Overview
India has been a global leader in telemedicine well before the COVID-19 pandemic. A comprehensive scoping review of telemedicine services launched from 2000 to 2023 maps how India designed, scaled, and evaluated these digital health initiatives. The findings illuminate what has worked at scale, where challenges persist, and how policymakers and health systems can build on decades of experience to improve access, quality, and efficiency of care across diverse populations.
What Telemedicine Looked Like in India (2000–2023)
Telemedicine in India has evolved from satellite-based links connecting spokes and hubs to multinational private networks and government-supported platforms. Early collaborations, notably ISRO-driven satellite connections, linked rural facilities with urban specialists. By 2015 the ISRO network encompassed hundreds of hospitals across the country, a trajectory that paved the way for modern national platforms such as eSanjeevani, launched in 2019. Telemedicine models span patient-to-provider and provider-to-provider exchanges, with both real-time (synchronous) and store-and-forward (asynchronous) modalities. Platforms range from specialized software integrated with electronic records to more basic channels like telephone, SMS, or consumer apps.
Key Model Characteristics and Scale
Among large-scale Indian telemedicine services that used specialized software (n=75), the private sector led implementation (about 64%), with public and public-private partnerships accounting for the rest. Nearly half of these services operated on a patient-to-provider model, while others combined provider-to-provider functions or employed hybrid models. Real-time consultations were common (about 69%), underscoring a preference for immediate clinical input in many settings. Across the portfolio, services commonly offered multispecialty care, though a substantial portion focused on specific conditions such as ophthalmology or mental health.
Scale indicators varied across programs. Notable examples include eSanjeevani, which, by 2023, boasted tens of thousands of registered providers and hundreds of millions of interactions across India’s vast health system. Other large networks, such as Apollo and private hospital groups, reported millions of teleconsultations through widespread spoke networks. These figures reveal a dominant trend: telemedicine scales most effectively when linked to extensive hospital networks, a national platform, or both.
Evidence on Effectiveness and Outcomes
Evidence on effectiveness exists for roughly 43% of large-scale services with specialized software. Analyses span diverse designs, including quasi-experimental studies, cohort studies, and cross-sectional assessments. Some studies report improved follow-up retention, better disease management, or increased screening reach, while others show mixed or neutral results in population health indicators. Importantly, randomized trials are scarce in this literature, highlighting a need for more rigorous evaluations that can disentangle telemedicine effects from other health system factors.
Notable health outcomes include improved mental health follow-up in telepsychiatry programs and better chronic disease management in diabetes telemedicine initiatives. Some programs reported higher diagnostic concordance with remote specialists, while others found no significant population-level changes in certain maternal health or infectious disease outcomes. The heterogeneity of study designs and settings cautions against sweeping generalizations, but the trend toward improved access and acceptance is clear in many contexts.
Costs, Sustainability, and User Experience
Cost assessments across studies reveal a mix of perceived savings (travel, time, and workdays) and actual program costs. A subset of articles provides costing analyses and, in a few cases, cost-effectiveness or cost-utility estimates. The wide variation in perspectives, time horizons, and data sources limits cross-study comparability but consistently points to potential savings for patients and health systems when telemedicine complements rather than replaces in-person care.
From a user-experience standpoint, scale is often tied to software choice. Some services rely on specialized telemedicine software integrated with records systems, while others depend on readily available apps and even WhatsApp. The latter supports rapid uptake but raises concerns about data privacy and continuity of care. The review highlights the tension between rapid scale and rigorous data governance, a challenge that national programs like eSanjeevani—supported by digital health missions—must continuously manage.
Policy and Practice Implications
India’s telemedicine journey offers several actionable lessons:
– Scale succeeds where telemedicine is embedded within a broad health system, linked to districts, primary health centers, and tertiary hubs.
– Hybrid models can balance accessibility with clinical safety, expanding reach while preserving care quality.
– Robust data governance and integration with electronic records improve continuity, monitoring, and evaluation.
– Rigorous, standardized evaluations are essential to quantify health outcomes and inform investment decisions.
– Addressing gender and rural access barriers is critical to ensuring equitable utilization of telemedicine services.
Conclusion
The two-decade arc of telemedicine in India demonstrates substantial progress in scaling digital health services, with clear gains in access and potential cost savings. Yet the landscape remains characterized by fragmentation and uneven evidence quality. Future work should emphasize standardized impact assessments, stronger data governance, and strategies to close remaining access gaps for women and rural populations. With these improvements, India’s telemedicine experience can guide other low- and middle-income countries seeking scalable, high-quality remote care.
