Telehealth and Telenursing – Progression in Healthcare Practice
Dr. R. Amudha1, Dr. R. Nalini1, Dr. R. Alamelu1, Dr. V. Badrinath2, M. Naveen Sharma3
1Faculty, School of Management, SASTRA University, Thanjavur
2Dean, School of Management, SASTRA University, Thanjavur
3Student, School of Management, SASTRA University, Thanjavur
Introduction: Now-a-days consumers in India are aware of e-health services forming a large market demand for online consultations with doctors. This helps the patients to remove the barriers of geographical distance and to receive the medical advice from experts from all over the world. Materials and methods: This paper signifies the case approach regarding telehealth and telenursing status and its need in Indian context. Results and Discussion: Telenursing is the blend of telecommunications and nursing services whenever a substantial physical distance exists between nurses or between patient and nurses. Telehealth practice in India is taking place over a decade with the help of satellite communication. Four hundred telemedicine nodes are set up in India by Indian Space Research Organization (ISRO). Teleconsultation, tele-education and observation of diseases are the major areas covered by ISRO. Advances in health care information technology helps to solve the deficiencies in healthcare infrastructure and shortages in medical professionals. Conclusion: The health care sector should leverage information technology to improve the quality of life, reduce human errors, reduce costs, increase response timings and to achieve patient-centric health care systems. The Indian government should also concentrate in establishing medical colleges, training institutes to offer required doctors, nurses and other paramedical professionals.
Now-a-days consumers in India are aware of e-health services forming a large market demand for online consultations with doctors. This helps the patients to remove the barriers of geographical distance and to receive the medical advice from experts from all over the world. Young and middle age groups are finding it easy to access, convenient and affordable to opt for e-health services with less waiting time. Private hospitals, Government hospitals and non-government organizations (NGO) are the three major providers in telemedicine market.
Appollo Telehealth services, Narayana Health Telemedicine Centres, Aravind Eye Care and telemedicine centres of Medanta are the private players. All India Institute of Medical Sciences and Sanjay Gandhi Post Graduate Institute of Medical Sciences have made treaty with district and sub-district hospitals in different states to be the government players. World Health Partners is the largest NGO having 1100 telemedicine centres in India. The telemedicine centres run by NGO form a market share of 56% of total telemedicine market. The telemedicine market consists of Tele-ophthalmology, Tele-ICU, Tele-dermatology, Tele-pathology, Tele-surgery and Tele-psychiatry. Tele-radiology, tele-consultancy and tele-ICU are the three major largest category in telemedicine market in India.
Telehealth and telenursing: An Indian context:
Information and communication technologies (ICTs) has made a tremendous influence in both developing and developed nations around the globe with regard to providing effective health care services at minimal cost, increased accessibility to the rural and under privileged people. With the increasing population, the need for efficient doctors and nurses in hospitals also increases. Telemedicine and telehealth are considered to be the best boon to the human population as it reduces the time of treatment and increases the number of patients to be attended. Telehealth nursing is an extension of telemedicine. Telehealth nurses require the skills and expertise alike the nurses practicing in specialized field. The telehealth nurses should possess knowledge about the technology and its application in assessing the patient’s physical and mental status. Telehealth includes distant doctor-patient consultations, blood pressure, deduction of fluctuations in patient’s condition, therapies, health education services, e-prescribed medications and treatments.
Telecare is different from telehealth and telenursing. Telecare monitors the important signs and transmits the data through a telephone line or a broadband to a telehealth monitoring centre or to a health care professional where the data transmitted will be monitored and compared with the parameters constructed by a physician. Thus, telecare uses a mobile phone which is connected to monitoring centre and assists the user to raise an alarm in case of emergencies. Telecare is normally extended to physically less able people to help them to remain in their own homes and receive a care and support from distance. This is made possible by providing sensors in the packages which moderate impairment towards problematic situations rapidly. Thus, telecare provides secured substantiation and lifestyle examination by having a defensive role in indentifying a weakening spot at the early stage. Telecare is not only a warning system but also a preventive system whereby the people are kept under consistent communication. The telecare services like pendent alarm, mobile carephone system, pill dispenser, telephone prompt service, and movement monitoring and fall detector are used in common with multi-lingual service to cover a wide range of people.
Telenursing is the blend of telecommunications and nursing services whenever a substantial physical distance exists between nurses or between patient and nurses. Where distance is decisive factor in delivering health care services, the professionals use information and communication technologies for effective diagnosis, research and education in healthcare in the welfare of the community at large. Telemedicine relates to delivery of service by the physicians alone while telehealth relates to delivery of service by healthcare practitioners like physicians, dentists, surgeons, nurses, therapists, phychologists, pharmacists and other para-professionals in the field of medicine.
Telenursing is the application of technology in delivering nursing care and conducting nursing practice. Tele-intensive care unit helps the practice telenursing through leveraging the resources available by using technology. Telenursing in India is emerging due to increased number of old aged and ill population, wider distance between patient and health care centre, concern for cutting costs of health care and thinly populated regions. Physicians develop protocols which can be used by nurses to assess the client over telephone and assists them to suggest permitted interventions. Nurses also conduct physical visits to homes of clients and the clients can be supervised by nurses in homes and agencies.
