A

Project report
on
Social-Relevance
A STUDY ON TELEHEALTH IN HELTHCARE FACILITIES INDUSTRY OF
INDIA
A Project Submitted to University of Mumbai
In Partial Fulfilment of Semester IV
For the award of
Master of Management Studies
In
Systems
By

Ms. Bhakti Harishchandra Patil

Roll. No: 2021-2023

Under the Guidance of
Prof. Shalu Maheshwari

ROHIDAS PATIL INSTITUTE OF MANAGEMENT STUDIES

(Affiliated to University of Mumbai, Approved by AICTE, New Delhi)

May, 2023

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 Shree Shankar Narayan Educational Trust

Rohidas Patil Institute of Management Studies

(Affiliated to University of Mumbai, Approved by AICTE, New Delhi)
Mahavidhyalaya Marg, Navghar Road, Bhayandar East, Thane – 401105.

CERTIFICATE

This is to certify that Mr. / Ms. Bhakti Harishchandra Patil is a bonafide student of our Institute and
the dissertation entitled A STUDY ON TELEHEALTH IN HELTHCARE FACILITIES
INDUSTRY OF INDA.
submitted by him / her is in partial fulfilment of the semester IV for the Degree of MASTER OF
MANAGEMENT STUDIES IN SYSTEMS by the University of Mumbai during the Academic Year
2022-23.

Place: Bhayandar, Thane Dr. Bhupesh V. Rane

Date: Director
Rohidas Patil Institute of Management Studies

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 GUIDE’S CERTIFICATE

This is to certify that the Dissertation entitled A STUDY ON TELEHEALTH IN HEALTHCARE

FACILITIES INDUSTRY OF INDIA is a bonafide record of independent research work done by Mr.

/ Ms .Bhakti Harishchandra Patil, Roll. No. 2021-2023- under my supervision during Academic year

22-23, submitted to the University of Mumbai in partial fulfilment of Semester IV for the Degree of

MASTER OF MANAGEMENT STUDIES IN SYSTEM.

Place: Bhayandar, Thane. _____________________

Date : Prof. Shalu Maheshwari

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 DECLARATION

I Ms Bhakti Harishchandra Patil hereby declare that the dissertation A STUDY ON

TELEHEALTH IN HEALTHCARE INDUSTRY OF INDIA submitted to the University of

Mumbai in partial fulfilment of the semester IV for the Degree of MASTER OF MANAGEMENT

STUDIES IN SYSTEM. is an original work and that the dissertation has not previously formed the

basis for the award of any other degree, Diploma, Associate ship, Fellowship or other title.

Place: Bhayandar, Thane _____________________

Date: BHAKTI PATIL

iv
 EVALUATION OF DISSERTATION

1. Name of the Candidate : Bhakti Harishchandra Patil

2. Registration / Seat Number : 2021059 /

3. Name / Code of the subject : Social -Relevance

4. Title of the Dissertation : A Study on Telehealth in Healthcare Industry Facilities of India

5. Evaluation:

Parameters Maximum Marks

Sr. No.
Marks Awarded
1 Situation analysis and Problem definition 10

2 Literature Review (secondary data) 10

3 Methodology of study 20

4 Data Analysis (Primary and Secondary data) 20

5 Conclusions and recommendations 15

6 Guide’s assessment of project progress 10

7 Viva Voce 15

Total 100

6. Name & Address of the Evaluator:

7. Signature of Evaluator with Date:

8. Signature of the Head of the Institution with seal:

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 ACKNOWLEDGEMENT

Apart from my efforts, the success of any project depends largely on the encouragement and guidelines
of many others. I take this opportunity to express my gratitude to the people who have been
instrumental in the successful completion of this project.

I would thank the Management of the Institute for providing valuable resources viz. Library, Computers
with Internet facility which is an essential pre-requisite in the successful completion of the project.

I would like to show my greatest appreciation to Prof. Shalu Maheshwari, I can’t thank enough
for his/her tremendous support and help. I feel motivated and encouraged to execute my project under
his/her mentorship. Without his/her guidance this project would not have materialized.

The support received from all the respondents was vital for the success of the project. I am grateful for
their time and efforts. Last but not least, I wish to thank my parents Harishchandra (Father) and
Archana (Mother) for their continuous motivation.

EXECUTIVE SUMMARY
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Telemedicine is the use of information communication technology platform to provide clinical health
care for patients located at a distance place. This technique helps to avoid distance barriers and helps to
access medical services for people living in distant rural areas. Telecommunication saves life in critical
and emergency situations. This article focuses to analyse the best practices and challenges faced at
Apollo Hospitals by introducing telemedicine in the Indian setting. In 1997, the Apollo Group Hospital
decided to extend their services to suburban and rural India using telemedicine. Now the Apollo
hospitals have 10,000 beds, 44 hospitals, and 4,000 consultants in 50 specialties, considered as one of
the largest healthcare provider in Asia. They have the largest multispecialty telemedicine network in
South Asia. Apollo Telemedicine Networking Foundation (ATNF) was developed. The success of
ATNF boosted other hospitals to join the bandwagon and made telemedicine in India a reality. Patients
from a distance of 120 to 4,500 miles are treated under telemedicine. The successful services from 2000
to 2001 by Apollo, has made the Indian Space Research Organization (ISRO) to realize telemedicine as
one of the thrust area. The significant role played by ATNF in the growth and development of
telemedicine is analyzed.

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 INDEX

SR NO TOPIC PAGE NO

CHAPTER NO 1: INTRODUCTION

1.1 Introduction 1

1.2 Statement of problem 12

1.3 Objectives of the study 14

CHAPTER NO 2 :REVIEW OF LITERATURE

2.1 Review of literature 15

CHAPTER NO 3 :INTRODUCTION OF THE TOPIC

3.1 Introduction 30

3.2 Vision 32

3.3 Mission 34

3.4 Pros 36

3.5 Cons 37

3.6 History 39

CHAPTER NO 4 : RESEARCH METHODOLOGY

4.1 Scope of the study 44

4.2 Significance of the study 56

4.3 Limitations of the study 57

4.4 Data collection 58

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 CHAPTER NO 5 : DATA COLLECTION AND ANALYSIS

5.1 Gap analysis 61

5.1 Data interpretation 65

CHAPTER NO 6 : FINDING. SUGGESTION AND CONCLUSION

6.1 Summary 74

6.2 Suggestion 75

6.3 Conclusion 76

BIBLIOGRAPHY 78

WEBLIOGRAPIIY 79

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INTRODUCTION
WHAT IS TELEHELTH
Telehealth is the use of communication technologies, such as video
conferencing or phone calls, to remotely provide healthcare services and
health-related information. It allows healthcare providers to consult with their
patients without being in the same physical location, which is particularly
useful for patients who are unable to travel to a healthcare facility or live in
remote areas.
Telehealth services can include virtual consultations, remote monitoring, and
online health education and resources. It has become increasingly popular due
to its convenience, cost-effectiveness, and ability to improve access to
healthcare. Telehealth is the use of digital information and communication
technologies to access health care services remotely and manage your health
care.
Telehealth can also be technology that your health care provider uses to
improve or support health care services. Offer primary care for many
conditions.

Telehealth helps ensure patients receive the right care at the right time.
Telehealth connects patients to vital health care services through
videoconferencing, remote monitoring, electronic consults and wireless

1
communications. By increasing access to physicians and specialists, telehealth
helps ensure patients receive the right care, at the right place, at the right time.
Almost every state Medicaid program has some form of coverage for telehealth
services, and private payers are embracing coverage for many telehealth
services.
Medicare generally still limits coverage and payment for many telehealth
services, lagging In addition, limited access to adequate broadband services
hampers the ability of some rural facilities to deploy telehealth. The federal
government needs to do more to increase the use of telehealth. State
policymakers are increasingly focusing their attention on telehealth.
Today, 35 states and the District of Columbia have enacted "parity" laws,
which generally require health insurers to cover services provided via
telehealth the same way they would reimburse for services provided in person.
States vary on payment parity.

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 Medicare reimbursement for telehealth services does not provide adequate
compensation to all sites of care. Telehealth helps increase health care value
and affordability. Limited Medicare coverage impedes the expansion of
telehealth services.
Current statute restricts most telehealth services to patients located in rural
areas and in specific settings (such as a hospital or physician office), covers
only a limited number of services, and
allows only real-time, two-way video conference capabilities, with limited
exceptions, such as telestroke.
Changes needed include: widespread elimination of geographic and setting
locations requirements so patients outside of rural areas can benefit from
telehealth; expanding the types of technology that can be used, including
remote monitoring; and covering all services that are safe to provide, rather
than a small list of approved services.
Research and experience under the Medicare program suggest that
policymakers' concerns about increased access to telehealth leading to
increased spending may be overstated, particularly when weighed against the
potential benefits in quality, patient experience and efficiency.
The FCC's Rural Health Care Program supports broadband adoption, but it is
administratively burdensome and provides an insufficient level of subsidy for
remote health care providers.

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 TYPES OF TELEHELATH
1. LIVE VIDEO
2. STORE AND FORWORD
3. REMOTE PATIENT MONITORING
4. MOBILE HEALTH

1. LIVE VIDEO:

This type of service is also referred to as "real-time" and may serve as a

substitute for an in-person encounter when it is not available.
Live video telehealth is a lifesaving technology that can be used for
consultative, diagnostic, and treatment services. Video devices can include
video conferencing units, peripheral cameras, video scopes, or web cameras.
Video conferencing has historically been the most common application of
telemedicine/telehealth care, and is an effective health care and consultation
tool for a variety of applications. Remote ICU monitoring programs at
hospitals provide 24-hour backup, supervision, and support to ICU medical
staffs by utilizing a combination of real-time video to observe patients,
interactive video communications with on-site ICU providers, and digital

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 patient monitoring equipment. Primary care providers can consult with medical
specialists who are not available locally, and medical specialists can examine
patients in remote locations when distance is a barrier. Psychiatric consults can
effectively be provided through live video for individuals who do not have
local access, or who may otherwise be reluctant to keep appointments in-
person at a psychiatric provider's office. Language translators can provide
video interpretation services to multiple locations, and health care professionals
can conduct continuing education programs with attendees in multiple
locations. Patients can use these technologies to take disease management
courses or receive other important health information.

2. STORE AND FORWORD :

Electronic medical information is used to evaluate cases and render services

outside of a real-time or live interaction.
use store-and-forward services to provide access to data and reduce wait times
for specialty care. These technologies are most commonly used in radiology,
pathology, dermatology, and ophthalmology, where physicians can forward X-
rays or MRI's to specialists at major medical centers for review. Electronic
consultations (eConsults) are also commonly used, where a primary care
physician (PCP) and a specialist can securely share health information and
discuss patient care. This physician-to-physician eConsult reduces the need for
unnecessary specialty referrals as patient's needs are resolved through the PCP.

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3. REMOTE PATIENT MONITORING:

Telehealth is the collection of personal health and medical data from an

individual in one location to a provider in a different location for use in care
and related support. Monitoring programs can collect a wide range of health
data from the point of care, such as vital signs, weight, blood pressure, blood
sugar, blood oxygen levels, heart rate, and electrocardiograms. Remote
physiologic monitoring (RPM) provides reimbursement for remote physiologic
monitoring, which is distinct to specific reimbursement service codes and does
not fall under the telehealth label in the Medicare program. More detailed
information on the benefits of RPM and care for the aging population can be
obtained from the Center on Technology and Aging and The Oregon Center for
Aging and Technology.

