Tele-ICU: A new innovation in digital health

The Union Government has actively promoted digital health during its tenure. Arguably, no digital health service has been adopted with such fervour as telehealth – especially during the COVID-19 pandemic. One manifestation of digital health services during the crisis is the tele-ICU – and Kerala has begun implementing the tele-ICU for the first time.

Tele-ICU facilities, as explained in a 2013 U.S. paper, have

“An off-site command center in which a critical care team (intensivists and critical care nurses) is connected with patients in distance intensive care units (ICUs) through a real-time audio, visual and electronic means and health information is exchanged. The aim of this paper is to review literature to explore the available studies related to efficacy and cost effectiveness of Tele-ICU applications and to study the possible barriers to broader adoption. While studies draw conclusions on cost based on the mortality and Length of Stay (LOS), actual cost was not reported. Another problem in the studies was the lack of consistent measurement, reporting and adjustment for patient severity. From the data available, Tele-ICU seems to be a promising path, especially in the United States where there is a limited number of board-certified intensivists.”

Tele-ICUs are not a new concept in India. In 2005, J. R. Raja, B. K. Abraham, and N. Ramakrishnan, of the Department of Critical Care Medicine at Apollo Hospitals in Tamil Nadu state capital Chennai wrote how “most ICUs in India face a shortage of trained intensivists. Additionally, many ICUs lack an effective ICU care delivery model, which is pervasively effective and continuously managed by experts. On the other hand, telemedicine departments are growing rapidly and an excellent synergy exists between the Indian Space Research Organization and private players in this field. This allows telemedicine to be applied to optimise ICU patient care in several ways, which we outline here.” 

In the years since, this sentiment has far from dissipated. The plight of the Indian ICU only underscores it.

As explained in a 2016 study regarding the state of the ICU in India, “in the past two decades, there has been tremendous growth of intensive care medicine in India.” However, the ICU has taken a hit due to the outbreak of COVID-19 – the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or, simply, coronavirus. A paper published in August this year outlined the “challenges in the delivery of critical care in India during the COVID-19 pandemic”, which identified that

“Even if less than five percent of patients require critical care services, this will still rapidly overwhelm the healthcare system in a country, where intensive care services and resources are scarce and unevenly distributed. In this perspective article, we highlight the critical care preparedness of India for the pandemic and the associated challenges.”

In the Keralite city of Kozhikode, the state’s first tele-ICU has been launched. K. K. Shailaja, the state’s Minister of Health and Social Welfare, inaugurated the facility virtually on Sunday, November 1st. 

The facility was erected at the Government General Hospital (also known as Beach Hospital) in Kozhikode. There, services offered will seek to mitigate the effects of what Meitra Hospital chairman Faizal E. Kottikollon described as “a shortage of intensivists.” Kottikollon identified that “the pandemic has exposed the vulnerabilities at a global level.” 

As explained in the Times News Network report, the facility “is expected to enable round-the-clock monitoring of critical care patients at the designated COVID-19 hospital by a team of intensivists from the command centre of Meitra Hospital, which is a tertiary hospital…the [state] health department had set up a new ICU with 22 beds at Beach Hospital with the help of NHM [National Health Mission] funds in the wake of the Covid-19 pandemic. Meitra authorities have installed high-definition cameras and software at the general hospital ICU and have connected it to their command centre for 24-hour monitoring of patients.” 

Telehealth services are being adopted at a rapid pace during the COVID-19 pandemic. As previously reported by Health Issues India, “online health startups are seeing increased use by consumers in numerous countries. Commentators suggest that the coronavirus pandemic could act as a catalyst for greater adoption of telehealth on the road ahead.” 

So much is the invigorated interest in telehealth, Lav Agarwal – Secretary in the Union Ministry of Health and Family Welfare – urged the Government to expand access to the app eSanjeevani in September to further allow citizens to access the telehealth services the app provides. “India is the first country to start thinking about the integrated approach at a grand scale for institutionalizing Digital Health across India, which is truly unparalleled,” Agarwal said at the time.