Video consultations for triage of patients with covid-19

Greenhalgh and colleagues discuss the potential use of video consultations for covid-19 and outline some of the system level challenges for implementation and scale-up.1 Despite the limited evidence, video consultations are widely used in resource limited settings with robust telecommunication networks and a large number of citizens who use smartphones.

In India, for example, there are several health start-ups offering video consultations, primarily as a triage tool providing medical advice and guidance on referral. Most of these video consultations and referrals are external to the public health system; nearly 70% of healthcare in India is provided by the private sector.2 Testing for covid-19 is currently only available at designated government laboratories. In a fragmented health system, video consultations could be the first line of contact between a person with suspected covid-19 and the health system. Video consultation platforms could be mandated to trigger notifications on potential cases that need further evaluation and confirmatory testing for covid-19. This would help strengthen the national disease surveillance network.

Healthcare facilities are likely to be overwhelmed with seriously ill patients in forthcoming days, so video consultation platforms would serve a complementary role. Embedding machine learning algorithms into the video consultation platform could facilitate the automation of triage, particularly for responding to queries and identifying those at risk using a symptom checklist and interactive voice interface that uses natural language processing capabilities.3 A potential model of remote home monitoring using video consultations and remote virtual presence has been described for chronic conditions such as end stage kidney disease.4 Covid-19 offers an unprecedented opportunity to augment the capacity of health systems using these digital health tools.