Andhra Pradesh: A Frontrunner in Adopting Telemedicine

Introduction

Access, equity, quality, and cost-effectiveness challenge health care systems around the world. These challenges have been exacerbated during the COVID-19 pandemic, when vulnerable health systems become overburdened. As a result, telemedicine and virtual care have emerged as valuable tools for patient care, ensuring the safety of both medical staff and the larger community during the COVID-19 pandemic. Moreover, with the advent of COVID the World Health Organization (WHO) has recommended telemedicine as an essential health care service.¹

Teleconsultation is being used to observe patients who must be isolated at home if they are  asymptomatic or have mild COVID-19 cases. Medical staff can also deliver primary care through telemedicine, triaging moderate and severe cases to ensure that external facilities remain available for those in greatest need.¹ One Indian state that has been a front-runner in adopting and implementing telemedicine is Andhra Pradesh.²

In addition to existing telemedicine programs like e-Sanjeevani and 104, the Dr. YSR Telemedicine program (This program was named after Y. S. Rajasekhara Reddy, former chief minister of Andhra Pradesh, who is popularly known as YSR) now provides outpatient department (OPD) services and assists the Andhra Pradesh health department in locating people with COVID-19 symptoms. Many people have taken advantage of this free service, initiated by the state government, which helps in significantly reducing the burden on OPDs.³

These complementary telemedicine systems brought welcome relief to patients with a range of ailments. More importantly, they also demonstrated efficiency in identifying and screening suspected cases of COVID-19. Health care can be delivered to people’s homes less expensively and with greater precision for many chronic disorders that require just a few specialist or hospital visits per year.⁴

Background

The Dr. YSR Arogyasri Health Care Trust, which manages the Dr. YSR Aarogyasri Health Insurance Scheme, now also includes the YSR Telemedicine program. The trust was set up by the Andhra Pradesh chief minister as an independent body. It is administered by a governmental officer in consultation with insurance and health care specialists.⁵

To staff the program, the trust recruited from those who already worked in the Arogyasri Scheme), training and sending them to offer telemedicine services.⁶

How was this promising practice implemented?

“The program aims to ensure uninterrupted medical consultation to every single patient along with provision of home delivery of drugs for all common ailments and to pick up any patient with symptoms that might be indicative of coronavirus infection and quickly get help to the doorstep of the patient.” —Dr. D. Raghunatha Rao, Founder & Director, Homi Bhabha Cancer Hospital & Research Center⁷

YSR Telemedicine⁸

In April 2020, Andhra Pradesh rolled out the YSR Telemedicine facility to make doctors available for COVID-19-related OPD services. YSR Telemedicine service assisted the state health department in locating people with COVID-19 symptoms in Andhra Pradesh. To access the service, patients dialed the toll-free number 14410, which was set up specifically for the telemedicine program. By mid-April 2020, 286 doctors and 114 other staff were trained and ready to offer their time as volunteers. The service was provided in three shifts from 8 a.m. to 6 p.m. daily. Within the first four days, the service had already received an impressive response: 8,243 people called in for medical advice, and over half received a doctor’s assistance.⁹

The workflow of YSR Telemedicine program was organized in three stages:

Stage 1 – Gather details

Those who wanted to use this service signalled their request by calling 14410 and promptly hanging up. They received a call back immediately from a trained staff member, who recorded the caller’s name, age, location, any symptoms of illness and other relevant data. The caller then received a unique identifying number for future reference. 

Stage 2 – Determine tests and medicines

Each patient’s details were forwarded to all system doctors. One doctor then connected with the patient through either telephone or video chat and advised them of which tests they needed. Based on the patient’s condition, the doctor might also prescribe medications.

For patients whose symptoms indicated COVID-19, they were classified as “suspected cases” and notified of their status via text message (SMS). Patients with severe cases were referred to either a nearby hospital or a prearranged isolation facility.

Stage 3 – Compose suspect lists

The YSR Telemedicine facility built a list of suspected cases from the data it had collected. YSR Telemedicine sent this list to district collectors and health department officials, who prepared a complete treatment plan for each patient. They sent prescriptions to the doctors at the primary health center level. They packed any needed medications separately and had accredited social health activist (ASHA) workers, auxiliary nurse midwives (ANMs), and village ward volunteers  deliver the packages to the patients through.

eSanjeevani

The telemedicine service eSanjeevani was introduced in August 2020 by the national government as a new element of its Digital India initiative. The web-based platform comprises two forms of service: doctor-to-doctor (eSanjeevani) and patient-to-doctor (eSanjeevani OPD).¹⁰ The COVID-19 pandemic prompted the development of eSanjeevani OPD, which rolled out in April 2020.²

In June 2021, even India’s rural and remote citizens began receiving OPD consultations, thanks to a collaboration between Common Services Centres (CSCs) and the Ministry of Health and Family Welfare. The eSanjeevani app links more than 374,000 CSCs. It offers video-based teleconsultation with doctors in local languages at no cost.¹¹

As of September 21, 2021, the eSanjeevani platform provided approximately 12 million consultations across India. Andhra Pradesh led the states with 3.7 million teleconsultations, followed by Karnataka (2.3 million) and Tamil Nadu (1.6 million).¹²

104 toll-free number to telemedicine¹³

India upgraded the 104 telephone Health Helpline during the second wave of COVID-19 in April 2021. As soon as May 2021, the 104 call center added teleconsulting. It has become a nationwide solution for all COVID-related queries and issues. The Andhra Pradesh health department brought in 5,523 doctors to offer teleconsultation through this center.

As of July 24, 2021, the 104  Health Helpline has provided teleconsultations to over 1 million people across the state.

“As we are appealing to the people to stay indoors to combat the spread of Coronavirus and are suspending the outpatient services, the telemedicine will enable extending outpatient services for those in need. Apart from providing the platform for consultation with doctors, we are also developing a uniform mechanism to ensure door delivery of medicines.” —B. Rajasekhar Reddy, Additional Chief Executive Officer, Dr YSR Aarogyasri Trust¹⁴

Supplementary material

Andhra Pradesh - A Frontrunner in Adopting Telemedicine.pdf

Sources

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