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4. MOBILE HEALTH:

Health is a rapidly evolving aspect of technology-enabled health care that

involves the use of mobile communication devices such as cell phones, tablet
computers, and PDAs. Applications can range from targeted text messages to
wide-scale alerts about disease outbreaks. The Food and Drug Administration
(FDA), the Federal Trade Commission (FTC), the Federal Communication
Commission (FCC), and the Department of Health and Human Services (HHS)
all have jurisdiction oversight in this area. This factsheet from the National
Consortium of Telehealth Resource Centers outlines some basic information
regarding mobile health and FDA regulation.

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 WHAT ARE THE DIFFERENT TYPE OF HEALTHCARE INDUSTRY
IN INDIA
 Hospitals
Virtual Hospital is a traditional healthcare referral system that connects villages
in the developing world with their main county hospitals and hospitals in the
West using Telemedicine.
The patient's medical information is collected by e-clinics in rural third world
communities and sent to a general medical practitioner based at the Virtual
Hospital
The GP provides a diagnosis or refers the patient to the relevant Virtual
Hospital Department where specialist consultants across the world are linked
together through the Internet.
Virtual Hospital uses ICTs to overcome geographical barriers and increase
access to healthcare services, particularly for rural and underserved
communities in developing countries.

 Medical devices
Medical devices in telehealth are electronic devices that allow patients to
monitor their health conditions and transmit data to healthcare providers in
remote locations. These devices can include blood pressure monitors, glucose
meters, pulse oximeters, wearable fitness trackers, and more. They are
becoming increasingly important in the wake of the Coved 19 pandemic, as
more patients are seeking remote healthcare services.
Medical devices can help patients better manage their health conditions by
providing real-time feedback and customized health recommendations.
They are an integral part of telehealth, enabling patients and healthcare
providers to remotely monitor and manage health conditions, improve
outcomes, and reduce healthcare costs.
 Clinical trials
Telehealth can improve clinical trials by enabling remote monitoring, data
collection, and patient engagement. It can track patients' health status more

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 efficiently, make scheduled virtual visits with healthcare providers, and provide
reminders for assessments, appointments, and medication schedules. Telehealth
can also reduce the burden of traveling and missing work or school, and
increase the chances of successful outcomes.
 Telemedicine
Telemedicine is the delivery of remote medical care and services using
telecommunication technologies such as video conferencing, messaging, and
remote monitoring. It has significant benefits for both patients and healthcare
providers, such as providing more convenient, accessible, and affordable
medical care, increasing continuity of care, reducing the spread of infectious
diseases, improving quality of care, enhancing the patient experience, and
reducing the stigma associated with traditional in-person care. Telemedicine
has the potential to revolutionize healthcare by enhancing access to medical
care, improving patient outcomes, and reducing costs.
 Medical tourism
Medical tourism is the act of traveling to a foreign country to receive medical
treatment or care. It has become increasingly popular in recent years as patients
seek more affordable and accessible treatment options, and is expected to grow
in the coming years. It has both potential benefits and risks, and it is important
for patients to understand the potential risks and make informed decisions
about their medical care. Medical tourism can also benefit the economy of the
host country, as it generates revenue through the use of local businesses and
services. However, it does have potential risks and challenges, such as
language barriers, cultural differences, varying healthcare standards and
regulations, and ethical concerns such as exploitation of patients or lack of
informed consent.

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Health insurance
Health insurance is a type of insurance that covers the cost of medical expenses
and healthcare services for individuals. It can provide significant benefits, such
as financial protection against unexpected medical expenses, improved access
to healthcare services, and prevention and management of chronic health
conditions. However, it can also have challenges and limitations, such as high
deductibles and copays, limited coverage for certain medical services or
providers, and restrictions on coverage for pre-existing conditions. To ensure
adequate coverage and protection, individuals should carefully research and
select a plan that best meets their needs and budget.

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 Medical equipment
Medical equipment is used by healthcare professionals to diagnose, monitor,
treat, and manage various medical conditions. It can range from simple tools
such as stethoscopes and thermometers to complex machines such as MRI
scanners and robotic surgical systems. It can be used in a variety of healthcare
settings, including hospitals, clinics, laboratories, and home healthcare. Proper
use and maintenance of medical equipment are essential to ensure its safety and
effectiveness, and healthcare professionals must receive proper training in the
use of medical equipment and adhere to established protocols for maintenance,
calibration, and replacement. Advances in technology have made medical
equipment more accessible and affordable, making it easier for patients to
access the care they need.

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TOOLS OF TELEHELTHCARE
Telemedicine
Telemedicine is the practice of providing healthcare services to patients using
telecommunication technology. It involves the use of audio, video, and other
digital communication tools to connect healthcare providers with patients who
are not physically present in the same location. It has become increasingly
popular in recent years due to its ability to overcome physical barriers, reduce
healthcare costs, and increase access to care for patients in remote or
underserved areas.
Telemedicine can be delivered in several ways, such as video conferencing,
telephone consultations, messaging and email services, remote patient
monitoring, and mobile health applications. It has several benefits, such as
increased access to healthcare, reduced healthcare costs, improved patient
outcomes, and reduced the burden on healthcare facilities and providers.
However, it also has some limitations, such as technical difficulties, privacy
concerns, and the inability to provide some types of physical exams and
procedures. It is essential to ensure that telemedicine services adhere to the
same standards of care as traditional in-person medical visits, and that both
patients and healthcare providers are properly trained in the use of the
technology.
Electronic health record
An electronic health record (EHR) is a systematized collection of patient and
population electronically stored health information in a digital format. It can be
shared across different health care settings and may include a range of data,
such as demographics, medical history, medication and allergies, immunization
status, laboratory test results, radiology images, vital signs, personal statistics
like age and weight, and billing information. EHRs have been touted as key to
increasing quality care and are used for other reasons than charting for patients.
They are designed to store data accurately and to capture the state of a patient
across time, and are more effective when extracting medical data for the
examination of possible trends and long term changes in a patient. Population-

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based studies of medical records may also be facilitated by the widespread
adoption of EHRs and EMRs. The terms EHR, electronic patient record (EPR)
and EMR have often been used interchangeably, but differences between the
models are now being defined. The EHR is a longitudinal collection of
electronic health information
Patient Portal
Patient portals are healthcare-related online applications that allow patients to
interact and communicate with their healthcare providers. They are available
on the Internet at all hours of the day and night, and can interface with EMRs
and communicate through the Continuity of Care Record standard.
Remote patient monitoring
Telehealth is the distribution of health-related services and information via
electronic information and telecommunication technologies, allowing long-
distance patient and clinician contact, care, advice, reminders, education,
intervention, monitoring, and remote admissions. It can include two clinicians
discussing a case over video conference, robotic surgery occurring through
remote access, physical therapy done via digital monitoring instruments, live
feed and application combinations, tests being forwarded between facilities for
interpretation, home monitoring through continuous sending of patient health
data, client to practitioner online conference, or videophone interpretation
during a consult.

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 Objective

 To study on explore the potential of telehealth technology in improving public

health outcomes, such as disease surveillance and outbreak management.
 To assess the readiness of healthcare facilities in India for telehealth adoption,
including infrastructure, technology, and workforce training needs.
 To investigate the potential impact of telehealth on healthcare disparities and
social determinants of health, and to identify strategies to address them.
 To study on assess the effectiveness of telehealth in improving patient
outcomes, such as reducing hospital readmissions and improving chronic
disease management.
 To study on patient and healthcare provider perceptions of telehealth.

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 Review of Literature
1. Effects and Effectiveness of Telemedicine. Jim Grigsby , Margaret M
Kaehny(1995)
To be covered by Medicare HCFA's policy of not paying physicians for
services provided using the telephone has complicated the establishment of
policy for telemedicine, as it is unclear how the use of the telephone differs
from other telecommunications technologies for the same purpose. This policy
is intended to contain expenditures and prevent over-use.
Teleradiology is the most commonly used and studied application of
telemedicine, with radiologists rarely having face-to-face contact with their
patients. There are no separate procedure codes for teleradiology, and some
diagnostic services are reimbursed by most payers.
2. Vinoth G. Chellaiyan, Nirupama A. Y.1, Neha Taneja (2019)
Telemedicine has become increasingly popular in recent decades due to
advances in wireless broadband technology, cell phone and internet use, patient
education, transfer of medical images, and real-time audio and video
consultations. Improvements in internet infrastructure have made e-health and
telemedicine stress-free and cost effective. Telemedicine uses existing
computing devices belonging to the patient or physician and inexpensive, self-
owned equipment like smartphone cameras, wearable biosensors, etc. It
reduces travel expenses, saves time, reduces medical costs, provides easier
access for the common man to specialist doctors without disrupting their daily
responsibilities, and makes the life of healthcare providers easy by decreasing
the load of missed appointments and cancellations, increasing revenue and
patient load, and improving follow up and health outcomes. The doctor to
patient ratio in India is low due to the time consuming and expensive training
of new physicians. To address this deficit, the Ministry of Health and Family
Welfare and the Department of Information Technology have set up
telemedicine services in various parts of the country. This includes a National
Telemedicine Portal, National Medical College Network, National Rural
Telemedicine Network, National Digital Health Authority of India National e-

15
 health authority and the National Rural AYUSH Telemedicine Network.
MoHFW has developed a set of Electronic Health Records (EHR) standards to
ensure safe data transmission during telemedicine practices. The National
Rural AYUSH Telemedicine Network aims to promote the benefit.
3. The future of medical practice October 2020, Nishith Desai
Telemedicine has the potential to increase access to quality healthcare for all
Indians. According to a study conducted by the WHO, 59.2% of all health
workers are located in urban areas and 40.8% in rural areas. Telemedicine can
help smooth over these inequalities by allowing doctors in urban areas to
consult the rural population, including providing specialized care as necessary.
The COVID-19 pandemic has highlighted the importance of telemedicine, as
hospitals have been overwhelmed with COVID-19 patients and have not been
able to make space for non-emergency consultations. Telemedicine is also an
effective way of treating minor cases of COVID-19 where hospitalization is not
required. This paper outlines the legal and regulatory framework regulating
telemedicine and provides inputs on how the space is evolving. It focuses
exclusively on the practice of telemedicine by allopathic practitioners and does
not deal with the regulations applicable to practitioners of traditional medicine
such as Ayurveda, Homoeopathy, Unani and Siddha forms of medicine.
4. Telehealth benefits and challenges during COVID-19 pandemic in India
Eslavath Rajkumar,Aswathy Gopi, Aditi Joshi,Prachi Kulkarni (jolly
2023)
Technology illiteracy among citizens is a challenge to implementing a
telehealth system, with patients relying on their children to operate devices.
Telehealth lacks physical examination, limited patient-provider relationship,
and suboptimal verbal communication and discussion. Lack of physical
examination is suitable for new patients, but not for follow-up care. Lack of
physical examination may not be suitable for follow-up care.
Data security and privacy are major challenges to telehealth, with patient-
provider apprehension about data confidentiality. Mobile health application
developers must take precautions to ensure privacy and security. Adhikari et al.

