International Journal of Scientific & Engineering Research, Volume 12, Issue 8, August-2021 89

ISSN 2229-5518

The impact of E-Health on clinical psychology

practices and the future of E-health /
Telepsychology/Telehealth in Pakistan
Zainab Muhammad Ullah, Muddasar Hussain, Salwa, Asfa Hanif, Faryal Fazal

Abstract—The present study was conducted to investigate the impact of E-Health on clinical psychology practice. The future of
E-health / Telepsychology/Telehealth in Pakistan for this purpose different articles were reviewed. The articles had been taken
from different journals and google scholar and main points were extracted. The findings suggests that in Pakistan the use of E-
Health and Telepsychology is in infancy phase which need to improve most importantly in times of crises such as in COID-19 the
use of Telehealth increased two-fold. So, this matter must be considered, and possible solution and policies must be taken as the
researcher suggested in the present study.

Index Terms— Telehealth, Telepsychology, COVID-19, Telecommumication, Clinicl Psychology, Pakistan.

——————————  ——————————

INTRODUCTION

T elemedicine, Telemedicine and E-Health is the term used

interchangeably and as a substitute for the innovation of
healthcare guidance by some telecoms such as smart phones,
can be useful for this reason.

IJSER
1. COVID-19 IMPACT ON MENTAL HEALTH WORLDWIDE
telephones or wi-fi mobiles, with or without video calls. Telemedi-
cine (TM) can benefit by providing compassionate treatment for When a novel corona virus (COVID-19) epidemic declared a
chronically ill patients, while reducing their proximity to other global pandemic on 11 March 2020 by the World Health Organiza-
severely ill patients. After all, a computer virus is the only illness tion (WHO) (Domenico & Maurizio , 2020) after that the whole
you can capture by using TM. About every insurance benefit and situation dramatically changed human life within a few weeks. A
big company offers provision of TM programs in order to pro- new, uncertain, and fast changing scenario is taking place in the
mote the TM solution (Hind & Sarah , 2021). Presently the dis- world. People need to remain confined at home, family relations
ease outbreak for coronavirus disease 2019 (COVID-19) is ex- have shifted markedly, travel is limited, and recreation and social
panding globally at a fast pace with a simple breeding rate of be- life are being reduced. It has also affected the working situation.
tween 2 and 2,5, with an extreme acute respiratory syndrome of Many people have lost their jobs temporarily or permanently,
coronavirus 2 (SARS-COV-2). The first case of COVID-19, caused many are working from home, sometimes inadequately prepared
by this novel coronavirus, Reported at the end of 2019 in Wuhan to do so, and many are forced to work in sectors Feel the work-
City China. The WHO Emergency Committee declared a global load, rising stress levels and the increased risk of viruses. Due to
health emergency throughout the world due to the rapid spread which a number of psychological issues arises due to this over-
and increased rate infection (Christian G & Thirumalaisamy P., whelming situation that is worsen day by day. the need for psy-
2020) chological services also become essential for every population
Although serval efforts are being made to limit the spread of the range from children to old age adolescence. Hospitalization is also
virus, but all in vain it produces a lot of emotional reactions Anxi- discouraged during epidemic, even if a patient thinks they have
ety, panic, fear and depression in different populations. This shed COVID-19. Patients, whether or not they have COVID-19, are rec-
light on the fact that with the physical effort to deal with the dis- ommended to remain at home until a hospital appointment is
ease, mental management, psychosocial and psychological well- completely unavoidable. For several patients in Pakistan this prac-
being is equally important to deal with. tice challenges conventional healthcare. After outpatient depart-
ments (OPDs) were closed and other routine operations in most
Hearing about the COVID-19 outbreak and spread from vari-
areas of the region increased as corona virus infections and ten-
ous sources such as television, social media, newspapers, family,
sions intensified in government hospitals, doctors were urged to
and friends will cause a great deal of anxiety, fear, panic, depres-
keep using online applications. (Khalid & Shahid, 2020).
sion, and anxiety among the public. It is important to remember
that all these emotions are natural responses to this situation
unusual circumstance, but the problem starts when the response 2. PSYCHOLOGICAL IMPACT OF COVID-19 IN PAKISTAN
become irrational. In Pakistan, where the healthcare system is in
disarray due to a lack of funding and abysmal socioeconomic cir- The Covid-19 spread rapidly to 209 countries in the United
cumstances, the future of telemedicine will be bright if supported States, Europe, Asia and Australia, along with Pakistan and then
by appropriate policies and a networking infrastructure. That around the world. According to (Abdul , Khan, Ali, Ali, & Baset,
would allow for the delivery of services on schedule, which would 2020) In the first case of Covid 19 was confirmed in Karachi
otherwise be unlikely. A lot of research and awareness programs province of Sindh by Pakistan, Minister of Health and Govern-
ment of Pakistan on 26 February 2020. During this epidemic,
IJSER © 2021
http://www.ijser.org
 90
International Journal of Scientific & Engineering Research, Volume 12, Issue 8, August -2021
ISSN 2229-5518

