StepOne: How a hurriedly rallied volunteers group is scoring a giant leap for telemedicine in India

The tiny colony of Kilpauk in southern India is a cluster of hospitals, clinics, medical laboratories and diagnostic centers. And yet, when Ganesh Chithambalam went to a health center there to consult with a doctor for his bedridden father he found the halls deserted. It was mid-March and the new coronavirus disease was starting to spread deeper in India. Healthcare professionals, among the most vulnerable to Covid-19, were beginning to panic.

Back home, Ganesh, co-founder of AI-based advertising platform Recotap, shared an online spreadsheet with a new collective of startups seeking volunteers to “do something in telemedicine.” In under 72 hours, a motley crew of entrepreneurs, investors, physicians, bureaucrats and software companies, among others, put together a phone-based remote healthcare infrastructure that’s now at the frontlines in India’s battle against Covid.

“Right from day one, we were sure this helpline product needed to work for the masses. So a phone approach seemed to be the best possible solution,” says Ganesh. “We could have built a website or an app but a farmer may not be able to access those.”

The initiative’s impact has been tremendous. Project StepOne, since its launch on 20 March, has onboarded more than 6,000 doctors as well as counselors as volunteers. Through phone helplines, they have triaged more than 1.2 million callers, handled more than 70,000 consultations, and identified 3,200 people as high-risk for Covid.

That’s not all. They have advised patients on other life-threatening conditions, helped prevent suicides, directed aid to disadvantaged families, and in one instance at least arranged for a couple to get their newborn vaccinated.

StepOne’s interventions have stretched well beyond its early brief of ensuring doctors were freely and easily accessible to people stuck in a lockdown. Now, the project, a frontrunner among other similar initiatives, could well shine a path for telemedicine to become mainstream in a country facing a shortage of doctors.

“It will prove to be a behavior changer,” says Rahul Gupta, an investment manager with Times Internet and a full-time volunteer with StepOne. “There will be millions of people who will continue to consult doctors distantly. Whether it is someone in a rural area who has to travel all the way to a town to meet a doctor or someone in a city who wants to follow-up with a particular specialist. A vast majority will move to telemedicine.”

Ganesh and Rahul have reason to be optimistic. The volunteer signup sheet that Ganesh had shared with members of the Startup versus Covid-19 group—comprising mostly startup founders focused on helping Indian state governments fight Covid—had gone viral within hours, much to their delight.

“We had a core group of 50-60 people working 20 hours a day, building partnerships, roping in bureaucrats from various state governments. We quickly put together a minimum viable product by incorporating solutions from various companies,” says Ganesh. “In just three days, we launched in Karnataka.”

Calls to the helpline, now named ‘Saathi’ (Hindi for companion or friend), began pouring in. Several called unsure of what to make of a cough or a sneeze. Others called to figure if they needed to quarantine themselves, worried for their families. Some called to prank. “There was no way to manage all of that. The lines were always busy or not going through,” says Ganesh. “Also, we had started focusing on helping governments screen potential Covid patients calling the helplines. We needed a system that could route tickets (or calls) among groups and do it at scale. We needed a lot of custom applications.”

StepOne approached Freshworks, which was already working on other Covid initiatives for volunteer groups and state governments. A core group of senior Freshworks executives immediately went into overdrive to build a system to help doctors remotely triage people calling the helpline.

“We worked 18 hours a day and were live in three days,” says Himanshu Singh, Head, India Pre-sales, at Freshworks. “It’s an ongoing process as we intend to have more adoption from both Central and State governments. We are now adding a chatbot based on ICMR guidelines to assess the risk and transfer to a doctor for Covid and other cases.”

This is how the system typically works: when someone calls the helpline an automated response system records their details such as language preference and their reason for calling; based on these inputs, Freshdesk, which is Freshworks’ flagship helpdesk product, assigns a doctor to the caller; the doctor gets in touch with them via the app and records the patient’s travel details, contact history and symptoms, offers medical advice, and raises an alert if they seem a Covid risk. All patient notes and data are recorded on the app itself.

“We developed an application within the Freshdesk environment for a ‘click-to-call’ action so doctors can reach out to possible high-risk patients from right inside the tool,” says Sriram Varrieth, Lead Solution Engineer at Freshworks. “The application automatically embeds the patient’s number within the ‘click-to-call’ URL. This helps keep all patient-related data on a single platform as doctors can take notes on the app itself during the call. It has also eased the triaging process based on the severity of a patient’s condition.”

These technology customizations have made remote consulting much easier for volunteers such as Dr. Vaishnavi Vasanth, allowing them to focus on genuine patients, including some from thousands of miles away. The ENT specialist came across the opportunity to volunteer via a WhatsApp forward with a link to a signup form. She filled it and got a call to sit through an online training module before she could be enlisted.

“I felt this was the safest way to volunteer,” says the doctor who lives with her husband and aged inlaws in Bengaluru. “Triaging at the ground level is the best way to contain the virus. There was no other way for people to get help because of the lockdown. With lots of people falling sick, and when we need to have eyes on almost everybody in every state, this is the best approach.”

StepOne, funded by Omidyar Network India and Action Covid-19 Team, has expanded to work with multiple Indian state governments and in more than two dozen regional languages. It is a core component of the federal government’s primary contact tracing app, Aarogya Setu. And to help people cope with the stress of the lockdown, it has added a mental health helpline as well.

Rahul foresees a few possibilities for StepOne’s future. One, as part of disaster management solutions. And two, as a remote healthcare program for the masses. Barely a week after StepOne launched, and a day into the world’s largest lockdown, India introduced guidelines that have made it legal for doctors to provide teleconsultation.

“Since the StepOne solution works so beautifully on feature phones we need to keep it alive for the future,” says Rahul, encouraged by the policy decision. Although India is among the fastest-growing smartphone markets, a majority of the country’s 1.35 billion people still use basic feature phones. “We can request doctors already on the platform to take queries from patients for just two hours a week. Assuming that only 1,000 doctors volunteer for this, that would still be useful to a very large number of people.”

StepOne’s brought together hundreds of smart people working selflessly and tirelessly for a cause. The pandemic that triggered the reason for the project’s existence seems a stubborn visitor, giving no clues about when it’s likely to retreat. Even when the threat eventually fades, an effective, no-fuss phone-based solution for the masses seems an ideal ally for India’s ambitions to achieve primary healthcare for all.