16
 reported that data safety of patients is the main limitation of using mobile-
based applications.
Telehealth is a feasible tool for delivering health services with high patient-
provider satisfaction, with benefits such as cost-efectiveness, easy accessibility,
new and follow-up care, and instant medical advice. Findings highlight the role
of telehealth in bridging the rural-urban healthcare divide.
5. Telemedicine during COVID‑19 in India—a new policy and its challenges
Sambit Dash, Ramasamy Aarthy, and Viswanathan Mohan.(19 may 2021)
The American Medical Association has encouraged its undergraduate and
postgraduate accrediting bodies to include core competencies for telemedicine
in their programs. India should act similarly to broaden the scope of
telemedicine in the country. The Telemedicine Society of India has been
working to emphasize the importance of telemedicine, update information
periodically, and sponsor training conferences for medical and non-medical
professionals. It also publishes a newsletter highlighting advances in and
applications of telemedicine in India.
The Board of Governors of the Medical Council of India (MCI) has issued
guidelines for the practice of telemedicine, but they lack clarity about privacy
and data usage. They require doctors to maintain records of all exchanges of
communication between themselves and patients, and do not specify duration
for storing data nor limits to further use of that data. MoHFW should revise the
guidelines to address the weaknesses and establish an ongoing system of
evaluation to make them more comprehensive.
6. Telemedicine and virtual care are being used to respond to the COVID-19
pandemic. Bokolo Anthony Jnr(15 June 2020)
This study employed a search strategy to identify studies relevant to provide
answers to the research questions. The search strategy was conducted based on
the search term and data resources to be researched, using keywords strings
with Boolean operators (OR/AND) utilized in the search terms. The relevant
studies were retrieved from well-recognized scientific databases and digital
libraries, such as PubMed, Google scholar, Scopus, Web of science,

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 ScienceDirect, ProQuest, Emerald, Taylor & Francis, Inderscience, Springer,
Sage, ACM, Wiley, and IEEE Xplore. The search results retrieved 87 articles
using the above mentioned keywords, with nine papers found as duplicates and
were removed. The remaining papers were assessed against the inclusion and
exclusion (see Table 1), and quality assessment criteria (see Sect. 2.3). 31
articles were found to meet the criteria, with 4 papers added based on
snowballing technique from cross referencing and a total of 35 papers were
included.
7. Telehealth and COVID-19 Pandemic: An Overview of theTelehealth Use,
Advantages, Challenges, and Opportunitiesduring COVID-19 Pandemic,
Khayreddine Bouabida, Bertrand Lebouché(16 November 2022)
Telehealth is the combined use of the internet and information technology for
clinical and organizational purposes, both locally and remotely. It includes
telemedicine, telecare, tele-expertise, teleconsultation, and
telemonitoring/remote monitoring. The WHO has considered m-health as a
priority in the fight against health inequalities and access to care, particularly in
developing nations. Telehealth models and technologies for delivering
healthcare remotely existed prior to the COVID-19 pandemic, and the idea of
telehealth dates back more than a century. In 1878, ABM advocated using the
telephone to illustrate and examine the sound produced by muscles during
contraction.
Telehealth‟s application to deliver medical expertise to areas lacking access to
treatment began in the 1960s at Massachusetts General Hospital, delivering
care to 1000 patients. In March 2020, telehealth was at the forefront of and was
a critical method for offering care services.
8. Telehealth at scale can improve chronic diseasemanagement in the
community during a pandemic: Anexperience at the time of COVID-19
Stefano Omboni , Tommaso Ballatore ,(29 September 2021)
The TEMPLAR Project was an observational, cross-sectional, retrospective,
multicenter study involving community pharmacies and general practitioners
distributed over the whole Italian territory. The study was registered with

18
 ClinicalTrials.gov at number NCT03781401 and with the Registry of Patient
Registries (RoPR) at number 41818. Two different sets of data were considered
for this analysis: individuals referred to local pharmacies or general
practitioners‟ offices for specific professional diagnostic tests through a
telehealth platform and patients monitoring various parameters at home
through a smartphone app connected to the same telehealth platform. Data was
collected between December 31, 2019 and July 26, 2020. The study was
conducted according to the principles of the Declaration of Helsinki and
informed consent was obtained electronically by the pharmacist from each
individual to use subjects‟ pseudo-anonymized data for aggregated analysis.
The pharmacist was previously appointed data processor by the controller and
was authorized to collect patient‟s sensitive data for the purpose of obtaining
the ABPM. The tests were performed as part of routine clinical practice and not
in the context of a research study. The telehealth platform used in this study
allows monitoring patients‟ health status either in a professional or home
setting, providing medical counseling and teleconsultations to final users.
Diagnostic tests are obtained through various clinically validated and certified
medical devices that enable collecting specific vital and non-vital parameters.
Data is transferred to the server host through the Internet and analyzed by the
core software using specific, clinically validated, and certified algorithms. In
the case of professional tests, an automatic test report is generated and then
checked, verified, and signed by a physician. In the case of data collected at
home, the mobile app provides immediate feedback to the user about the
parameter‟s critical level. All these data are also made available on the web
portal, where they can be viewed by an authorized physician who can provide a
medical opinion.
9. The AMA's 2021 physician survey gathered insights on telehealth use and
trends to inform research, advocacy and practice sustainability. Mercedes-
Benz(2021)
In 2020, the COVID-19 Healthcare Coalition conducted a survey highlighting
the wide expansion of telehealth services in many specialty areas. The AMA

19
 recently fielded a follow-up survey of physician experiences with telehealth,
gathered insights on current and expected future use. Of the 2,232 physician
respondents, 85% indicated they currently use telehealth. Of those using
telehealth, 93% are conducting live, interactive video visits with patients and
69% are conducting audio-only visits. 8% of respondents were using remote
patient monitoring technologies with patients in their homes. 76% report data is
usually shared manually.
10. A Prioritization Model for Emergency Telepsychiatry Service Evaluation
and Selection
Jacqueline Sandling BA, Kathleen Carrothers MS(February 2023)
The most important details in this text are the efforts by individual institutions
to leverage telepsychiatry within the ED to decrease psychiatric patients‟ long
lengths of stay (LOS). Two nationally representative surveys found that one in
five EDs used telepsychiatry instead of an in-person psychiatrist. Advances in
technology have incorporated interactive synchronous videoconferencing into
telemedicine, allowing it to be a critical tool in the delivery of mental health
care. However, there is a scarcity of literature proposing an actionable,
reproducible method for selecting a telepsychiatry service partner based on
institutional priorities. Additionally, only a portion of the existing literature
addresses the financial costs associated with psychiatric coverage. The intent is
for the generated framework‟s results to guide hospitals‟ decisions on how to
implement a new ED psychiatric coverage service, and so far, it has been
successful in the case of one community hospital in California.
11. Care, health, and dignity are essential for successful telehealth delivery.
Nicol Turner Lee,Niam Yaraghi (July 2022)
The White House and Congress acted quickly to transition patients to telehealth
during the COVID-19 pandemic. However, the future adoption and use of
telehealth will depend on how the U.S. healthcare system addresses coverage
and reimbursement, medical licensure, and service modalities. Policy
coherence, or a “telehealth 2.0 roadmap”, is essential to harmonize the goals of
value-based care, health disparities, and digital access. This paper proposes

20
 flexibilities within the current health care system to accommodate the changes
imposed by new technologies, as well as continued government incentives to
drive more competitive options and alternatives for health care delivery.
Government must continue to promote the use of remote health care and
leverage national investments in broadband infrastructure to drive the
complementary use of telehealth with traditional health care. Finally, telehealth
must be positioned and implemented in coordination with value-based
payments to ensure patient access to meaningful care.
12. Opportunities and challenges for telehealth within, and beyond, a
pandemic Ann Blandford, Janet Wesson, René Amalberti, Raed AlHazme
(August 10, 2020)
The pandemic has forced individuals and health-care systems to review what is
possible and desirable and adapt models of care to the rapidly evolving
situation. Many countries have seen a shift towards telephone and video
consultations, while some hospitals have introduced robots and tablet
computers to facilitate physical distancing while monitoring and
communicating with patients. For individuals, the pandemic has led to
improved computer literacy and access to technology to facilitate physical
distancing. Technologies to support telehealth include wearable devices, smart
phones, and instrumented (smart) homes. These devices can monitor patient
health and send messages to responsible clinicians when emergency situations
are detected. The cost of these devices is falling, and an almost unlimited
amount of data can now be stored and analysed.
13. Telehealth nursing research: adding to the evidence-base for healthcare
Claudia c Bartz PhD rn(2020)
This paper is a critical analysis of nurse-led intervention research, systematic
reviews and meta-analyses, and a brief discussion of descriptive research
papers found during the study period. Literature searches in 2016, 2017 and
early 2018 found nurse-led research publications with predominantly
descriptive designs that covered telehealth nursing, clinical practice, education
and research. Of 51 papers identified in 2017 plus first quarter 2018, 38 used

21
 descriptive designs and 5 described technology (apps) evaluations. Eight
papers used quasi-experimental designs, resulting in some evidence for
practice. The purpose of this paper is to discuss nurse-led telehealth research
from 2018 through first quarter 2019, organising the papers by design:
intervention research, systematic reviews and meta-analyses, and descriptive
designs. The greatest emphasis will be on intervention research.
Further, the terms and keywords used in telehealth articles vary a great deal,
e.g., tele-(specialty), eHealth, mHealth, mobile health, digital health, artificial
intelligence. And, databases that use automatic term mapping make searches
more difficult as the search terms are identified wherever they are in the article,
making a more detailed manual search necessary after all.
14. COVID-19 and the Future of UK Telemedicine and eHealth Albert
Einstein,Peter Gayo Munthal (February 17, 2023)
Telemedicine is convenient and empowering for patients, as it can be instant
through video/teleconferencing or asynchronous. Patients can be monitored
passively using sensors or actively by uploading their own data or pushing on
data to the healthcare worker. There is now evidence to support the use of
telemedicine in many chronic conditions, as patients are in their own
environment and in charge of their lives, avoiding common hospital risks such
as hospital acquired infection and physical and mental deterioration.
The Future of Telemedicine in the NHS is being driven from top down by the
government in the form of virtual wards backed by new government funding.
In July 2022, the NHS waiting list had grown to 7 million, putting immense
pressure on all NHS providers. To address this, all NHS providers are eager to
implement virtual wards, where "inpatients" with several designated conditions
will be managed in their own homes and patients will participate in the
management of their conditions.
15. War and its Serious Unforeseen Effects on Health and Humanitarian
Action Abdulfattah Mohammad Al-Mahdi (March 14, 2023)
The war in Yemen has had a major impact on the health of vulnerable and
marginalized groups of children and women, as well as those with limited

22
 income. This has led to the spread of diseases and epidemics in large numbers.
The Ministry of Public Health alone is not concerned with all of this, as there
are other influential players in health work and its outputs. Targeting water and
sewage tanks and hitting the infrastructure had a major role in the spread of
cholera in 2016-2018 in Yemen. The absence of the government water project,
which requires the presence of diesel and its derivatives to operate the pumps
and the water purification plant, has affected the exacerbation of the problem.
To stop the spread of cholera, the process of providing chlorine for
chlorination, carrying out awareness and health education campaigns, opening
treatment centers and units, and sanitary isolation procedures was necessary.
The lack of awareness of the importance of cleaning and washing vegetables
before eating them was important in reducing disease and using safe and clean
water for drinking. Sectoral coordination between all partners from government
ministries and partners in human development was also important to limit the
epidemic. Humanitarian action must be fast and effective and does not accept
procrastination or delay, as it is the most important thing in life, which is the
human lives that were destined for survival and life.
16. CPR Training with Augmented Reality with Smart Glasses: A New
Reality Aranda-García( January 05, 2023)
A CPR training modality with augmented reality is through video calls with
smart glasses. The student wears the wearable (smart glasses) that are
connected via WIFI with the trainer, and the trainer and the student are
telecommunicated by audio and video in real time through the smart glasses.
The trainer can also have the student visualize additional graphic information
on the lens of the smart glasses, such as images, gifs, or videos on victim
assessment or resuscitation skills. This type of CPR training with augmented
reality has the additional advantage of not needing to hold the device while
using it, allowing the student to practice the different skills necessary to
perform in cardiorespiratory arrest. In remote locations where basic life support
training is difficult to reach, this teletraining through video calls with smart
glasses could help bystanders to access learning for care in cardiorespiratory

