It is a notable fact that no implementation models for Telemedicine systems to combat COVID-19 has been documented so far. This led to the design of a proposed model and the execution steps for implementation of the same. To enable this, the country is thought of to comprise three main sectors: (1) Rural Area, (2) Semi-Urban Area and (3) Urban Area.
(1) Rural Area Model:
The present healthcare system in the rural area is far inferior than desired. There are hardly a couple of dispensaries with utmost a single healthcare unit. In some villages the scenario is even worse with no medical facility at all. In case of critical emergencies, the patients have to travel for hours to reach a health-center, while a significant number of people restrict themselves to quack drugs owing to their inability to bear transportation or treatment costs. The poverty and illiteracy also results in enhanced belief in charms or superstitions. In the present situation of COVID-19, the scenario has even worsened. Lack of proper information, fear due to less knowledge and spread of rumors, lead the infected patient completely abandoned which confirms the death of the person without any treatment. Besides they sometimes ignore the government cautions completely which causes the rapid spread of diseases. To overcome this, a proposed model implementing Telemedicine system is presented (Fig. 1).
- This model is expected to comprise only one healthcare center with internet facility in every village consisting of a small team of health-workers. They should be properly trained in handling technology for the use of telemedicine.
- A proper listing of the symptoms of COVID-19 proposed by researchers is required to be communicated with the residents.
- A healthcare worker may be assigned to check the patients, having any non-infectious symptoms at their home, to reduce their chances of being affected.
- An individual who is experiencing any of the stated symptoms has to inform to the center.
- The patient can be diagnosed by a doctor from a distant hospital via video-conferencing. The doctor will address all the problems reported by the patient and may pose query for cross-checking.
- In case of a non-viral disease showing similar symptoms to coronavirus, the doctor may prove instrumental in deciding that after cross-questioning, and decides the severity of the patient’s condition which may lead to two possible outcomes:
Case 1: Patients with high percentage of doubt would be quarantined. Test sample will be collected and sent to labs. They would be isolated and treated until the test results arrive. Now, if the person’s test turns positive and have a severe condition, he/she will be sent to the hospital while for moderate condition can be treated by the health-workers with the aid of doctor’s consultation via telemedicine. Once they get completely cured, they may be released.
Case 2: Patients diagnosed with some other disease by doctor’s experience will be kept in isolation at the center. They will be treated with prescribed medicine by the doctor. Their conditions should be consulted regularly via telemedicine. Doctor can change/update the treatment depending on patient’s condition. After complete recovery the person will be released after consultation with the doctor.
Advantages of the proposed model:
- The system will formulate distribution of resources according to the need.
- Everyone facing the symptoms need not rush to the hospital which will decrease the chances of rapid spreading.
- Patients with moderate condition can be treated locally which will save huge cost as well as resources.
- Doctors can give advice to these patients via telemedicine while treating the critical patients physically, which will resolve the manpower problem.
(2) Semi-Urban Area Model:
Healthcare system in semi-urban area is in an organized condition consisting of one or two moderately structured hospitals and some pharmacies. A few private chambers operated by individual doctors are also available. Most citizens are literate and have moderate level of income to avail the cost of medical facilities. During pandemic or treatment of infectious diseases, situation gets difficult without proper communication hierarchy. People with symptoms are driven by sudden surge of fear and rush to the local hospitals. Hospitals face complications due to their limited infrastructure. Another setback is the prioritization of patients which may cause the sever patient to be deprived from their needs. Additionally, fear drives expenditure as people start spending to gather medicine beyond their need in advance. This causes unequal distribution of resources where one stores beyond necessities while the others get deprived of the basic necessities.
- Spreading the correct information among the citizens about the disease is the first step which will reduce fear, panic and lack of knowledge and will also improve the awareness about the symptoms.
- A single point-of-service (POS) facility may be constructed with the equipment to provide telemedicine service.
- Everyone should be advised not to avail any private facilities or hospitals at the first go and should neither self-diagnose to take medicines.
- Patients having symptoms other than that of coronavirus may avail private consultation to avoid chances of being affected.
- Patient having symptoms of COVID-19 should first report to the POS facility, where they will be checked by doctors via video-conferencing and will be questioned to take further decision. Doctor with their expertise will judge the disease and treat accordingly.
- This will lead to two further cases.
Case1: Patient, diagnosed with high chance of COVID-19, would be kept quarantined and sample will be tested. In case of positive result, he/she will be sent to the hospital and treated on emergency basis for severe conditions. Patients having moderate condition would be kept in hospital’s quarantine facility for further treatment.
Case2: Patients having similar symptoms but not diagnosed with coronavirus may be kept in isolation in that POS center. They will be treated by healthcare workers in consultation with doctor via telemedicine and be released upon complete cure.
- Person having a facility to avail telemedicine from their residence may do so via appointment through POS and be diagnosed with any of the above mentioned cases.
Advantages of the proposed model:
- Unnecessary expenditure on treatments will reduce while increasing cost-effective distribution of resources.
- Patients may be diagnosed from the comfort of their home which will reduce chances of inducing or spreading the disease.
- Doctors can treat patients simultaneously via offline and online solely on the basis of their need.
(3) Urban Area Model:
Healthcare facilities in urban area is quite promising. Enormous number of private and government hospitals in addition to a lot of private chambers are widespread and some of which are highly equipped with cutting-edge healthcare facilities. The urban area comprising mainly of the affluent society enables them access and availability to any or all possible healthcare services. In case of any infectious disease, like COVID-19, all rush to the hospitals for testing irrespective of their level of emergency and results in greater exposure to being contaminated. People also spend uselessly for some high-end facilities which are highly chargeable, and results in economic gap. In addition to this, the critical patients are often ignored and are forced to shift to different hospitals due unavailability of services.
- Assuming that a huge percentage of citizens have all the facilities to avail telemedicine from their home, yet they should be made aware about the symptoms of COVID-19.
- Most of the hospitals already have telemedicine facilities, otherwise they may construct a User Interface (UI).
- People having non-coronavirus symptoms should visit doctors privately, while those having similar symptoms should connect themselves to desired hospitals through common UI.
Case1: If the doctor diagnoses a high chance of COVID-19 then a healthcare worker will be sent to collect the sample. If the result is positive with serious condition then he/she should be admitted to the hospital and treated. If the condition is moderate even being positive, then he/she may be home-quarantined and treated via telemedicine. Medications can be delivered to the patient by local pharmacies.
Case2: If doctors conclude that the patient’s symptoms are due to other disease then he/she may also be treated via telemedicine from home. A time to time update must be sent to the doctor about that patient’s recovery.
For some people who cannot avail the facility of telemedicine from home, may visit a local facility with minimum requirements that will be constructed temporarily to avail telemedicine consultation. Accordingly the stated cases may occur and appropriate measures may be taken.
Advantages of the proposed model:
- The proper utilization of telemedicine will ensure the right distribution of resources while decreasing the initial rush.
- As the numbers of doctors are limited, it will ensure that the critical patients will get the proper treatment.
- Use of telemedicine will decrease the requirements of doctors to be present physically, hence some will be transferred to the semi-urban or rural area to attend the patient in need, maintaining even distribution of manpower.
- Above all, the expenditure of both the patients and the hospitals will decrease, making if cost-effective.