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Is telehealth the future of medicine in Pakistan?

From providing swift treatment, to safeguarding medical practitioners and channelizing health records, the fight against covid-19 might have permanently revamped the healthcare system
by Arooj Khalid & Kunwar Khuldune Shahid

The healthcare sector has remained resilient in the face of the covid-19 pandemic, managing to address the fast-growing burden of coronavirus infections, along with the existing multitude of patients.

This resilience, however, has come at the cost of overwhelmed healthcare professionals, many of whom contracted and succumbed to the disease they were vying to treat.

Various limitations have been delineated in global healthcare systems. As is the case with other sectors, technology has been tasked with finding the solutions. In medicine, these can come from a wide gamut, ranging from robotic surgeries to precision medicine.

Adoption of such practices has gradually approached war-footing during a pandemic, where the use of contactless technologies has been urged to ensure social distancing, in turn curbing the spread of the virus.

On the frontline

Despite standing ovations and tributes to healthcare professionals, the likeliness of doctors, nurses, and other hospital staff contracting the virus from patients remains high. Hundreds of health workers around the world have already lost their lives while serving the public.

Within two months of fighting the coronavirus outbreak, 253 Pakistani healthcare professionals had tested positive for the virus, a number that continued to rise as time went by. Pakistan has already lost 58 healthcare professionals to the fight against covid-19.

The lack of protective equipment and preventative measures in hospitals has been a concern since the beginning of the pandemic, prompting regular protests.

While there have been promises of relief to the healthcare staff, and an increase in their stipends, the lack of awareness among the masses has driven the doctors to be a victim of mental stress and even physical harm, which has aggravated the situation against already overwhelmed health professionals.

To add to this, hospital visits are discouraged during the pandemic even if a patient thinks they have covid-19. Patients, whether covid-19 related or not, are advised to stay home until it is absolutely necessary to visit the hospital. This practice endangers the accessibility to traditional healthcare for many patients in Pakistan.

Medical experts have long advocated for telehealth. The covid-19 pandemic has now brought it to the forefront.

Credit: Dawn

Remote cure

A Frost and Sullivan study maintains that covid-19 will create space for the development and implementation of a wide range of health technologies, and virtual care systems. According to researchers, the industry will grow up to seven times in the United States in the next five years.

The Asia-Pacific Front Line of Healthcare Report 2020 similarly predicts the onset of a new age of telemedicine where consumers demand more control over how they receive healthcare services. The healthcare system must transform itself in order to treat patients without face to face contact using digital tools and platforms.

The survey also suggests that the shift in demographics, rising cost of healthcare, dynamic regulatory requirements, and technological advancements, are major factors in the transforming nature of healthcare systems in Asia-Pacific.

Pakistan’s digital handicaps, such as lack of internet connectivity, distrust in digital platforms, and dearth of online literacy, however, continue to be a roadblock for telehealth accessibility. Even so, the step by step integration of such a system has been ongoing, with covid-19 accelerating its rise, as global organizations identify the need for telehealth in Pakistan.

Last week, Lahore-based health-tech startup secured a $250,000 seed funding.    Ventures such as Oladoc, Marham, Sehat Kahani, among others, have been promoting the use of digital platforms to bolster healthcare, with the covid-19 pandemic now creating more tangible space to develop virtual health facilities.

Over 20,000 doctors are registered at the digital portal. After the spread of covid-19, the digital appointments through their platform has increased by up to 400%. Currently, is conducting around 10,000 online consultations per month.

Similarly, the government of Pakistan launched several chatbots and awareness campaigns to encourage the masses to stay at home, including a telehealth portal for coronavirus related checkups.

With outpatient departments (OPDs) and other regular operations shut down in many parts of the country, as the coronavirus infections rose and strained the government hospitals, doctors have been asked to operate virtually through a software application.

The doctors can access this portal by using their personal logins and video calling or voice calling with a patient, whereas patients can contact a doctor using the government helpline, website, or mobile application.

Even so, despite the growth of health-tech, practitioners say there remains reluctance to embrace telehealth in Pakistan.

Contextualizing technology

Ehsan Imam, co-founder and CEO of tells MIT Technology Review Pakistan that he faced substantial resistance from patients and doctors in the implementation of the virtual telehealth system. This was remedied by promoting awareness and the benefits of such a system and conducting virtual camps with free consultations in order to allow citizens to test it.

“The prevalence of a telehealth system in Pakistan is only possible if it is integrated gradually. But in the next five to 10 years, the country will observe a mass reformation of the healthcare system with multiple applications of telehealth,” says Imam.

