On December 31, 2019, the Chinese authorities informed the WHO about the emergence of a new viral pneumonia epidemic, COVID-19- in the Wuhan city of Hubei province of China. It marked the beginning of the greatest global health care crisis our generation was going to witness. Since then, in less than four months, the infection has spread to almost every country in the world, affecting more than 1.4 million individuals and causing close to one lakh deaths. And, this just seems to be a beginning as there are hardly any signs of this pandemic relenting.

Though this virus is not as virulent as other coronaviruses, its highly infective nature such that even asymptomatic individuals can be a source of transmission, has resulted in rapid transmission of this infection beyond geographical boundaries. Modes of virus transmission are predominantly during close contact through respiratory droplets, and fomites. Hand hygiene and physical distancing are the most important measures to reduce the risk of infection and thereby interrupting the spread of the virus.

In this time of pandemic where COVID-19 has inflicted havoc on the healthcare system and when social distancing is of utmost importance to prevent the viral transmission, telemedicine has emerged as a promising technology to provide clinical services. Till a few months ago, only a small subset of physicians and hospitals were using telemedicine and was limited for patients in rural and remote areas. Laws regarding teleconsultation were also restrictive. But the COVID-19 outbreak has changed the perspective of health care providers and policymakers.

As this public health crisis is escalating, telemedicine is rapidly establishing itself as an effective and sustainable method to slow this virus transmission among health care workers and patients by preventing overcrowding in the hospitals. Moreover, with most of the countries now in a state of lockdown, telemedicine remains the only option to provide care to patients who are unable to visit the health care facilities. As we have experienced during this short period, telemedicine can certainly bridge the gap between the patient and the physicians facilitating uninterrupted patient care during these troubled times

Multiple technologies can be used to deliver telemedicine consultation which can be in the form of video consultation, audio communication, or through text and media sharing (text messaging, WhatsApp, email). This can be further supported by the use of various medical devices such as digital thermometer, blood pressure instrument, pulse oximetry device, etc. for remote patient examination, even in the absence of additional human presence.

Telemedicine can play an important role in two distinct scenarios- caring for suspected COVID-19 patients and for those with chronic non-COVID illnesses. Most of the people who develop flu-like symptoms do not have COVID-19 and even those who have COVID-19, develop only mild illness. With the help of telemedicine, medical staff can remotely ascertain whether care is urgently needed, or if the patient can continue to self-monitor symptoms at home while recovering.

The patients who are continuing with home care can be followed up very closely through telemedicine and appropriate actions can be taken immediately if there is any change in the clinical state. This will reduce interaction between health care providers and the infected but mildly symptomatic individuals, thus minimizing the risk of COVID-19 transmission.

Perhaps the greatest utility of telemedicine is for patients suffering from chronic illnesses who can continue to receive care from home, without entering medical facilities, minimizing their risk of contracting the virus. As COVID-19 can be very serious and even fatal for the elderly age group, those who are immunocompromised and those with other co-morbidities, it is paramount to ensure that such patients do not get exposed to this infection unless a visit to the health care facility is absolutely unavoidable.

When patients need to visit the hospital, telemedicine can again be used for tele-triage or forward triage which means that patients can be divided into a likely infected and not-infected group so that appropriate measures, to minimize the risk to healthcare workers and other patients, can be taken even before the patients arrive in the hospital.

There can be additional advantages of telemedicine. Many healthcare workers exposed to COVID-19 or with confirmed COVID-19 have to be quarantined resulting in loss of workforce capacity of the healthcare system in this crucial time. Quarantined physicians with mild or no symptoms can still be helpful in the healthcare system by working remotely with patients, giving the second opinion for severe cases, teleradiology and online trainings for healthcare workers, thus reducing the burden from physicians who are performing in-hospital duties. Telemedicine can also be used as a mental health support tool for patients and health workers.

Despite these advantages, this technology is not devoid of challenges. Firstly, healthcare delivery involves several health professionals including nursing and paramedical staff who contribute significantly to patient care. Unfortunately, telemedicine cannot replace them all. Secondly, as specifically applicable to COVID-19, the cornerstone of management of this pandemic is widespread testing, which traditional telemedicine may not be able to facilitate.

Thirdly, the lack of our trained medical personnel at the patient’s end may lead to miscommunication and incorrect treatment leading to untoward complications. This could have serious medicolegal implications as well. For the same reason, governmental authorities have, in the past, put several restrictions.

Fourthly, telemedicine experience also depends heavily on the availability of good infrastructure, most importantly good connectivity, which may not be available in remote rural areas.

And finally, it is also likely that the hospital telemedicine services get overwhelmed due to sudden spurt in the demand for teleconsultations while the systems are not geared to cater to this load.

The ongoing COVID-19 pandemic crisis has presented before us a unique opportunity to learn from these challenges and overcome them. The hospital systems need to ramp up infrastructure and allocate additional resources to prepare for the increased demand. Technical aspects also need to be taken care of. For example, acoustics of the telemedicine rooms should be optimized and better internet connectivity needs to be ensured. Healthcare providers need to be trained to use telemedicine channels to be able to efficiently assess a patient’s clinical status remotely and provide appropriate guidance.

It is also important to identify and liaise with local trained non-medical or paramedical persons who could help patients seek teleconsultation and facilitate the process. Local diagnostic centers also need to be identified that can provide required diagnostic facilities, including COVID-19 testing, accurately and cost-effectively, as and when needed.

Most importantly, in view of the urgent requirement of telemedicine services due to the COVID-19 pandemic, the existing telemedicine guidelines need to be revised to enhance uptake of this technology while also safeguarding interests of all the stakeholders. The recently released revised telemedicine by the National Medical Council of India is a welcome step in this direction.

The importance of telemedicine in the present scenario is underscored by a new WHO policy emphasizing that telemedicine should be one of the alternative models for clinical services and clinical decision support. Indeed, telemedicine could never be more needed and more appropriate than at present during this global health crisis. COVID-19 has emerged as a huge obstacle but also an unprecedented opportunity to transform our health system in numerous ways. Digitization and telemedicine are going to be the most important steps to transform our health system.