Krishna
Founder, ShylCare
In April 2020, every hospital in India suddenly needed telemedicine. Lockdowns meant patients couldn't visit. Doctors couldn't see patients in person. The Telemedicine Practice Guidelines got notified in record time. Platforms like Practo, MFine, and DocsApp saw 10x usage spikes. Hospital chains scrambled to launch their own video consultation portals.
It was genuinely impressive how fast the ecosystem responded. Within weeks, doctors who had never used anything more complex than WhatsApp were doing video consultations on dedicated platforms.
Then in-person volume came back. And most of it quietly died.
Here's the pattern I saw at hospital after hospital:
Phase 1 (2020-2021): Hospital signs up for a teleconsultation platform. Doctors do video calls. Patients are grateful because they have no alternative. Revenue from teleconsultation grows. Everyone calls it "the future of healthcare."
Phase 2 (2021-2022): In-person OPD reopens fully. Patients come back to the clinic — because in India, most patients want to see their doctor in person. It's cultural, it's about trust, and for many conditions it's clinically appropriate. Teleconsultation volume drops 60-80%.
Phase 3 (2022-2023): The teleconsultation platform is now a separate system from the hospital's regular workflow. The doctor does in-person consultations in their EMR (or on paper), and teleconsultations on a completely different app. Different prescription format, different billing flow, different patient record. The administrative overhead of maintaining two parallel systems exceeds the revenue from the shrinking tele-volume. Hospital quietly stops using the platform. Nobody announces it.
Phase 4 (2024-present): Some doctors still do "teleconsultation" — on WhatsApp. Patient sends a photo of their previous prescription, doctor replies with advice and a photo of a new prescription written on their pad. Zero documentation, zero billing, zero medicolegal protection. But it's frictionless, so it persists.
This isn't a failure of telemedicine as a concept. It's a failure of implementation — specifically, the failure to integrate teleconsultation into the clinical workflow rather than bolting it on as a separate system.
Not everything died. Some use cases proved durable because they solve a real problem better than the in-person alternative:
Follow-up consultations. A patient who had surgery last week doesn't want to travel two hours for a five-minute "how are you feeling, looks good, continue the same medicines" conversation. Follow-up tele-visits have genuine patient demand. The doctor spends 3-5 minutes instead of 15, the patient saves half a day of travel, and the clinical quality is fine for most follow-ups.
Specialist second opinions. A doctor in a district hospital wants to discuss a complex case with a specialist in the city. This happened over phone calls before COVID. Now it happens over video, sometimes with shared screen of reports and imaging. It's better than a phone call, and nobody needs to travel.
Rural outreach. Hospitals that serve rural catchment areas have found that a weekly tele-clinic — where a local health worker sets up a tablet at a PHC and connects patients to specialists at the main hospital — works. It's not replacing in-person care; it's providing access where none existed. The volumes are small but the impact is real.
Chronic disease management. Diabetes reviews, hypertension medication adjustments, thyroid follow-ups — conditions where the consultation is primarily about reviewing numbers and adjusting medication. The patient doesn't need to be physically examined every time.
General OPD over video. For most conditions, Indian patients want to be examined in person. The doctor wants to examine them in person. A video call where the doctor says "I can't really tell without seeing you, come to the clinic" helps nobody. First consultations for new problems are overwhelmingly better in person.
Standalone tele-platforms for hospitals. If a platform is just a video call with a prescription generator, and it doesn't connect to the hospital's existing patient records, billing, or pharmacy — it creates more work, not less. Doctors won't maintain two separate systems for the 10-15% of consultations that happen online.
The "Uber for doctors" model. Several startups tried to build marketplaces where patients could consult random available doctors on-demand. This works for truly urgent, simple queries. It doesn't work for ongoing care, because patients want continuity — they want their doctor, not a doctor.
Here's what I've concluded after watching this cycle play out:
The only version of telemedicine that works long-term for hospitals is one where teleconsultation is a mode of consultation, not a separate product.
What does that mean practically?
Same patient record. Whether the doctor sees a patient in person or over video, the clinical notes, prescriptions, and investigation orders should go into the same patient file. The doctor shouldn't have to switch applications.
Same prescription workflow. The prescription generated during a tele-visit should look identical to an in-person prescription — same format, same drug database, same template. It should be digitally signed and delivered to the patient electronically (and to their linked pharmacy, if applicable).
Same billing. A teleconsultation should appear in the same billing system as an in-person visit. Different fee, same workflow. The hospital owner should see tele-revenue and in-person revenue in the same dashboard, not in two different systems.
Same scheduling. The doctor's appointment calendar should show both in-person and tele slots. The patient booking system should offer both options. The front desk should manage both from one screen.
Minimal friction for the doctor. The doctor should be able to start a tele-visit with one click from their existing consultation screen. No separate login, no separate app, no separate anything.
When teleconsultation is built this way — as a feature of the EMR rather than a separate platform — doctors actually use it. Because it doesn't add work. It's just another way to see a patient, using the same tools they already use.
I want to be realistic about what teleconsultation can and can't be in India:
It will never replace in-person OPD for most hospitals. And it shouldn't try. The goal isn't to move all consultations online. The goal is to make the 15-20% of consultations that don't need a physical visit more convenient for everyone.
Regulatory clarity is still evolving. The Telemedicine Practice Guidelines cover the basics, but questions around cross-state practice, prescription validity, and liability in tele-consultations are still being worked out. Hospitals should follow the guidelines conservatively.
Digital literacy varies wildly. A 25-year-old patient in Bangalore can handle a video call easily. A 65-year-old patient in a small town might struggle. The system needs to accommodate both — which often means the hospital providing assisted tele-visits where a staff member helps the patient connect.
Telemedicine isn't dead. The hype is dead, which is actually a good thing. What's left is the practical, unsexy version: follow-ups, second opinions, chronic disease management, rural outreach. Integrated into the EMR, not bolted on top. That's the version worth building.
This is the future we're building toward at ShylCare. Come see where we are today.
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