A Tale of Two Technologies: TeleMedicine And Chatbots
Telemedicine’s rise in India shows how digital tools can expand primary care access in resource-limited settings
Two important pieces of technology–telemedicine and chatbots–have been at the forefront of efforts to use digital tools and technology to improve health services delivery in resource-limited settings. While efforts at integrating telemedicine into health systems go back at least a few decades, chatbots have made their way into health services delivery fairly recently, following progress in Natural Language Processing and Language Models. Understandably, the science and knowledge base around the implementation of these technologies into our health systems to improve health services delivery is meagre yet best.
A few recent studies shed light on these two important components of what appears to be an increasingly digital future of our health systems. Evidence from studies like these will help inform whether and how digital tools and technologies might be integrated into health systems to improve health services delivery.
First a study on the implementation of telemedicine to expand access to primary care: an evaluation of India’s national telemedicine program found that telemedicine services could be used to rapidly scale up primary care services across India. The study, published in Oxford Digital Health, analysed data on the adoption and utilisation of eSanjeevani–India’s government-led telemedicine platform. Since 2019, eSanjeevani has been rolled out across India, both directly to patients with access to the internet connection, but also through publicly owned primary care centers.
The analysis found that between 2019 and 2023, 163 million consultations were provided across India via eSanjeevani. Although the study did not cover the period beyond 2023, the authors do report that by the end of 2024, 276 million consultations were carried out on the eSanjeevani platform.
A few things stand out remarkably from the study: First, while most large scale telemedicine efforts elsewhere have been privately led, this is the most extensive government-led initiative at expanding primary care access in the world. Second, while the model appears to have gained traction with the COVID epidemic, it has stuck beyond the initial implementation, with patients using the service, not only for although consultations covered acute conditions like fever and diarrhea, but also chronic conditions like diabetes and asthma. Patients with chronic conditions also benefited from the fact that the eSanjeevani platform was able to integrate with India’s publicly owned patient record system.
Third, while eSanjeevani is directly available to patients, the provider-led model was responsible for more than 93% of the consultations. Through these centers, health workers used the eSanjeevani platform to provide patients clinical services beyond their expertise by consulting physicians with the required clinical expertise.
Fourth, the platform integrated well with India’s public health services delivery systems, allowing people otherwise unable to access to health services, including specialist care with access to such services. Of note,and remarkably, women formed a large portion of the patients who accessed care via the eSanjeevani platform.
While the study has not evaluated the quality or the outcome of the care provided, the fact that patients have seemed to like the services provided to the extent that almost a quarter of a billion consultations have occurred over a 5 year period speaks to the utility of such services. The challenge now will be in untangling the quality of services provided to see if this meaningfully improves patient outcomes. That may not be that hard to establish, when the alternative scenario was access to no care at all. Also, important will be to establish that these services can be scaled up in a cost-effective manner. These inferences will only be established after studies designed to look at granular outcomes.
Next week we will follow up with experience from the implementation of chatbots in improving access to health services, where the experience hasn’t been as positive.
Kiran Raj Pandey is a physician and a health services & systems researcher. Learn more about him and his work at kiranrajpandey.com.
 | A guest post by
|