While the pandemic has sped up this process, critics say it will take some time for the masses to trust the virtual system.

According to Imam, telehealth requires special digital platforms where certain protocols must be taken. For example, ensuring the safety of the patient’s data is a major concern. Such software must be end-to-end encrypted and follow security guidelines.

Another concern is the medical history of the patient, which needs to be made available to the doctor during a consultation. The developed software doesn’t only need to be specific to the needs of healthcare, but also the context of where it is being implemented.

“We had to build a system that was specific to the Pakistani context, which was a software that would run on low bandwidth, and automatically switches from a video call to a voice call if the internet speed decreases,” he explains.

Muhammad Jalil, the CEO and founder of AI firm Moutainise, which uses data science to provide solutions to a multitude of industries, including medicine, maintains that the healthcare sector can benefit from artificial intelligence that contextualizes and discerns the growing needs of patients.

“With AI each step of the [patient’s] journey can be plotted and deeply analyzed to understand what they want and how [tech] capabilities and resources can be designed to meet their needs,” says Jalil.

Jalil maintains that machine learning and data analysis ensure that the best medicinal decisions are taken. He further underlines that while a pandemic makes it easier to capture the obvious medicinal trends, the overflowing data needs to be thoroughly discerned.

“The [telehealth] patterns will allow AI to capitalize on the wealth of data to devise future strategies [post covid-19],” he says.

Credit: Aljazeera

Techtonic shift

Experts underline that the global fight against covid-19 has positively impacted the health-tech space in a matter of weeks around the world. Cleveland Clinic went from under 5,000 telemedicine visits a month to over 60,000 in March this year.

Toronto-based Dot Health, which collects the individual’s entire medical data in one place, underlines that the world of health records has also been shaken by covid-19.

Dot Health CEO and Founder Huda Idrees

Typically, our biggest competition is health records departments inside of hospitals and clinics and the dreaded fax machine. With the pandemic in full force and the need to care for people quickly and efficiently at an all-time high, health care institutions are understaffed and overworked and have realized the need for adopting technology to optimize basic processes like health record data transfers.

Idrees maintains the rise of telemedicine goes hand-in-hand with the need for access to patient health information: both, for the patient as well as their care providers. She says no other industry has fought the adoption of technology more than healthcare.

The Dot Health founder believes Pakistan might actually be in an advantageous position when it comes to healthcare innovation. “Our mobile infrastructure and affordable Internet data packages make connecting with the health care consumer easier than most markets. To layer on top of that, we have an incredible set of health care educational institutions that have led the charge in responding to patient health crises in the country time after time,” Idrees says.

She further alludes to mistakes that, unlike other parts of the world, Pakistan hasn’t made, especially with regards to technological revamp. Idrees cites the example of Canada mandating Electronic Medical Records systems without any condition as to the portability of data. Avoiding such mistakes could help Pakistan herald a health tech revolution.

“I would love to see our provincial and federal layers of government mandate open data standards when it comes to health records. This has the power to create a brand new market in Pakistan when it comes to health technology,” she suggests.

Tele blues

During the pandemic, real-time access to basic test data carries wide-ranging significance, from illustrating nationwide infection numbers and to helping plan reopening of economies.

With medical data carrying a precipitously rising paramountcy, practitioners have urged the shoring up of medical record privacy and securing the information exchanged between the doctor and patient. However, doctors ring alarm bells over the lack of awareness with regards to data privacy, given the lack of digital literacy in Pakistan.

Dr. Saima Khaliq, a dermatologist at Jinnah Hospital Lahore, recounts that during her practice, which has now been shifted to a virtual platform instead of the general OPD, a common challenge is patients not being able to “figure out how to turn on the video, because they are not familiar with the platform.”

Other issues she faces include the lack of internet speed, which causes disruption in the consultation, improper devices or environment at the patients’ end, with household noise often making it difficult for doctors to ask questions, examine the patients or diagnose them.

“While some patients were content with the telehealth services being offered, many have expressed dissatisfaction with the virtual consultations and they insist on in-person consultations,” she says.

Dr. Khaliq does not believe telehealth can be prevalent in the Pakistani healthcare system, in the near future. “However, it can be a development to consider for the stakeholders,” she maintains.

However, Huda Idrees is confident that Pakistan’s health industry will continue to incorporate technology beyond covid-19. “Caring for patients virtually… coupled with easy, simple, seamless access to patient health records – COVID-19 may have tricked us into accidentally creating the perfect health care system!”