EPFO APFC 2023 General Studies · Question 93 of 120

Correct — B, (b) Promotes the use of telemedicine. 'eSanjeevani' is the national telemedicine service of the Ministry of Health and Family Welfare — a cloud-based platform designed, developed, deployed and maintained by the Centre for Development of Advanced Computing at Mohali, on which a patient in one place consults a doctor in another over a video link. It runs in two arms, and knowing both is what makes the scheme easy to place. The first arm works doctor-to-doctor: an Ayushman Bharat Health and Wellness Centre acts as a spoke, where a community health officer sits with the patient and connects to a hub at which doctors and specialists are available, so that a village patient reaches a specialist without either of them travelling. The second arm works patient-to-doctor, allowing a person to consult a doctor from home through an outpatient service delivered online. The platform is described as the world's largest telemedicine implementation in primary health care. Every element of that description is the delivery of a clinical consultation at a distance, which is what telemedicine means, so the objective the scheme serves is the promotion and delivery of telemedicine. The other three options are all real activities of the health administration, and each was carried out by something other than this scheme. Building a database of people affected by an epidemic, maintaining a national clinical registry for research and issuing health advisories to the public are respectively a surveillance function, a research function and a communication function. A teleconsultation platform performs none of them. The distinction the question is really drawing is between systems that move information about patients and a system that delivers care to a patient, and eSanjeevani belongs firmly to the second.

• (a)Creates a database of people affected by COVID-19 — This is a surveillance and record-keeping function, and it belongs to different instruments. During the pandemic the Government maintained case reporting through its health surveillance machinery, ran a contact-tracing application, and operated a separate platform for vaccination registration and certificates; none of those was eSanjeevani. The option is plausible because the timing of the two things overlapped — the patient-to-doctor arm of eSanjeevani expanded very quickly during the pandemic, when outpatient departments were closed and travelling to a hospital was itself a risk — and a candidate who remembers the scheme only from that period may associate it with the pandemic response in general. But the scheme is a consultation service, not a register. What it produces at the end of a session is a prescription for a patient, not a row in a national database of cases, and it was designed and launched to extend clinical consultation into rural India rather than to count anybody.
• (c)Establishes an electronic National Clinical Registry — A clinical registry is a research instrument. It systematically collects standardised clinical data on patients with a defined condition, across many hospitals, so that the course of the disease, the treatments used and their outcomes can be studied; India's national clinical registry for COVID-19 was set up under the Indian Council of Medical Research for exactly that purpose. Both the object and the sponsoring body are different from those of eSanjeevani, which operates under the Ministry of Health and Family Welfare and exists to connect a patient to a doctor in real time. The option is included because both are electronic, both are national and both are health-sector platforms, and a candidate matching on those surface features rather than on function can be drawn to it. The test that separates them is simple: a registry looks backwards at data about patients for research, while a teleconsultation service acts forward on a patient who needs advice now.
• (d)Efficient promotion of health advisories — Issuing health advisories is one-way public communication — a ministry telling the population what to do about a disease outbreak, a heatwave or a vaccination round — and it is carried out through the ministry's own channels, the press and general-purpose applications. A teleconsultation is the opposite kind of transaction: it is two-way, it is specific to one patient, it involves a registered medical practitioner exercising clinical judgement, and it ends in individual advice and a prescription rather than in general guidance. The confusion the option trades on is that both use digital channels to carry health information at a distance. The useful distinction to carry away is between information systems, which distribute or collect health information, and service delivery systems, which deliver care itself. eSanjeevani is the second kind, and it is that character which makes telemedicine the objective it serves.

Telemedicine is the delivery of health care services at a distance using information and communication technology, where distance is a critical factor — a doctor and a patient who cannot conveniently be in the same room are connected so that consultation, diagnosis and advice can still take place. It works in three modes. Synchronous telemedicine is a live interaction by video or telephone. Asynchronous, or store-and-forward, telemedicine transmits recorded clinical material such as images, traces or reports to a specialist who examines them later and responds. Remote monitoring collects physiological data from a patient over time and sends it to a clinician. The organising design in most public systems is hub-and-spoke: peripheral facilities with a health worker but no doctor act as spokes, and a hub staffed by doctors and specialists serves many spokes, which is how scarce specialist time is spread over a large rural population. India's public telemedicine effort is built on that model through eSanjeevani, which runs both a doctor-to-doctor arm anchored on Ayushman Bharat Health and Wellness Centres and a patient-to-doctor arm reaching people at home. The wider policy context is the digital health architecture the country has been assembling — the Ayushman Bharat Digital Mission with its health accounts and registries, the health and wellness centres delivering comprehensive primary care, and the insurance arm of Ayushman Bharat for secondary and tertiary treatment. The practice of telemedicine was also put on a clear professional footing when Telemedicine Practice Guidelines were issued in 2020, giving registered medical practitioners an authoritative framework for consulting, prescribing and keeping records remotely.