Telenursing: Need recognition:
With the racially and culturally diversed population and large geographical area, it is very difficult to provide for essential healthcare. Telenursing is considered to the best solution to this hindrance and guarantee an effective, inclusive and comprehensive association of trust within the different communal population. Centre for Connected Health Policy (CCHP) is established in 2008 by California Health Care Foundation and it is integrating telehealth into the healthcare systems through research and practices. According to Centre for Connected Health Policy (CCHP), telemedicine is the traditional clinical diagnosis and monitoring delivered through technology and telehealth is the diagnosis, health education and other relevant areas of healthcare. According to ASSOCHAM report in the year 2016, the telemedicine sector’s market size stands at 15 million dollars and it is expected to double to 32 million dollars by year 2020. Improving patients’ experience is the main reason to use technology in healthcare.
Telehealth practice in India is taking place over a decade with the help of satellite communication. Four hundred telemedicine nodes are set up in India by Indian Space Research Organization (ISRO). Teleconsultation, tele-education and observation of diseases are the major areas covered by ISRO. Integrated services digital network (ISDN) was used to demonstrate the first mobile e-health system in the year 2001. In the year 2005, satellite based mobile e-health system was developed and subsequently, mobile tele-ophthalmology and mobile tele-oncology systems were deployed. With the advent of wireless mobile communication like 3G, WiMax and multimedia, the follow-up and appointment scheduling were done between health care providers and care seeking people through mobile phone. Decreasing prices of electronic devices and its ease of use make the mobile technology as a suitable method in telemedicine projects in rural areas. But the cost of network and cost of incorporating telemedicine in network is too high. This makes the adoption of technology as tough in low economic environment in India. The need of the hour is the low-cost, delivery of healthcare at gross root level with a continued telemedicine services.
The revenue from medical tourism is continuously increasing in the past decade and India stands number four after Mexico, Thailand and CostaRica. There exists a chance to proceed in this field as there is insufficient expertise and facilities in Africa and existence of expensive treatments in America and Europe. India has 0.7 doctor to 1000 people in comparison to west where the best countries have 3 to 4 doctors per 1000 people.
Central Bureau of Health Intelligence of India states that 1305.95 people were served by one doctor. The ratio of bed to patients is 1:350 in United States, 1:85 in Japan and 1:1050 inn India. To meet the standards of developed nations, India needs 1,00,000 beds in this decade with an investment of 50 million dollars. India has to increase its spending in health care information technology to extend patient-centric service. The scarcity of qualified health care professionals is considered to be the major challenge in health care industry. India’s ratio of 0.7 doctors and 1.5 nurses per 1,000 people is considerably lower than World Health Organization average of 2.5 doctors and nurses per 1,000 people. The situation is still worsened by the scarcity of paramedical and administrative professionals along with their concentration in urban areas which constitute only 30% of the Indian population. The patients from rural and semi-urban areas receive medical services only from unqualified medical professionals. The pharma industry in India need 1.54 million doctors and 2.4 million nurses to equate with the average of the world.
Indian health care sector is the largest sector in terms of revenue and employment generation and it covers hospitals, medical devices and equipment, medical outsourcing, telemedicine and health insurance.  Pharma players in India are presently using e-commerce to resolve the problems in retail pharmacy indicating that the information technology plays a nourishing role not only in health care sector but also in allied pharma retail sector. Advances in health care information technology helps to solve the deficiencies in healthcare infrastructure and shortages in medical professionals. Telemedicine extends consultation and diagnostic facilities at low cost to remote areas through internet and telecommunications and fill the rural-urban gap in India. The launch of 4Gand improved mobile technology infrastructure has helped the adoption of mobile health (mHealth).
Indian government has announced a new health policy by aiming to decreasing malnutrition, increasing immunization, modernizing government hospitals, improving use of life saving medicines and combating the use of tobacco among public. The government aims to have a comprehensive health care system which is considered to be accessible, affordable with less out of pocket expenses. Indian government has given importance to health care sector in 2014-2015 budget. The announcements made in the budget include the starting of four medical institutions with the status of All India Institute of Medical Sciences, staring of 12 more government medical colleges, raising of foreign direct investment limit in medical insurance business to 49% and expanding broadband connections in rural areas to have access of telemedicine. A new corpus fund of 1.7 billion dollars was sanctioned to start-ups, setting up of 15 model rural health research centres and biotech clusters to develop innovative technologies in health care sector. 
A National Health Regulatory and Development authority was suggested by the expert group of planning commission of India to supervise health care providers in private and government sector in 2011. The same expert committee also suggested establishing a National Health and Medical Facilities Accreditation Authority to define health care facility standards.
Indian health care sector is capital-intensive with longer pay back periods and it needs 60-70% of the investment in infrastructure. The sector also needs capital investment to upgrade, maintain, replace and expand medical equipment facilities. The health literacy is used to express the capacity to deal with health information and health-care services.  The health care sector should leverage information technology to improve the quality of life, reduce human errors, reduce costs, and increase response timings and to achieve patient-centric health care systems. The Indian government should also concentrate in establishing medical colleges, training institutes to offer required doctors, nurses and other paramedical professionals.
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