23
 arrest. Therefore, basic life support training through augmented reality with a
video call with smart glasses is a methodology to be taken into consideration
due to its potential in learning the knowledge and skills necessary to act in the
event of cardiorespiratory arrest.
17. Machine Learning and Big Data in Remote Health Care . Spiridon
Likothanassis (October 26, 2022)
Machine Learning (ML) has been used for many applications to real world
problems, such as Big Data Mining. Healthcare is one of the fastest growing
data segments of the digital world, with healthcare data increasing at a rate of
about 50% per year. There are three primary sources of big data in healthcare:
providers and payers, omic data, and patients and non-providers. Big data in
oncology and other severe diseases can provide unprecedented opportunities to
explore the biopsychosocial characteristics of these diseases and for descriptive
observation, hypothesis generation, and prediction. The results of big data
analysis can be incorporated into standards and guidelines and will directly
impact clinical decision making. Oncologists and professionals from related
medical fields can increasingly evaluate the results from research studies and
commercial analytical products that are based on big data, using ML
techniques. The use of PROMs and PREMs in oncology practice has the
potential to improve clinicians‟ understanding of the effect of disease and
treatment on patients‟ daily lives, and has the potential to narrow the gap
between clinical reality and the patient world. PROMs and PREMs provide a
patient-focused, clinically relevant, and reliable perspective on the patient
symptom experience. The scientific evidence supporting the use of PROMs and
PREMs is ever increasing and has revealed a variety of benefits for patients
and health care professionals. Additionally, using PROMs and PREMs in
everyday practice can improve clinicians‟ understanding of the effect of
disease and treatment on patients‟ daily lives, and has the potential to narrow
the gap between clinical reality and the patient world.

24
18. GPs, Patients and Health Data Commercialisation in England .Malcolm
Fisk,( September 12, 2022)
This communication does not challenge the benefits of AI in healthcare, such
as the identification of skin cancers based on image analyses. However, there
remain questions about the robustness and representativeness of the data that
are utilised for the patient populations or groups for whom better treatment
outcomes are sought. It is in focus on the matter of data sharing and the
commercial „market‟ for those data, which is a matter of concern to GPs due to
their moral responsibility for its safeguarding. The lack of explicability of
machine learning has been highlighted, with Verdiccio affirming that if doctors
do not understand why the algorithm made a diagnosis, why should patients
trust the recommended course of treatment?
19. Machine Learning and Big Data in Remote Health Care. Spiridon
Likothanassis,( October 26, 2022)
Machine Learning (ML) has been used for many applications to real world
problems, such as Big Data Mining. Healthcare is one of the fastest growing
data segments of the digital world, with three primary sources of big data:
providers and payers, omic data, and patients and non-providers. Big data in
oncology and other severe diseases can provide unprecedented opportunities to
explore the biopsychosocial characteristics of these diseases and for descriptive
observation, hypothesis generation, and prediction. However, multiple
challenges remain related to data quality, acquisition and processing, analytical
methodology, and interpretation.
Patient Reported Outcome and Experience Measures (PROMs and PREMs) are
becoming increasingly important in routine clinical care due to their ability to
turn subjective experiences into numerical scores. This data can be used for
strategic and analytical purposes, such as health policy decisions, quality
improvement and comparison of clinical practices. The scientific evidence in
support of using PROMs and PREMs in routine clinical care is robust, with key
benefits for patients including improved quality of life, symptom management
and satisfaction with care.

25
20. Letter to The Editor on Virtual Guided Support Groups. Cailyn Green
PhD(April 13, 2023)
The most important details in this letter are that Alcoholics Anonymous (AA)
was first created in 1935 and has a direct association with better health
outcomes. Telehealth has changed dramatically since the COVID-19 global
pandemic, making it possible for clients to receive health care they otherwise
would not have access to due to physical or geographical restraints. Telehealth
has opened the door for support for recovering addicts who work in the
restaurantindustry in Upstate, New York. AA meetings are designed to be
nonjudgement places where people can gather for support in their alcohol
addiction. Telehealth has opened the door for support for recovering addicts
who work in the restaurantindustry in Upstate, New York. A support group is a
group of individuals who share a common situation or experience and are
seeking mutual aid. Alcoholics Anonymous now offers multiple platforms, and
appointments for virtual support groups to reach more potential individuals
seeking help.
21. Towards a Hybrid Society for Personalized Healthcare. Stefania
Costantini, (April 24, 2023)
These projects are aimed to cope with all aspects related to the physical
interaction between humans and (embodied) machines, including self-driving
cars. A small international workshop on “Methods for Self-Organizing
Distributed Systems” was held in Laubusch, Germany in 2015, which found
that hybrid societies are made of different components instead of having a
homogeneous identity. Digital health and care refers to tools and services that
use Information and Communication Technologies (ICTs) to improve
prevention, diagnosis, treatment, monitoring and management of health-related
issues and to monitor and manage lifestyle-habits that impact health. The
relevance and potentially huge impact of the synergy between ICT and
Artificial Intelligence (AI) in this field is demonstrated by the IBM Watson
attempt, which lead to implement the Health Platform, but has been dismissed
as it has been shown to be unreliable. The provision of quality healthcare in a

26
 cost-effective way is a critical issue in all countries due to the aging population,
the reappearance of diseases, and the development of new issues such as the
Ebola and Covid-19 pandemics.
22. Patient Relation with Doctor & Telemedicine and Nanomedicine. Mario M
D’Elios(June 28, 2022)
The doctor-patient relationship has been based on a fiduciary liaison, which
goes beyond the technical competence of the doctor. However, the use of smart
devices has been thought to pave the way to the self-reliance of the patient,
potentially compromising the fiduciary nature of the doctor-patient
relationship. This has led to a crisis of the doctor-patient fiduciary relationship,
as the doctor enters the patient‟s body through a device that is able to replace,
at least in part, the doctor‟s hand, ear and eye and traditional diagnostic
instruments. This has led to a crisis of the doctor-patient fiduciary relationship,
as the doctor enters the patient‟s body through a device that is able to replace,
at least in part, the doctor‟s hand, ear and eye and traditional diagnostic
instruments. This has led to a crisis of the doctor-patient fiduciary relationship,
as the doctor enters the patient‟s body through a device that is able to replace
the doctor‟s hand, ear and eye and traditional diagnostic instruments
23. Privatization of Health Sector: An Indian Perspective. Tanya
Tanu(December 19, 2022)
Private hospitals are expensive and unaffordable to the poor sections of society,
leading to expensive medical care and distrust towards the medical community.
Privatization is fearful of inequitable distribution of health resources, patient
discrimination based on income or medical coverage, and corruption. Extensive
privatization runs the risk of converting health into an economic commodity,
which is perilous for a developing country like India as it may widen the
existing health gaps. To reduce the risk of medical casualty, private firms may
screen patients based on their health status and chances of recovery, leading to
further discrimination. Additionally, there is a lack of a proper regulatory body
to look into their internal actions and they are not accountable to the outside
world. The State should step in and act as a regulator and not merely a

27
 facilitator for health care delivery through the private sector. Manpower and
human resources should be deployed by the government for vigilant resource
mapping, planning, and monitoring of both the public and private units. States
should form a Health Advisory Committee which comprises experts from the
field of public health, health administration, state health departments, and non-
profit organizations.
24. . Telehealth: A Concept Analysis from a Nursing Perspective. Ibrahim Al
Baalharith,( February 16, 2023)
The concept of energy is based on the idea that God or a higher form of power
is responsible for the energy that flows to an individual. Transcendence equips
a nurse to ask practical questions surrounding a patient that will help them feel
at peace and align with the spiritual realm. The higher power gives patients and
the nurse a better understanding of their intrinsic being and that they can
separate themselves from the physical realm and chaos. Spirituality is an
essential concept in enhancing an individual‟s mental, physical, and emotional
state, and can enhance that of a nurse. From a nursing perspective, spirituality
is a consequence that will allow the flow of energy and alignment of currents
with their life‟s purpose keeps nurses in tow about why they became nurses
and, in turn, take care of the patients fully.
25. Co-Creation of an Academic Integration Center in Virtual Modality.
Margareth Villalobos Guiza(November 15, 2022)
Crises require effective strategies to get through them, but they are also
opportunities to evolve. This article summarizes the development of a Business
Plan in Lima/Peru in 2021-2022, with the objective of determining the viability
of the co-creation of an “Academic Integration Center in Virtual Modality” to
offer innovative virtual courses and avant-garde. The scenario in which the
academic integration center will operate will be the LMS platform, a support
that has the necessary resources for the learning process, which enables the
integration of teaching experts, with active, innovative, technological,
immersive, and critical methodologies. The business plan for a training center
on health issues in virtual mode is characterized by its practicality in the

28
reality. It is aimed at people between the ages of 24 and 35, recent graduates,
who wish to increase or strengthen their skills in the labor and professional
world. The External Factors Evaluation (EFE) Matrix highlights 15 Success
Determining Factors (SDFs), of which 9 are threats and 6 are opportunities.
Market research was conducted for health professionals, and the professions
with the highest demand for courses in virtual mode are Nursing (88%) and
Obstetrics (12%), and the E-Leaning teaching methodology has an excellent
score. The subject with the greatest demand is clinical and soft skills courses,
the most accepted.

29
 Introduction of the Topic

 Client history
 History
 Mission
 Organization chat history
 Pros and cons of
 Topic name
 Vision

 Telehealth, also known as telemedicine, is the remote delivery of healthcare

services, consultations, and information exchange using telecommunications
and digital technologies. It has emerged as a viable solution to address the
challenges of accessibility, affordability, and quality of healthcare services in
India. This study aims to examine the implementation and impact of telehealth
in the healthcare facilities industry in India, examining the adoption,
challenges, and benefits of telehealth. This research seeks to shed light on the
potential of this innovative approach to reshape the healthcare landscape in the
country.

30
Telehealth has emerged as a potential solution to bridge the gap between
patients and healthcare providers in India, overcoming the barriers of shortage
of healthcare professionals, inadequate infrastructure, and long distances
between patients and medical facilities. This could lead to delayed diagnoses,
limited access to specialized care, and increased healthcare costs.
India faces significant challenges in providing accessible and affordable
healthcare services to all its citizens. The country's healthcare infrastructure is
often concentrated in urban areas, making it difficult for individuals in remote
and rural regions to access timely medical care. Telehealth has the potential to
revolutionize healthcare delivery in India by overcoming geographical barriers
and transforming the way healthcare services are accessed and provided.
Telehealth leverages telecommunications and digital technologies to enable
remote consultations, diagnosis, treatment, and monitoring of patients,
reducing the need for in-person visits to healthcare facilities.
Telehealth has become an essential tool to deliver healthcare during the
COVID-19 pandemic, but it has limitations such as not being suitable for all
medical conditions and not all individuals have access to technology.

