Digital health and telemedicine – Powering the next growth wave

When Covid-19 struck, telemedicine in India experienced an unprecedented surge. Platforms scaled overnight. Regulations were relaxed. Video consultations became mainstream. The Ministry of Health released Telemedicine Practice Guidelines in 2020. Consultations on major platforms reportedly grew 300–500 percent. eSanjeevani, the Government of India’s telemedicine service, has since conducted more than 200 million consultations. It appeared that digital health had finally found its inflection point.

And yet, as the pandemic receded, telemedicine usage plateaued instead of accelerating into the next growth wave many had predicted.

As someone building healthcare systems across small towns and underserved districts of North India, I believe the explanation lies not in technological limitations, but in our unique socio-clinical realities.

India was already practicing informal telemedicine
Unlike Western systems, in which digital consultations help fill access gaps in primary care, India has long operated on a deeply personal healthcare network. Most urban families–and even many in Tier-II towns–have direct access to their physician’s mobile number. Patients routinely call or message their family doctor, paediatrician, obstetrician, or even a super specialist and receive guidance over the phone or via WhatsApp.

In effect, we were already practicing telemedicine–just not through formalized platforms.

This informality carries trust. A known physician understands the patient’s history, family dynamics, socioeconomic constraints, and behavioural patterns. In India, healthcare is relational rather than transactional.

Large platforms that offer one-time teleconsultations often struggle to replicate this relational capital.

The behavioural dimension of care
Another under-discussed factor is patient behaviour.

Indian patients are pragmatic and often medication-averse. Many prefer as little medicine as possible. Adherence to dosages and treatment duration is inconsistent. Follow-ups are frequently skipped once symptoms subside.

In such a context, continuity of care matters enormously.

A physician who has treated the family for years can counsel adherence more effectively than an anonymous online consultation. Behavioural nudges in healthcare are not algorithmic–they are deeply human.

Telemedicine platforms optimized for speed and scale often underestimated this cultural dimension.

Infrastructure was not the core constraint
During Covid, we proved that digital infrastructure was not the bottleneck. With 800+ million internet users, some of the world’s lowest data costs, and near-universal smartphone penetration in urban and semi-urban areas, access was not the constraint.

The challenge was integration.

Telemedicine was largely offered as a parallel channel rather than embedded within hospital ecosystems, primary care networks, and referral pathways. It remained an add-on instead of becoming a core layer of service delivery.

At Ujala Cygnus, where we operate across districts with fragile health indices, we learned that digital tools only work when anchored in physical trust networks–hospitals, outreach programmes, community health workers, and local clinicians.

Telemedicine must be integrated into hub-and-spoke systems, not exist as a stand-alone solution.

Rural India – Promise and reality
Ironically, rural India–where access gaps are real–has seen slower adoption of pure teleconsultation platforms.

Why?

Healthcare access is not solely about specialist availability. It is about diagnostics, drug access, follow-up capability, and emergency backup. A video consultation without laboratory access or assured referral pathways offers limited value.

In rural ecosystems, telemedicine must be coupled with:

• Local diagnostic capability,
• Pharmacy integration,
• Community health worker engagement, and
• Referral assurance to secondary and tertiary centres.

Without this continuum, digital advice remains incomplete care.

From platform model to ecosystem model
If telemedicine is to become India’s next growth wave, we must move from platform thinking to ecosystem design.

This means:

• Embedding telemedicine into hospital networks. Every secondary hospital should digitally extend its specialist layer to peripheral clinics.
• Strengthening doctor continuity. Teleconsultation should prioritize repeat interactions between the same physician and patient.
• Integrating diagnostics and e-pharmacy. Digital consultation must trigger seamless lab and medication pathways.
• Aligning reimbursement models. Insurance and government schemes should incentivize continuity and outcomes–not just episodic digital visits.

A systems change perspective
India does not need telemedicine to replace physical healthcare. We need it to multiply its reach.

In our districts, digital tools can enable cardiologists to mentor general physicians, intensivists to guide stabilization in remote units, and specialists to triage referrals before patients travel long distances.

The next phase of telemedicine in India will not be consumer-led convenience. It will be system-led augmentation.

It will strengthen referral chains, reduce unnecessary travel, improve follow-up adherence, and optimize specialist time.

Covid proved the feasibility of digital health.

The next decade must prove its integration.

If we design telemedicine as an extension of trusted care relationships rather than a substitute for them, India can create a uniquely blended model–digital where appropriate, relational where necessary, and always anchored in accountability.

Technology can scale access.

Only trust can scale care.