people may experience fear of death, of being affected by them- worked with 7.07% Telepsychology rose by a factor of 12 to
selves or their family, fear, anxiety, anger, symptoms of depression 85.53% during epidemics., and 67.32% of psychologist perform-
and other mental health concerns. In this unpredictable situation ing all their clinical work through telepsychology. Psychologists
those who are not tested positive may also developed some psy- predict that they will perform 34.96% of their clinical work
chological issues due to the fear of being infected this is called through telephone science after the epidemic. Psychologists have
secondary mental health problems because people are not direct- reported a 26-fold increase in the use of telepsychology in epi-
ly exposed to the virus. To address secondary mental wellbeing demic. Telehealth is rapidly evolving and has the potential to
issues concerns taking part in the COVID-19 epidemic, Internet modernize the delivery of health services to the majority of the
Psychological Technology should immediately develop a Psychiat- population. Despite the fact that relatively few people have seen
ric Crisis Intervention Model (PCIM). The PCIM brings together its historic/ancient use and impact. Fewer than 1-3 people are
teams of doctors, therapists, counsellors / mental health provid- aware of its open worth. The ultimate goal of telehealth is to im-
ers, and social workers to support patients, relatives, and hospital prove patients' access to health care. This accessibility is made
personnel with earlier treatment strategy. (Rana, Mukhtar, & possible by the advancement of broadband and portable medical
technology. In technologically advanced countries, treatment for
Mukhtar, 2020).
acute conditions such as stroke and pneumonia are moving from
the emergency department to the doorstep or bedroom by video
3. USE OF E-HEALTH / TELEPSYCHOLOGY/TELEHEALTH conference in the ambulance or at home.
DURING COVID-19
4. FUTURE OF E-HEALTH /
Telehealth is not a new concept. Telehealth has been in operation
since 1959, when the University of Nebraska Medical School and TELEPSYCHOLOGY/TELEHEALTH IN PAKISTAN
the State Mental Hospital conducted a two-way video conference
using microwaves. The rapid expansion of computing and infor- Pakistan is a heavily populated developed world that faces many
mation technology in the 1990s resurrected telehealth. The ad- healthcare problems. Access to healthcare is a major issue, espe-