31
 Vision
 Accessibility: Telehealth aims to make healthcare services more accessible to
individuals who face barriers to traditional in-person care.
 Continuity of Care: Telehealth aims to improve continuity of care by enabling
seamless communication and collaboration between different healthcare
providers involved in a patient's treatment.
 Health Education and Prevention: Telehealth envisions the integration of
digital platforms and tools for health education, preventive care, and wellness
promotion.
 Empowering Patients: The vision of telehealth includes empowering patients to
take an active role in their healthcare.
 Research and Innovation: Telehealth holds the potential to generate vast
amounts of data that can be analyzed to improve healthcare delivery, identify
trends, and drive medical research and innovation.
 Enhanced Access: Telehealth aims to break down geographical barriers and
improve access to healthcare services, particularly for individuals in rural or
underserved areas.
It enables patients to connect with healthcare providers remotely, reducing the
need for travel and increasing access to specialists who may not be available
locally.
 Convenience and Efficiency: Telehealth eliminates the need for in-person visits
for routine or follow-up consultations, enabling patients to receive care from
the comfort of their homes.
 Improved Outcomes: By leveraging telehealth, healthcare providers can
monitor patients remotely, collect vital health data, and provide personalized
interventions.
This allows for proactive management of chronic conditions, early detection of
health issues, and timely intervention, leading to improved patient outcomes
and reduced hospitalizations.

32
 Patient Empowerment: Telehealth empowers patients to take charge of their
health by providing access to medical information, educational resources, and
self-management tools. It enables patients to actively participate in their care,
make informed decisions, and engage in virtual consultations with healthcare
professionals.
 Cost Savings: Telehealth has the potential to reduce healthcare costs by
eliminating unnecessary hospital visits, emergency room overcrowding, and
the need for physical infrastructure.
It can help optimize resource allocation and reduce healthcare expenses for
both patients and healthcare systems.
 Continuum of Care: Telehealth facilitates a seamless continuum of care by
enabling healthcare providers to collaborate and share information more
effectively.
 Technological Advancements: The vision of telehealth includes the integration
of advanced technologies such as artificial intelligence, machine learning, and
remote monitoring devices.
These technologies can automate processes, enhance diagnostics, enable
virtual reality-based therapies, and improve decision-making in healthcare
delivery.

33
 Mission
 Healthcare Access: Telehealth enables patients to connect with healthcare
providers regardless of geographical constraints, reducing the burden of travel
and improving access to specialists and healthcare facilities.
 Rural Healthcare: Telehealth plays a crucial role in addressing the healthcare
challenges faced by rural populations in India.
It aims to bridge the urban-rural healthcare divide by bringing specialized care
to remote areas.
Telehealth initiatives can include virtual consultations, remote monitoring of
patients, and telemedicine clinics in rural healthcare centers, providing timely
and appropriate healthcare services.
 Collaboration and Capacity Building: Telehealth initiatives in India focus on
fostering collaboration and capacity building among healthcare professionals.
Telehealth platforms facilitate virtual discussions, case consultations, and
knowledge sharing among healthcare providers, enabling them to deliver better
care through collective expertise and best practices.

34
 Emergency Care and Consultations: Telehealth aims to provide timely access
to emergency care and medical consultations, especially in situations where
immediate physical presence may not be possible.
 Health Education and Awareness: Telehealth focuses on promoting health
education and awareness among the population.
It enables the dissemination of medical information, preventive healthcare
guidelines, and disease management strategies through digital platforms.
By empowering individuals with knowledge and resources, telehealth
encourages proactive health management and prevention of diseases.
 Maternal and Child Health: Telehealth initiatives in India aim to improve
maternal and child health outcomes.

35
 Pros and corn
Pros
 Increased accessibility: Telehealth eliminates geographical barriers and
allows patients, particularly those in remote or underserved areas, to access
healthcare services without traveling long distances.
It improves healthcare access for individuals who may have limited mobility
or transportation options.
 Convenience and flexibility: Telehealth enables patients to receive medical
care from the comfort of their homes, reducing the need for in-person visits to
healthcare facilities.
It offers flexibility in scheduling appointments, making it easier for patients to
fit healthcare consultations into their busy lives.
 Time and cost savings: By avoiding travel time and associated costs, such as
transportation and parking, telehealth can save patients both time and money.
It is particularly beneficial for individuals who require frequent follow-up
visits or have chronic conditions that necessitate ongoing medical supervision.
 Improved continuity of care: Telehealth facilitates better coordination and
continuity of care, especially for patients with complex medical conditions who
require multidisciplinary care from different specialists.
Healthcare providers can easily share patient information, collaborate on
treatment plans, and ensure consistent follow-up.
 Reduced exposure to contagious diseases: Telehealth helps mitigate the
spread of contagious diseases by minimizing face-to-face interactions and
reducing the need for patients to visit crowded healthcare settings.
This is especially relevant during public health crises, such as the COVID-19
pandemic.
Enhanced monitoring and remote patient management: Telehealth enables
healthcare providers to remotely monitor patients' vital signs, chronic
conditions, or post-operative recovery.

36
 Through wearable devices and remote monitoring tools, healthcare
professionals can collect real-time data and make informed decisions about
patients' care without requiring them to visit a medical facility.
 Improved access to specialists: Telehealth allows patients to consult with
specialists who may be located in a different city or even a different country.
This can be particularly beneficial for patients who require specialized care or
expertise not readily available in their local area.
 Health education and self-management: Telehealth platforms often
incorporate educational resources and tools to empower patients to actively
manage their health.
Patients can access educational materials, receive personalized health advice,
and learn about preventive measures or lifestyle modifications.
 Increased patient engagement: Telehealth can improve patient engagement
by providing convenient and accessible healthcare options.
Patients who might otherwise delay or forgo care due to barriers like
transportation or time constraints are more likely to engage in regular
healthcare consultations and follow treatment plans.
Corn:
 Nutritional value: Corn is a good source of dietary fiber, vitamins (such as
vitamin C, thiamine, and folate), and minerals (such as magnesium and
phosphorus).
It provides essential nutrients for a balanced diet.
 Energy source: Corn is rich in carbohydrates, making it an excellent source of
energy.
It can be consumed in various forms, including whole corn, cornmeal, corn
flour, and cornstarch.
 Versatility: Corn is a versatile ingredient used in a wide range of food
products.
It serves as a primary ingredient in many dishes, including soups, stews,
tortillas, tacos, and snacks.

37
 Additionally, corn is used to produce corn syrup, corn oil, and ethanol, among
other industrial products.
 Agricultural significance: Corn plays a crucial role in agriculture as a major
cash crop.
It provides economic opportunities for farmers, contributes to food security,
and serves as a raw material for various industries.
 Dietary versatility: Corn can be prepared and consumed in various ways,
making it a versatile ingredient in cooking.
It can be boiled, steamed, grilled, or roasted, and used in a wide range of
recipes including salads, side dishes, and main courses.
 Antioxidant properties: Corn contains several antioxidants, such as lutein and
zeaxanthin, which are beneficial for eye health and may reduce the risk of age-
related macular degeneration.
 Fiber content: Corn contains dietary fiber, which aids digestion, helps regulate
bowel movements, and contributes to a feeling of fullness.
Including fiber-rich foods like corn in your diet can support gastrointestinal
health.
Corn and its derivatives, such as cornmeal or corn flour, are naturally gluten-
free, making them suitable for individuals with gluten intolerance or celiac
disease.
 Animal feed and industrial uses: Corn is a vital component in animal feed,
providing essential nutrients for livestock.
Additionally, corn is used in the production of biofuels, bioplastics, and
various industrial products.

38
 History about telehealth

In the early 2000s, telemedicine initiatives began in India, primarily driven

by the
ISRO launched the Satellite-based Telemedicine Pilot Project in 2001 to
connect rural healthcare centers with specialty hospitals through satellite
communications.
It aimed to provide teleconsultation and tele-education services to rural and
underserved areas.
The Telemedicine Society of India (TSI) was formed in 2002 to promote
telemedicine adoption and awareness.
Expansion and Adoption (2010-2015): In 2010, the Indian government
launched the “National Rural Telemedicine Network" (NRTN) as part of the
National Rural Health Mission. It aimed to connect primary health centers in
rural areas with specialist doctors through telemedicine.
Mobile health (mHealth) applications and services started gaining popularity,
leveraging the widespread use of mobile phones in India.

39
Government Initiatives and Policy Changes (2015-2020):In 2015, the Indian
government launched the "National Telemedicine Initiative" under the Digital
India

.
Public-Private Partnerships: Public-private partnerships have played a
significant role in the development and implementation of telehealth
technology in India.
Collaborations between government institutions, healthcare providers, and
technology companies have helped drive innovation and expand telehealth
services.

40
Government Support and Funding: The Indian government has shown
support for telehealth technology through policy initiatives and funding.
The Ministry of Health and Family Welfare has provided guidance and support
for the implementation of telemedicine services.
Government funding has been allocated to initiatives like the National Rural
Health Mission and the Digital India program to promote telehealth adoption in
rural and underserved areas.
Telemedicine Training and Awareness:Efforts have been made to train
healthcare
professionals and raise awareness about telemedicine in India.
Organizations like the Telemedicine Society of India (TSI) have conducted
workshops, conferences, and training programs to educate healthcare providers
about telehealth technology and its applications.
Regional Initiatives: Several state governments in India have launched
telemedicine initiatives to improve healthcare access in their respective
regions.
For instance, the Government of Karnataka implemented the Suvarna Arogya
Suraksha Trust telemedicine project to provide teleconsultation services in
remote areas of the state.
Technological Advancements: Advancements in technology have played a
crucial role in the growth of telehealth in India.

41
The increasing availability and affordability of high-speed internet connections
have facilitated the adoption of telehealth services.
Mobile applications, web-based platforms, and video conferencing tools have
made it easier for patients and healthcare providers to connect remotely.
Integration with Digital Health Ecosystem: Telehealth technology has been
integrated with the broader digital health ecosystem in India.
Initiatives like the National Digital Health Mission (NDHM) aim to create a
comprehensive digital health infrastructure that includes telemedicine services,
electronic health records, and interoperability among various healthcare
stakeholders.

The output of papers on telemedicine-related subjects as indexed on

MEDLINE has been fairly constant over the last five years, with Finland and
Norway producing the greatest number of publications per head of population.
There has been an increasing number of randomized controlled trials and
systematic reviews, but the results of these reviews are rather critical of much
of the telemedicine literature. Telemedicine has a number of separate attributes
– feasibility, acceptability, cost, effectiveness, safety, sustainability – and the
importance of studying each of these systematically will vary from application
to application. The paradox here is that if research is tightly controlled to meet

42
the strict requirements of the writers of systematic reviews, it may become less
relevant to telemedicine.
The recent development of telemedicine has been facilitated by advances in
electronic methods of communication and the pioneering efforts of a few
organizations and individuals. Television was a major influence on the
development of telemedicine, as it allowed for interactive consultations
between specialists and general practitioners, and facilitated education and
training at the distant site. Another early example of television linking doctors
and patients was at the Massachusetts General Hospital/Logan International
Airport Medical Station, which used a two-way audiovisual system in 1967.
Telemedicine has been facilitated by advances in electronic methods of
communication and the pioneering efforts of a few organizations and
individuals.

43
 Research Methodology
Scope of the study
 Telehealth has the potential to address key challenges in providing health
services during the COVID-19 pandemic, minimize risk of transmission, and
provide continuous care to the community. Clinicians and patients are strongly
recommended to use telehealth tools to prevent and contain COVID-19
infection.
 Telehealth has several benefits in providing allergy and immunology services,
including limiting exposure of health professionals to potentially infected
patients and access to rapid evaluation for COVID-19 infection. Mobile health
technology should be used to develop staffing plans and bill healthcare
services.
 Future research should focus on defining obstacles and facilitators in health
providers and patients, setting up telehealth in primary care, examining the
effectiveness of telehealth approaches in different health areas, and evaluating
satisfaction with telehealth services.
 Infrastructure
Telehealth relies on stable and high-speed internet connections, so it is
important to assess the availability and reliability of internet connectivity in
healthcare facilities. Hardware devices such as computers, tablets,
smartphones, webcams, and audio equipment must also be evaluated. Network
security measures must also be in place to protect patient data during telehealth
consultations.
 Technology Healthcare facilities should assess the availability and suitability of
EHR systems, telehealth platforms, appointment scheduling and patient
management systems, and remote monitoring devices. EHR systems should be
integrated with telehealth platforms for seamless data exchange and
documentation. Telehealth platforms should be user-friendly, compatible with
various devices, and support video/audio consultations. Appointment
scheduling and patient management systems should be in place.

