduce themselves, or make eye contact, or say what they are doing to you and why. The doctor’s body language says it all. No Artificial Intelligence (AI), no technology will ever substitute for a doctor who empathises, sympathises with his far away patient, wiping the patient's tears albeit virtually.

Alas the powers that be, including teleconsultants, forget that providing remote healthcare is not like selling / buying a pizza online or booking a train ticket. Technology in healthcare should only be a tool, a means to achieve an end, not an end by itself. Technology helps in producing remarkable solutions. Sometimes after this we go in search of problems! Lars Leksell the inventor of the Gamma Knife famously remarked half a century ago, “ A fool with a tool, is still a fool”. I belong to the BC era – not before covid but, before computers. Yes, I am a technology buff. I even brought out a special edition for the journal Neurology India on “Extra Terrestrial Neurosciences”- the ultimate in technology. Over the last 21 years when I first started telemedicine, it has been my privilege to see the radical transformation and the exponential growth of remote care. I am optimistic that soon telehealth will be centre-stage in the core of the healthcare delivery system. This phenomenal growth is no doubt a direct byproduct of technological advances. An app a day may keep the doctor far far away, but I would still like my tech savvy doctor to be commiserating, to understand what I want so that he will prescribe the right apps for me. 'Customer delight’ is the only way that telehealth will truly come centre-stage and be integrated into the core of the healthcare delivery system. Worldwide remote healthcare is driven by technologists, software/hardware entrepreneurs, communication engineers, mobile network operators, CEO’s of startups. Manufacturers of peripheral medical devices, wearables etc . During the last 21 years 95 per cent of the numerous talks I have given have been organised by the telemedicine ecosystem! Medical colleges, medical associations, clinical societies do not include telehealth in any CME programme. It is extremely unusual to find a clinician giving up a medical or surgical career to embrace telehealth.

The clinician should be the first among equals if patients are to get excited about telehealth and take the initiative requesting his/her doctor to appear on the screen. Circumstances and necessity will make doctors understand that this tool for connecting, ensuring a continuum of care will no longer be a choice but will become the writing is on the wall!

--Issue 52--