IJSER
vancement of emerging technologies allows telehealth to evolve cially because of geographical, cultural, and social barriers the
into a more sophisticated and feature-rich application (Jose A. , COVID-19 epidemic is more than just a health crisis; it is also an
Matthew A., Ashley, Jon R, & Michael , 2020). Telehealth is the use economic and social crisis that has revealed health inequalities.
of digital media to link people to health information, services, and (Khan, 2020). When faced with an extraordinary public health
activities from a distance. It enables access to health care anytime, emergency, people face a variety of psychological and mental dis-
anywhere. We can do medical checkup from the comfort of our orders. From the other side, COVID-19 quarantine raises the like-
home this is called telemedicine a category of telehealth. With lihood of emotional and physiological illnesses. The main reason
telemedicine a patient can be diagnosed and treated using remote for this is that quarantine which slowly moving people apart from
communications. Apart from that Telehealth services can include one another. Depression and anxiety are more prone to arise in
online prescriptions, blood pressure monitoring, and professional the absence of contact. but at the other side, decreases the acces-
counselling. With the help of telehealth people in the remote are- sibility of urgent mental health services. interventions, and men-
as can now speak with medical experts with whom they may not tal and emotional guidance is common in the current situation.
have access before. Persons with any physical disability and elder- There is an urgent need for a new type of psychological and men-
ly can do their treatment remotely. People who are busy and can- tal distress strategy that is possible and accessible to address men-
not go for medical treatment and a housewife who is busy in her tal and emotional problems (Xiao, 2020). The public needs to be
home and cannot leave her home, but her daughter needs to go made aware of common measures such as sleep hygiene, activity
for checkup because she got sick and similarly if someone lives in schedules, exercise, social networking, avoiding social media for-
village and need a good doctor but cannot travel. Now with help of wards, and relaxation techniques. Also, they need to be informed
telehealth they are just needed to set Infront of computer or lap- about the sources of help and the authentic website (Banerjee,
top and contact with a doctor for consultation. Now adays due to 2020). The government should regulate the E-health, because
COVID-19 people are advised to stay at home to prevent the "future" challenges such as COVID-19 which demand a more effi-
spread of the novel virus. cient and parallel healthcare system across the country it is nec-
essary to have alternative health and mental health delivering
COVID-19 epidemic transforms Telepsychology, according to the platform. We can look at a hub and scope plan for distant
American Psychological Association (APA), is unlike any other healthcare. A legislation should put together.
event in human society in terms of mental health treatment dis-
tribution, with the use of one or more telecommunications tech- (Imam, 2020) stated the Telehealth system was implemented
nologies to provide mental health services (APA, 2013). Similarly, faced strong resistance from patients and doctors. He further ad-
E-Health is commonly referred to as the use of Internet and com- dressed that awareness should be given to people by putting on
puter to healthcare and broadly refers to the use of information free virtual camps consultation to promote the benefits of such a
technology. A study was conducted by (Naseem, Rashid, & system and to encourage people to put it to the test. He said the
Kureshi) Through accurate monitoring, e-health technologies will extension in Pakistan's telehealth system would only be feasible if
play a vital role in controlling many epidemic diseases. E-health it is integrated progressively. However, the country's health sec-
adoption would result in increased productivity, improved public tor will undergo a massive redesign over the next five to ten
access to the health-care system, and disease elimination in Paki- years, including various implementations in telehealth, including
stan. Before COVID-19 epidemic, mental health practitioner Telepsychology.
IJSER © 2021
http://www.ijser.org
 91
International Journal of Scientific & Engineering Research, Volume 12, Issue 8, August -2021
ISSN 2229-5518

Pakistan remains an obstacle to access to telehealth because it has tion, critical discoveries such as diminished feelings or a
digital obstacles such as a shortage of Internet penetration, mis- significant heart problem may go unnoticed. To main-
conduct on digital media and lack of literacy. But nevertheless, the tain a high level of patient satisfaction, ensuring patient
integration of such a structure is being progressively accelerated privacy and responding to patient complaints will con-
with COVID-19 speeding-up, as international organizations em- tinued to be difficult. Likewise, physi-
phasize Pakistan's need for telehealth. Marham-like companies, cians/counselors/clinicians in Pakistan confront a vari-
Among the health stories, the outbreak of COVID-19 leads to the ety of issues, ranging from “No-Touch” medicine to
creation of virtual health services and promotes use of multime- managing time, teamwork, and digital literacy for physi-
dia technologies to improve medical treatment. There is sound cians, particularly those who were educated several
room. years previously. More significantly, doctors may face
A study conducted by (Perrin, et al., 2020) COVID-19 concluded additional stress as they master these new abilities
that Telepsychology is essential for the provision of psychological while retaining and keeping up with rapidly rising med-
services during an epidemic, because this is not possible to alter ical information. The healthcare system faces a multi-
as long as therapists and clients appreciate it. A more focused tude of barriers. This would be the moment for Pakistan
approach to the training and implementation of telepsychology to tackle the use of technology in healthcare and to en-
that takes into account the needs and concerns of the target psy- list the help of physicians, public health officials, and in-
chology group can benefit organizations promoting its use. The formation technology specialists to uncover the numer-
new increase in telemedicine in Pakistan was caused by the wor- ous problems that arise. The formulation of policies and
ry of developing COVID-19 and the burden of social distancing. the establishment of a mechanism for compliance and
The need for time here is to ask the right questions and come up evaluation will become the most difficult tasks. Major
with a detailed answer. adjustments to the present system may be required for
 Future Trajectory of Telemedicine in Pakistan: medical certification and licensing, as well as the estab-
Whenever people discuss telehealth as a possible way lishment of dependable reimbursement mechanisms
to solve, the fragile healthcare system and flawed ser- and the definition of responsibility. In addition, to