44
 Remote monitoring devices should be integrated to transmit patient vitals or
other health data during telehealth consultations.
 Digital literacy and patient engagement Evaluate digital literacy and patient
engagement to identify barriers and implement patient education programs to
create awareness and provide guidance on using telehealth services.

 Access to technology and internet: is important for telehealth services. To

address this, partnerships with community organizations, providing technology
resources, and using public spaces with internet access are needed. Mobile
solutions should be developed to leverage the widespread use of mobile phones
in underserved communities, and improved internet infrastructure should be
advocated for in remote or disadvantaged areas.
 Patient education and user-friendly interfaces are essential for telehealth
platforms to ensure accessibility and minimize the learning curve for
individuals with varying levels of digital literacy.

45
 Language and Cultural Competence: a. Language Services: Implement
language interpretation services to cater to diverse language needs, ensuring
effective communication between healthcare providers and patients.
 Community Partnerships: a. Collaborate with Community Organizations:
Partner with local community organizations to raise awareness about telehealth
services, provide education, and support enrollment and utilization among
underserved populations.
 Telehealth in Public Health Initiatives: Integrate telehealth into public health
initiatives focused on addressing social determinants of health, such as
community health screenings, health education programs, or chronic disease
management
 Cultural Sensitivity: Train healthcare professionals on cultural competency and
sensitivity to address the unique needs and beliefs of different populations,
reducing cultural barriers to care.

 Discussion
The most important idea is that the discussion is ongoing. Telehealth is a
feasible tool for delivering health services with high patient-provider

46
 satisfaction. Benefits include cost-effectiveness and easy accessibility, new and
follow-up care, and instant medical advice. However, evidence suggests that
insufficient medical and technological infrastructure and technical illiteracy are
potential challenges to telehealth.
Additionally, many patients had to share smartphones with their family
members,
 which supports related research that some patients lack appropriate gadgets in
their homes to access telehealth. Virtual consultation leads to challenges such
as lack of physical examination, limited patient-provider relationship, and
difficulty with appointment and consultation time. This systematic review
presents comprehensive evidence on the role of telehealth technology in India
within the COVID-19 pandemic and in the future.
 The study demonstrates the applications, benefits and challenges of telehealth,
including telemedicine across various medical specialities in primary and
follow-up care.
 It also proposes some crucial recommendations for effectively implementing
telehealth practices in the country. The government and policymakers should
improve technological infrastructure across the country and the technological
literacy of the population in this era of digitalisation.

47
 Data privacy and security should be strictly maintained, and improved
documentation and adherence to information management principles could
help healthcare providers avoid medicolegal issues.
 Telehealth is seen as a feasible tool for delivering health services with high
patient-provider satisfaction. Benefits include cost-effectiveness and easy
accessibility, new and follow-up care, and instant medical advice. However,
insufficient medical and technological infrastructure and technical illiteracy are
potential challenges to telehealth.
 Virtual consultation leads to challenges such as lack of physical examination,
limited patient-provider relationship, and difficulty with appointment and
consultation time. This systematic review presents comprehensive evidence
on the role of telehealth technology in India during the COVID-19 pandemic
and in the future. It demonstrates the applications, benefits and challenges of
telehealth, including telemedicine across various medical specialities in
primary and follow-up care.
 It also proposes some crucial recommendations for effectively implementing
telehealth practices in the country, such as improving technological
infrastructure, technological literacy, data privacy and security, improved
documentation and adherence to information management principles.

48
 WHY WE NEED A TRIAGED APPROACH TO TELEHEALTH
When we think about health care in the U.S., it is not often perceived as critical
infrastructure. Yet, the Bipartisan Infrastructure Bill suggests the importance of
universal broadband for the purposes of telehealth, education, job applications,
and beyond. The bill also recognizes that telehealth and health care provision
are an integral part of citizen welfare and development and fit it in with the
larger agenda to expand broadband access and close the digital divide. But
before delving into our final recommendations, the U.S. must adopt some
tenets to facilitate more ubiquitous and robust telehealth adoption and use that
include
1. Telehealth adoption and use are invaluable benefits to improving care
equity among all patients.
Definitively, telehealth is a factor in the improvement of care equity, which
centers a value-based care approach to 21st century health care. As opposed to
the conventional fee-for-service health care mode, in which a health care
provider is paid a fee for each service rendered, value-based care ties payments
to the quality of care provided instead.101 Such permissions incentivize health
care providers to utilize resources in a more efficient manner and to be more
resourceful when it comes to helping patients diagnose and manage chronic
diseases and other hospital readmissions. Value-based care is meant to reduce
health care spending while increasing quality of care.102 In 2015, HHS
reported that Accountable Care Organization (ACO) programs have
successfully helped Medicare save $417 million, while reducing 30-day
hospital readmissions by 14 percent.103 2020 data shows that savings have
since increased to $4.1 billion over the last five years.104 Over the course of
the COVID-19 pandemic, value-based health care providers were uniquely able
to utilize telehealth creatively to improve care management programs and limit
community spread while resources were scarce. Value-based models allowed
more flexibility in services provided compared to other provision models,
ensuring comprehensive care for their patients. Listed below are examples of

49
 how value-based organizations have rolled out programs to alleviate pressures
of the pandemic:
Oak Street Health (Chicago, IL): Launched a remote care program with
telephone wellness checks. Individuals could then be triaged to a COVID-19
hotline as necessary, or enrolled into their COVID-19 Care Disease
Management Program.
Carillon Clinic (Roanoke, VA): Used data to identify high-risk patients, used
outreach programs to contact these individuals and provided information about
COVID-19 assistance with chronic conditions and addressing needs.
Central Ohio Primary Care (Westerville, Ohio): Reached out to over 4,000
high- risk patients to screen for COVID-19 and other needs.10
2. Telehealth can mitigate health disparities by harmonizing delivery
strategies and avoiding strict limitations on modalities
Health disparities in the existing health care system disproportionately affect
vulnerable groups, including those living in rural areas and people of color.
Telehealth should be used to bridge these gaps and address disparate health
equity, providing underserved communities with much-needed care.
While about 20 percent of Americans live in rural areas, less than one-tenth of
physicians practice there.
The shortage of health care providers in rural areas is further compounded by
the growing elderly population.
While older patients comprise 37 percent of hospital admissions in urban
settings, they make up over one-half in rural communities.
Rural populations lack access to health care in “proximity, affordability, and
quality.” The geographical inconveniences of seeking health care mean that
many in rural communities often opt to substitute local primary care providers
for subspecialists. Others postpone or forego care altogether.
This, in combination with existing inequalities in economic opportunities, lead
to shorter life expectancies for those in rural areas, [who reportedly] die two
years earlier than those in urban areas.

50
 Some rural residents also face greater mortality risks from a multitude of
diseases including cancer, cardiovascular disease, and drug-related injuries
compared to those living in urban communities.
People of color struggle with significant health inequities. Black and Hispanic-
majority communities often have fewer hospitals and health care providers
because of residential segregation. Many of these providers also provide lower-
quality care. Historic economic inequities also mean that Black Americans are
more likely to be essential or frontline workers and are more likely to be
uninsured. Many are
3. Telehealth is critical to national efforts to close the digital divide.
To talk about telehealth involves conversations on digital equity because
without internet access, the future applications of remote health care will be
futile. For example, community health centers in the South and rural areas
continue to report the lowest average percentage of weekly telehealth visits,
according to the CDC.124 Low rates of telehealth adoption could be attributed
to the rural-urban digital divide and lack of digital literacy in rural
communities. According to the Pew Research Center, 28 percent of rural
residents lack home broadband access, compared to 21 percent of suburban
residents.125 Among urban residents, low-income households are also
adversely affected by the digital divide. According to a Pew Research study,
while 24 percent of low-income adults do not own smartphones,126 almost
double (41 percent) do not have access to a desktop or laptop computer.127
Along the lines of race, Black and Latino adults are less likely than white
adults to have broadband access and device ownership. According to the Pew
Research Center, eight in ten white adults report owning a desktop or laptop
computer, compared to 69 percent of Black adults and 67 percent of Hispanic
adults. Eight in ten white adults also report having a broadband connection at
home, compared to 71 percent of Black adults and 65 percent of Hispanic
adults.128 For communities of color in rural areas, this issue is compounded,
with the percentage of people with internet access decreasing to 62 percent,
according to a report published by the Joint Center for Political and Economic

51
 Studies.129 Barriers to broadband access do not stop there. Even those with
broadband access may struggle
PROPOSED RECOMMENDATIONS
1. Federal and state governments must continue telehealth availability and
use in a post-pandemic environment through codifying its use, especially
in legislation
Federal and state actors must act to make telehealth flexibilities permanent.
The CMS should also extend or make permanent flexibilities to expand the list
of covered telehealth services and modalities. States might also move away
from payment and coverage parity models to reduce costs and encourage the
use of telehealth services, especially by giving clinicians some room to
innovate how they institute remote care in their respective practices. As parity
laws mandate same rates of reimbursements for telemedicine and in-person
visits, the worry is that this may stagnate the abilities of physicians and patients
to embrace a wider range of technologies and modalities for eligible services
that could be more cost-efficient or stray from traditional practice models. As
delivery of telehealth tends to be leaner, lower prices are in-line with
highlighting telehealth‟s cost-effective nature. Whereas coverage parity laws
may have worked throughout the pandemic, it can work either way for
providers who are opening their doors to more in-person visits.134 Further, the
pandemic has demonstrated that telehealth enables a more effective triaging of
resources, improving risk mitigation measures during times when infectious
diseases spread resources thin. It‟s time for Congress and other state regulators
to permanently incorporate telehealth into the health care system to provide
more cost- and time- efficient health care for patients, especially those in need
or with limited financial or geographic resources.
2. Modality neutrality must become a standard practice to adequately
address digital disparities, and ensure full use of remote health care
Both synchronous and asynchronous telehealth delivery systems must be part
of the future of telehealth, as both have unique value-adds to the existing health
care system. It should not be positioned as either / or depending on the

52
circumstances of the patient. Modality flexibility is essential to the future of
telehealth, and future legislation should allow providers maximum flexibility to
let providers and individual patients determine the technologies and services
most suited for cases. As demonstrated in this paper, while synchronous
telehealth has its benefits in cutting down on travel times and increasing the
convenience of real time visits, asynchronous telehealth also has its uses by
letting patients and providers communicate test results or other information at
times of convenience. Modality neutrality also enables innovative uses of
existing technologies to enhance health care services. For example, the further
integration of AI in health care can improve efficiency in triaging patients.135
Yet if providers will not be compensated or covered for utilizing new
technologies, they are less likely to involve such technologies. Having the
CMS recognize different technology-driven services, as they already have with
RPM and RTM, allows providers more flexibility to incorporate technology
into their service provision.