The polity and governance block of this paper regularly names a government scheme and asks what it does, and the option sets are built from other real government activities in the same sector rather than from invented ones. That is what makes these items harder than they look: a candidate cannot eliminate an option because it describes something that does not exist, since all four describe things that do. The elimination has to be done on function and on sponsoring body. The reliable method is to decode the scheme's name and its sector, then ask which of the four described functions a platform of that description could actually perform. Here the name itself gives away nothing, but the sector is health and the four options divide neatly into surveillance, care delivery, research and communication, so the question becomes which of those four a named platform belongs to. The second thing this item rewards is resisting the pull of the pandemic. A great many health-sector schemes became prominent in 2020 and 2021, and a candidate who dates a scheme to that period tends to assume it was part of the epidemic response. eSanjeevani did grow enormously in those years, but it was built to take specialist consultation into rural India through the health and wellness centres, and it continues to do that. The paper tests scheme identification often enough that a one-line note against each major scheme — ministry, objective, delivery mechanism — is worth more than deeper reading on any one of them.

• eSanjeevani is the national telemedicine service of the Ministry of Health and Family Welfare, a cloud-based platform designed, developed and maintained by the Centre for Development of Advanced Computing at Mohali, and it is described as the world's largest telemedicine implementation in primary health care.
• It runs in two arms. The doctor-to-doctor arm uses Ayushman Bharat Health and Wellness Centres as spokes, where a community health officer sits with the patient and connects to a hub of doctors and specialists; the patient-to-doctor arm delivers an online outpatient consultation to a person at home.
• Telemedicine means the delivery of health care at a distance using information and communication technology, and it operates synchronously by live video or telephone, asynchronously by store-and-forward of recorded clinical material, or continuously through remote monitoring of a patient's physiological data.
• The hub-and-spoke design is what makes the model work in a country with few specialists and a dispersed rural population: one hub serves many spokes, so specialist time is shared across a wide area without either the doctor or the patient travelling.
• The practice of telemedicine in India was placed on a clear professional footing when Telemedicine Practice Guidelines were issued in 2020, giving registered medical practitioners a framework for consulting, prescribing and maintaining records at a distance.
• The scheme belongs to the service delivery side of health administration rather than the information side. Disease surveillance databases, clinical registries maintained for research and the issue of public health advisories are all separate functions carried out by other instruments and, in the case of research registries, by a different body.

• Assuming that a health scheme prominent during the pandemic must have been part of the epidemic response. eSanjeevani grew rapidly in those years but was built to extend clinical consultation into rural India and continues to do so.
• Matching options on surface features such as being electronic, national and health-related. All four options here describe genuine government activities, so the elimination has to be done on function and on sponsoring body.
• Confusing a clinical registry with a service. A registry collects standardised data about patients for research; a teleconsultation platform delivers advice to a patient in real time.
• Treating the issue of health advisories as equivalent to telemedicine. Advisories are one-way public communication, while a teleconsultation is a two-way clinical transaction with an individual patient.
• Overlooking that the scheme has two distinct arms. Questions sometimes describe only the doctor-to-doctor arm or only the patient-to-doctor one, and a candidate who knows just one of them may reject a correct description of the other.

Government schemes are asked in this paper in three ways. The commonest is scheme identification of the kind set here: the scheme is named and four objectives are offered, all of them real government functions in the same sector. The second reverses it, describing an objective and asking which scheme serves it, which requires the same one-line notes read in the other direction. The third asks an administrative detail — which ministry runs the scheme, which body implements it, whether it is a central sector or a centrally sponsored scheme, or which year it was launched. The efficient preparation is a single table of the major schemes with four columns only: name, ministry, objective in one clause, and delivery mechanism. Depth on any single scheme is rarely rewarded, but confusion between two schemes in the same sector is punished every time, so the notes should be written to separate neighbours — the teleconsultation service from the digital health mission, the insurance arm of Ayushman Bharat from its primary care arm, the surveillance system from the research registry.

No directly related past PYQ was found.

• practice — not a real PYQ

  The doctor-to-doctor arm of India's national telemedicine service works on a hub-and-spoke model. In this arrangement, the spoke is

  • (a)the Health and Wellness Centre where the patient and a community health officer are present
  • (b)the district hospital at which the specialists sit
  • (c)the data centre on which the platform is hosted
  • (d)the patient's own home, from which the consultation is initiated

  Answer(a) the Health and Wellness Centre where the patient and a community health officer are present — the spoke is the peripheral facility that has a health worker but no doctor, and it connects to a hub where doctors and specialists are available. The second option describes the hub, and the fourth describes the separate patient-to-doctor arm, in which the patient consults from home rather than through a facility.

• practice — not a real PYQ

  In telemedicine, which one of the following best describes the store-and-forward mode?

  • (a)A live video consultation conducted between a patient and a doctor in real time
  • (b)Transmission of recorded clinical material such as images or reports to a specialist who reviews it later and responds
  • (c)Continuous transmission of a patient's vital signs from a wearable device to a hospital
  • (d)Automated dispensing of medicines at a kiosk on the basis of a digital prescription

  Answer(b) transmission of recorded clinical material such as images or reports to a specialist who reviews it later and responds — this is asynchronous telemedicine, so called because the two parties are not connected at the same moment, and it is what makes teleradiology and telepathology possible. The first option describes synchronous telemedicine and the third describes remote patient monitoring, which are the other two modes.