What can we learn from over 20 years of telemedicine programs in India? : Findings from a systematic review of telemedicine programs initiated from 2000 to 2023 (Preprint)
Authors: Ummer Osama , Sarangi Anjora , Mendiratta Jai , Khanna Arjun , Mohan Diwakar , Scott Kerry , LeFevre Amnesty 
Published: July 2024

BACKGROUND

India is home to some of the world’s earliest and largest telemedicine programs. Since the first telemedicine programs emerged in the 1990s, the growing digitization of health care services has highlighted the potential for telemedicine services to increase access to timely and appropriate care seeking, corresponding to improved health outcomes and cost savings to the individual and health system. Despite this potential, little is known about the varied typologies of telemedicine programs providing services in India, their design and model characteristics, scale of implementation and the available evidence on their impact.

OBJECTIVE

This systematic review aims to identify the characteristics of telemedicine services in India, including type of telemedicine model, details on the timing of delivery, health services provided, and service delivery channel. Additional details are extracted on the scale of implementation, software used and evidence gathered, including impact on care-seeking, health outcomes, and cost.

METHODS

Telemedicine programs in India were identified through searches of google, the Google Play Store, three major scientific databases (Embase, PubMed and Scopus), and a reference review of identified peer review articles. Included programs were restricted to those implemented in India between January 1, 2010 and 4 July 2023 which included humans, and were published in the English language. Once identified, articles were imported to Covidence and the process of abstract screening initiated using two independent reviewers and a third person to resolve conflicts. Full text articles were screened and data extracted into Microsoft Excel.

RESULTS

2368 articles were identified; 151 of which were included for the full text review and data extraction. From the 151 studies a total of 115 unique programs were identified and further classified based on scale – moderate to large (n=89), and small (n=26). Among moderate to large scale programs (n=89), 75 used specialized software and 15 non-specialized software such as WhatsApp. On average, three new telemedicine programs were initiated annually from 2000 to 2019 and the growth of new programs occurred predominately in the private sector. Evidence was available for 43% (32/75) of the programs. While 21 programs reported on some facet of the quality of care, no studies systematically assessed quality of care. Where structured surveys were reported, questions were often leading, employed longer Likert scales response options, and asked respondents about broad constructs subject to varied interpretations (e.g. quality of care, satisfaction). Additional details on model characteristics, reach, and impact are presented.

CONCLUSIONS

The widespread proliferation of telemedicine services in India has much potential to improve access to and continuity of timely and appropriate care-seeking for health. However, improved evidence demonstrating the impact of telemedicine services on care-seeking, quality of care, cost and health outcomes is needed.