53
3. . The larger health care community must understand that they, too, are
part of efforts to close the national digital divide through training, device
availabilities, and online consumer engagement
Digital equity is a core factor in the effective deployment of telehealth. Large
and local health centers can be essential in assessing the online needs of patient
populations. Community health centers can combine digital literacy training
with patient education, provided they, too, are sufficiently connected to high-
speed broadband networks and internetenabled devices. Prior to the pandemic,
in 2018, 43 percent of health centers had already begun using telehealth for
care delivery, with even higher use rates among rural communities.141
Throughout the COVID-19 pandemic, they also played an integral role in
COVID-19 prevention, testing more than 3.7 million patients and treating
nearly 745,000 affected by the pandemic.142 While community health centers
have played an integral part in the health care system, they have consistently
struggled with
problems such as insufficient access to broadband, technical training, and
assistance.143 The Bipartisan Infrastructure Bill should consider community
health centers as anchor institutions, who would be afforded support after
certain deployment requirements are met. Past efforts to distribute technologies
in local communities have been most effective when programs were
community-led.144 Since health care providers are deeply embedded in their
local communities, they can better equip patients to understand and use
telehealth services.

54
55
Significance
Telehealth has the potential to bridge the gap in access to healthcare services
by allowing patients to receive virtual consultations, especially when physical
access is limited.
Telehealth can help address healthcare disparities by enabling individuals in
rural or underserved areas to connect with healthcare providers, increasing
access to specialized care and reducing geographical barriers.
Telehealth is essential for ensuring continuity of care and minimizing virus
transmission, and studying its implementation and readiness in Indian
healthcare facilities helps identify areas for improvement.
Telehealth can improve healthcare delivery by reducing travel time and costs,
optimizing provider schedules, and potentially reducing healthcare expenses,
making it essential for resource allocation and sustainable healthcare practices.
Assessing the implementation of telehealth in healthcare facilities can help
shape the design and delivery of telehealth services to meet patient needs
effectively. Policy and Regulatory Considerations can inform policymakers
about the current status, challenges, and potential solutions for enabling a
conducive environment for telehealth implementation.
Evaluating healthcare facilities' readiness for workforce training helps identify
gaps and opportunities for upskilling healthcare professionals in telehealth
operations, patient communication, and data security.
Telehealth has the potential to improve disease management and chronic care
by enabling remote monitoring, check-ins, and timely interventions. Studying
its implementation in healthcare facilities can shed light on its effectiveness.
Telehealth can facilitate preventive care and health promotion initiatives by
providing convenient access to preventive services, health education, and
lifestyle interventions

56
 Limitations
Inadequate infrastructure in India's healthcare infrastructure can hinder the
widespread adoption and effectiveness of telehealth services, limiting access
for certain populations.
The digital divide in India is a result of disparities in access to and usage of
technology, particularly among marginalized populations, which can limit the
benefits of telehealth.
Language and cultural barriers can limit effective communication between
healthcare providers and patients, requiring interpretation services and
impacting patient acceptance and utilization of telehealth services.
Telehealth consultations lack the ability to conduct physical examinations,
limiting the accuracy of diagnoses and treatment decisions for certain medical
conditions.
Telehealth requires robust privacy and data security measures to protect patient
confidentiality, as inadequate security measures can lead to data breaches.
The question of maintaining human contact and the pertinence of the virtual vs.
in-person care process has been often raised by patients, healthcare
professionals, and researchers.
Additionally, the quality of care in terms of patient engagement, empathy, and
emotional and human consideration can be affected during virtual patient
interactions with healthcare professionals on a telehealth platform.
Additionally, the use of telecare in rural areas and among patients with a lower
income is inadequate due to lack of resources and supplies, the accessibility of
medical facilities, and internet access.
Additionally, the income and social-economic status of telehealth users affect
the effectiveness and adequate use of telehealth platforms. Finally, certain
experts raise various malpractice liability concerns such as informed consent,
rules and procedures for treatments that meet the classical and appropriate
standard of care, supervision of care providers, and the availability of
professional liability insurance coverage specific to telecare use.

57
 Data collection:
Case study:
1. A case study on Telemedicine practices implemented with respect to
Apollo Hospitals Dr.P.Uma Rani, Dr.A. Defendant
The health care sector is projected to grow to 40 billion dollars. Private hospital
doctors are highly qualified, with good infrastructure and patient care, and 90%
of patients do not require surgery. Apollo Hospital was incorporated in 1979
and has treated 7.4 million patients and 315000 health checkups, with a success
rate of 98.5%. Dr. Prathap C. Reddy, the founder of Apollo Hospitals, was
inspired by St. Francis of Assisi's words of Start by doing what is necessary.
India Telemedicine was initially started in Pune with the Tata Council for
Community Initiative (TCCI). The main aim of telemedicine systems in India
is to provide the service at an affordable cost through telecommunications
infrastructure. Today, there are 550 telemedicine units located in suburban and
rural India offering telemedicine consultation from specialists from 70 tertiary
care hospitals. 500,000 teleconsults have helped to identify technological issues
for which corrective measures were taken. Apollo established its
Telecommunications Unit in Pune.
2. A Case Study of Using Telehealth in a Rural Healthcare Facility to
Expand Services and Protect the Health and Safety of Patients and Staff.
Daniele Giansanti and Joost van Hoof
The primary objective of this project was to develop a schedule where 2–4
providers worked from home providing telehealth on a rotating basis. At the
time, all providers were working on site, including those that provide
telehealth. In mid-September, there was a notable increase in telehealth visits
that had not been seen before. This generated the idea of trialing a weekly
rotating telework schedule to improve telehealth utilization. This also gave the
healthcare facility the ability to place quarantined providers on telework if they
were otherwise well.
By the end of summer, little to no telehealth visits were taking place. WEHC
leadership agreed that allowing the medical providers to telework would only

58
 give them the option to provide telehealth and help maintain staff in the case of
a COVID outbreak in the clinic.
3. Telemedicine and digital technology play an important role in public
health. Revathi G. Maroju , Sonali G. Choudhari
Telemedicine is the technique of treating and diagnosing patients online from
anywhere in the globe using communication networks. It can improve long-
term health and increase access to preventive care, particularly for those who
struggle to find adequate treatment due to their financial circumstances or
geographical condition. The Ministry of Health of India has started to work on
initiatives to advance the cause.
Telemedicine technology is essential for providing access to high-quality
healthcare to the poor in India's North Eastern states. It enables clinicians and
patients to be nearly anywhere, allowing them to obtain local care while
consulting with specialists in larger cities. Despite government and private
sector attempts, the lack of access to high-quality healthcare in rural and distant
locations remains a problem.
4. Telehealth App Development: A Comprehensive Guide for New Age
Healthcare.
Telehealth App Development provides comprehensive patient and practitioner
functionalities, remote enablement, HIPAA compliance, seamless integration
with other healthcare software, and instant guidance from professionals.
Telehealth is a must in today's world, as healthcare needs to be accessible to
all, regardless of physical distance. It can take care of all obstacles, such as
transport, rural background, mobile services, budget, and staff.
Healthcare is an important part of our lives, and Telehealth is the answer to
these hurdles. Telehealth can take care of transport, rural background, mobile
services, budget, and restricted staff. It is a must in today's world, where
healthcare needs to percolate in every section of the society and being
physically present is not necessary. Telehealth is the solution for those who
cannot access healthcare facilities due to physical distancing.

59
5. Telehealth can be used to coordinate care for youth transitioning from
pediatric to adult care.
David is a 19-year-old young adult with autism spectrum disorder, intellectual
disability and attention-deficit/hyperactivity disorder (ADHD). His primary
care clinician works closely with his interprofessional team, including
psychiatry, speech-languagepathology, occupational therapy, education team
and social work, to increase his functional independence and begin transition to
adult care. However, David does not typically transition well to unfamiliar
environments. His father, who is his health care power of attorney, called the
office with concerns about recent aggressive outbursts at school despite
behavioral and pharmacologic treatments. Telehealth is being used to help
address these acute concerns as well as his transition to adult care. Team
members should be involved in telehealth encounters, how can telehealth help
address social determinants of health and connections to community
organizations, how can telehealth provide an opportunity to focus on David‟s
family strengths and support systems, and what actions will be taken to
implement coordination of David‟s care via telehealth? Challenges might be
faced in coordinating care via telehealth, and how can telehealth address his
needs and care goals.

60
Gap Analysis
Assess the existing telecommunication and digital infrastructure in India,
including internet connectivity, mobile network coverage, and availability of
digital devices. Identify gaps in infrastructure that may hinder the widespread
adoption and smooth functioning of telehealth services, particularly in rural and
remote areas. Access and
Equity: Examine the extent to which telehealth services are accessible and
available to different segments of the population. Policy and Regulations:
Evaluate the existing policy and regulatory frameworks governing telehealth in
India.
Healthcare Provider Adoption: Analyze the level of adoption of telehealth
by healthcare providers.
Patient Acceptance and Awareness: Evaluate the level of awareness and
acceptance of telehealth services among patients in India. Integration with
Existing Healthcare
System: Assess the integration of telehealth services with the existing
healthcare system in India.
Quality of Care and Clinical Outcomes: Evaluate the quality of care
delivered through telehealth services and assess its impact on clinical
outcomes. Reimbursement and Financing: Evaluate the reimbursement
mechanisms and financial models for telehealth services in India.
Telehealth Technology: Evaluate the range and sophistication of telehealth
technologies being used in India. Data Privacy and Security: Examine the
existing data privacy and security measures in place for telehealth services in
India.
Training and Capacity Building: Assess the level of training and capacity
building initiatives for healthcare professionals to effectively use telehealth
technologies and provide teleconsultations.
Interdisciplinary Collaboration: Analyze the extent of interdisciplinary
collaboration in telehealth services in India. Patient Experience and

61
Satisfaction: Evaluate the patient experience and satisfaction with telehealth
services in India.
Telehealth Research and Evidence: Evaluate the level of research and
evidence supporting the effectiveness and outcomes of telehealth services in
India.
Public-Private Partnerships: Evaluate the level of engagement and
collaboration between public and private stakeholders in telehealth initiatives.
Socio-Economic Profile of the respondents
Telehealth is the provision of healthcare services remotely using
telecommunications technology, which has the potential to overcome
geographical barriers, improve access to healthcare services, and reduce
healthcare costs. In India,
where there is a large population and uneven distribution of healthcare
infrastructure, telehealth can play a significant role in providing healthcare
services to underserved areas and populations.
Socio-economic factors such as access to technology, healthcare awareness,
affordability, trust, and cultural factors can influence the adoption and
utilization of telehealth services.
Access to technology requires access to technology infrastructure such as
smartphones, internet connectivity, and digital literacy. Healthcare awareness
and knowledge can be influenced by socio-economic factors such as income
levels, education, and urban/rural divide.
Affordability can vary depending on the platform or service provider. Trust and
cultural factors can affect the acceptance and utilization of telehealth services.
Urban-rural divide: India has a significant urban-rural divide, with variations
in healthcare infrastructure and access to services.
Telehealth has the potential to bridge this gap by providing remote
consultations, diagnostic services, and specialist advice to patients in rural
areas.
The socio-economic profile of respondents in rural areas may reflect lower
income levels and limited access to healthcare facilities.

62
Employment and occupation, age and demographics, health insurance
coverage, and government initiatives can all influence the utilization of
telehealth services.
Government initiatives such as the Telemedicine Practice Guidelines issued by
the Indian government in 2020 aimed to expand the reach of healthcare
services through telehealth may have varying degrees of success in different
socio-economic strata, depending on factors such as awareness, accessibility,
and implementation.
These initiatives may have varying degrees of success in different socio-
economic strata, depending on factors such as awareness, accessibility, and
implementation.
The education level of respondents can affect their perception and utilization of
telehealth services.
Language and cultural factors can affect the utilization of telehealth services, as
effective communication between healthcare providers and patients is crucial.
Geographic location can also influence the utilization of telehealth services, as
different regions have different levels of development, infrastructure, and
access to healthcare
Occupation and income can also influence the utilization of telehealth services,
as individuals with white-collar jobs and higher income levels may have better
access to technology and resources required for telehealth consultations.

63
Chronic conditions and healthcare needs may be more inclined to utilize
telehealth services due to factors such as accessibility to specialized care, the
need for regular follow-ups, and the convenience of remote consultations.
Socio-economic factors play a role in determining the prevalence of chronic
conditions, access to necessary medications, and the ability to afford ongoing
healthcare services.

64
Data Interpretation
A case study on Telemedicine practices implemented with respect to
Apollo Hospitals Dr.P.Uma Rani, Dr.A. Defendant
Apollo hospitals are providing telemedicine services to the rural masses as a
way to show their corporate social responsibilities. Their revenue stream must
come from other sources such as patients who value their CSR activities or
secondary markets that use the existing telemedicine network. However, virtual
medical treatment has a risk of error and compromised health information, and
there is difficulty in claiming reimbursement from insurers or government
programs. Hospitals involved in telemedicine are unable to start treatment
immediately due to unclear legal regulation.

65
2. A Case Study of Using Telehealth in a Rural Healthcare Facility to
Expand Services and Protect the Health and Safety of Patients and Staff.
Daniele Giansanti and Joost van Hoof
The primary objective of this project was to develop a schedule where 2–4
providers worked from home providing telehealth on a rotating basis. At the
time, all providers were working on site, including those that provide
telehealth. In mid-September, there was a notable increase in telehealth visits
that had not been seen before. This generated the idea of trialing a weekly
rotating telework schedule to improve telehealth utilization. This also gave the
healthcare facility the ability to place quarantined providers on telework if they
were otherwise well.
By the end of summer, little to no telehealth visits were taking place. WEHC
leadership agreed that allowing the medical providers to telework would only
give them the option to provide telehealth and help maintain staff in the case of
a COVID outbreak in the clinic.

3. Telemedicine and digital technology play an important role in public

health. Revathi G. Maroju , Sonali G. Choudhari
India has been using technologies for information and communication in
healthcare and education for more than 10 years. The biggest challenge
policymakers, governments, and implementing committees have faced is a lack
of legislative support to promote the adoption of digital health solutions. The
National Medical College Network and the National Rural Telemedicine
Network are part of an e-health project being carried out by the Ministry of
Health and Family Welfare. Telemedicine is an innovation whose growth and
widespread use have the potential to greatly affect public health, and its cost-
effectiveness will likely be its most significant outcome.
4. Telehealth App Development: A Comprehensive Guide for New Age
Healthcare.
Telehealth is a superset of Telemedicine, both of which have E-Health as their
superset. Telehealth consists of both clinical and non-clinical healthcare

66
services, while Telemedicine focuses on the clinical side only. Both aim to
offer the best healthcare services to remote areas/patients/stakeholders, but the
functionalities involved differ.

5. Telehealth can be used to coordinate care for youth transitioning from

pediatric to adult care.
The most important details in this text are the practices used to deliver care
coordination through telehealth services. These include inquiring about the
family's access to digital technology and internet broadband coverage,
connecting them to clinic resources and/or community partners, ensuring they
are enrolled in the patient portal, establishing whether the youth is independent
or has a health care proxy or power of attorney, notifying David's family of the
option of scheduling certain visits virtually, inquiring whether members of his
care team would be willing to co-host multi-disciplinary telehealth visits,
setting expectations with David and his family of advantages and limitations of
telehealth visits versus in-person care, and referring youth and families to
telehealth resources such as Family Voices National's Telemedicine

67
Reporting:
Kilkari:
It delivers free, weekly, time-appropriate 72 audio messages about pregnancy,
child birth and child care delivery to families‟ mobile phones. Approximately 6
crore successful calls have been made so far under Kilkari in Bihar,
Chhattisgarh, Haryana, Himachal Pradesh, Jharkhand, Madhya Pradesh,
Odisha, Rajasthan, Uttar Pradesh and Uttarakhand.

Health Management Information System (HMIS) :

HMIS is a web based portal for monitoring the programmes under National
Health Mission (NHM).
For monthly service delivery data reporting from public health facilities to
improve program monitoring and management.
Approximately 2 lakhs Health facilities are regularly reporting on HMIS Portal.
It is integrated with GIS and available in public domain.
Website: https://nrhm-mis.nic.in/

68
Mobile Academy
It is a free audio training course designed to expand and refresh the knowledge
base of ASHAs and improve their communication skills Launched in 2016. A
total of over 70000 ASHAs have completed the Mobile Academy course since
inception in Bihar, Chattisgarh, Himachal Pradesh, Jharkhand, Madhya
Pradesh, Rajasthan and Uttarakhand.
Toll free number: 1800-3010-1704

69
National Telemedicine Network
National Telemedicine Network (NTN)” has been envisaged to provide
Telemedicine Services to the remote areas by upgrading existing Government
Healthcare Facilities (MC, DH, SDH, PHC, and CHC) in States.
Telemedicine nodes across India are being created inter connecting
SDH/PHC/CHC, District Hospital and Medical College in every State for
providing Citizen-centric services. This TM Network will start in Synchronous
with the roll out of NOFN across country.
In the first phase of National Telemedicine Network project, it is proposed to
connect 500 PHC/CHC/SDH at remote/rural locations with 100 District
Hospitals and 50 Medical Colleges.
Mission Directors of NHM of all the States/UTs have been advised to seek
financial assistance under their respective State/UTs Programme
Implementation Plan (PIP) of National Health Mission (NHM) scheme for
strengthening and promoting Telemedicine network. So far financial aid has
been provided 7 States.

70
Telehealth in India has both benefits and challenges.

Respiratory viral pandemics are a major challenge for nations and their
healthcare systems. Research has revealed that various approaches, such as
non-pharmaceutical interventions, healthcare policies, mental health
interventions, communication strategies, epidemiological surveillance
strategies, and workplace and university measures, could limit the spread of
viral infections.

The recent COVID-19 pandemic has also posed unanticipated hurdles to public
healthcare systems across the world, with many countries enacting a variety of
pharmaceutical and non-pharmaceutical interventions as containment
measures. However, social isolation and lockdown made medical assistance

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difficult and people‟s lives miserable. This has led to the rapid implementation
and expansion of telehealth services worldwide and healthcare providers have
begun to switch from traditional in-person consultations to telehealth.
Telehealth refers to the use of digital communication technologies and
telecommunications to provide and facilitate healthcare services such as
provider and patient education, medical care, health-related information
services, and self-care.

Literature on earlier respiratory viruses suggested the use of telephone-based

facilities and media to cope with the pressures of healthcare during pandemics.
Telehealth is a useful and popular technology for COVID-19 patients because
it is portable, simple, and small. Teleconsultations are an application of internet
of things (IoT) and could be used for behavioral and therapeutic adjustments,
improving the quality of life of patients, training them about COVID-19, and
follow-up.

Telehealth is especially beneficial in non-emergency/routine medical care and

when direct patient-provider contact is not required, such as delivering
psychological services. Telehealth technology is found to be patient-centred,
safeguards patients, doctors, and others, and provides complete access to
caregivers. India went through an unimaginable healthcare crisis during the
COVID-19 pandemic, with only 23% of qualified consulting doctors working
in semi-urban areas and 2% in rural areas.

This study aimed to understand the role of telehealth-assisted healthcare

delivery in the context of the COVID-19 pandemic in India and its applicability
even after the pandemic. It used a scoping review methodology to identify the
challenges in providing primary care via telemedicine technology, but a
detailed investigation of telehealth utilization in multidisciplinary primary and
secondary healthcare has received minimal attention.

A systematic literature review presented extensive evidence on the contribution

of telehealth to the detection, management, and control of illnesses during and

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after the pandemic. The review question was: what are the applications,
benefits and challenges of telehealth in India during the COVID-19 pandemic
and beyond?

Data security and privacy: Data security and privacy are major challenges to
telehealth, and patient-provider apprehension about data confidentiality needs
to be addressed. There is no option to know if the mobile health application
developer has taken the necessary precautions to ensure the privacy and
security of the application against malicious attacks. Adhikari et al. reported
that the major limitation of using these mobile-based applications is the data
safety of the patients.

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Summary of the project
Telehealth is the use of communication technologies, such as video
conferencing or phone calls, to remotely provide healthcare services and
health-related information. It allows healthcare providers to consult with their
patients without being in the same physical location, which is particularly
useful for patients who are unable to travel to a healthcare facility or live in
remote areas.
Telehealth services can include virtual consultations, remote monitoring, and
online health education and resources. It has become increasingly popular due
to its convenience, cost-effectiveness, and ability to improve access to
healthcare. Telehealth is the use of digital information and communication
technologies to access health care services remotely and manage your health
care.
Telehealth can also be technology that your health care provider uses to
improve or support health care services. Offer primary care for many
conditions.
The primary objective of this project was to develop a schedule where 2–4
providers worked from home providing telehealth on a rotating basis. At the
time, all providers were working on site, including those that provide
telehealth. In mid-September, there was a notable increase in telehealth visits
that had not been seen before. This generated the idea of trialing a weekly
rotating telework schedule to improve telehealth utilization. This also gave the
healthcare facility the ability to place quarantined providers on telework if they
were otherwise well.
By the end of summer, little to no telehealth visits were taking place. WEHC
leadership agreed that allowing the medical providers to telework would only
give them the option to provide telehealth and help maintain staff in the case of

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 Suggestion

 Invest in infrastructure to ensure reliable and high-speed connectivity.

 Establish guidelines and regulations to govern telehealth services.
 Provide training programs to familiarize healthcare professionals with
telehealth technologies and practices.
 Telehealth platforms should facilitate video consultations, secure messaging,
prescription management, and EHR integration.
 Provide a rural healthcare service
 Manage all the online platform
 Improve the technology to supply the medicine

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Conclusion and reporting interpretation

elehealth in India has improved accessibility to healthcare services,

particularly for individuals residing in remote or underserved areas. It
has also been beneficial during public health crises such as the COVID-
19 pandemic by minimizing in-person visits and enabling patients to
receive medical advice and prescriptions remotely.
However, telehealth is not without challenges, such as inadequate
infrastructure, data security, patient privacy, and the ability to accurately
diagnose and treat certain conditions remotely.
Despite these challenges, telehealth has emerged as a transformative
force in the Indian healthcare industry, enhancing access to healthcare,
improving patient outcomes, and increasing efficiency.
Telehealth has facilitated the delivery of specialized medical services,
allowing patients to consult with experts in various fields regardless of
their geographical location.
It has empowered patients by providing them with tools and resources to
actively participate in their healthcare. It has the potential to alleviate the
burden on healthcare infrastructure by reducing the number of
unnecessary hospital visits.
Telehealth in India has seen significant growth and acceptance in recent
years, fostering innovation and the development of new technologies. It
is important to establish robust regulatory frameworks to govern its
implementation and ensure patient safety and privacy.
Collaboration between traditional healthcare and telehealth can lead to
more comprehensive and patient-centric care delivery models.

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Telehealth has the potential to shift the focus of healthcare from reactive
treatment to proactive preventive care, support for mental health
services, address healthcare disparities between urban and rural areas,
provide follow-up care and post-operative monitoring, integrate with
digital health technologies, foster research and innovation in healthcare,
and play a significant role in the professional development and training
of healthcare workers.

Telehealth has the potential to shift the focus of healthcare from reactive
treatment to proactive preventive care, support for mental health
services, address healthcare disparities between urban and rural areas,
provide follow-up care and post-operative monitoring, integrate with
digital health technologies, foster research and innovation in healthcare,
and play a significant role in the professional development and training
of healthcare workers.

77
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