IJSER
vice delivery, do they truly grasp the nature of the is- achieve long-term effectiveness in telehealth, a cyber
sue? There have been few studies analyzing access to security network, hardware, and trained employees will
medical care in Pakistan, and they have primarily fo- be required.
cused on economic impediments. Therefore, we need to  Decisions regarding Policy making Pakistan, in gen-
dwell on following issues so to reach a tangle solution eral, needs a strong improving health policy at all levels.
where the awareness of telehealth in masses should be E-health, which makes use of computer technology,
accompanied by its uses as in all developed countries. might provide the impetus for a governmental and hos-
Let us reach each problem individually. pital-level reform of healthcare policy. It's crucial to fig-
 How to bring long term changes: Unless an effort is ure out who will create the policies, how much money
made to identify expected results that will lead to a de- will be spent on equipment and personnel, and also how
crease in healthcare delivery inequality rather than programs will be evaluated. The communities of Health
widening the gap for persons with restricted access to will play a key role in guaranteeing that these policies
healthcare services, the short-term rise in telemedicine are adherent, monitored and accountable. Telehealth
use during the COVID-19 epidemic may not endure to may be the much-needed excellent way to boost health
become a long-term solution. in Pakistan by answering queries and detecting difficul-
 The doctor-patient / counselor-client/ service pro- ties.
vider- services user relationship: What about such a
connection, should be another key question? What a
powerful thing it would be if the two could develop em- CONCLUSION
pathy for one another. In today's Pakistan, it's critical to
envision a "cyber" interaction among physicians and pa- From all the study the researcher concluded that there exists a
tients based on cultural awareness. It is necessary to considerable lack in implementation and awareness regarding the
address the expectations of both physicians and pa- use of E-health and Telepsychology in Pakistan. Telepsychology
tients in order for such a partnership to be accepted in has the potential to help connect psychologists with people in
the future. need of mental health services who are struggling to attend indi-
 Obstacles for providers and users: Access to tech- vidual therapy or abandon traditional practices because of
nology, acceptability of technology, relationship with COVID-19 restrictions. The future of E-health and Telepsychology
the practitioner, and degree of E-health literacy are all is bright if the government make some legislations and act upon
issues that patients face. Healthcare is complex, and di- it, provide proper equipment, an internet with high speed to
agnosis can be hard to understand for patients. avoid barriers between mental health professional and client
during assessment. The government should also make some free
 Why masses should be educated about telemedi-
websites to which people could access in time of crises such as
cine: At the same time as dose adjustments and pre-
COVID-19. The privacy concern of client regarding their data
scription drafting, patients are educated about pharma-
should also be addressed with them so client will seek online psy-
ceutical side effects and compliance. This efficacy may
chological intervention without any hesitation.
be compromised during a telemedicine appointment.
Due to a complete lack of a thorough physical examina-
IJSER © 2021
http://www.ijser.org
 92
International Journal of Scientific & Engineering Research, Volume 12, Issue 8, August -2021
ISSN 2229-5518

36(6), 1405–1407. doi:10.12669/pjms.36.6.3112

Naseem, A., Rashid, A., & Kureshi, N. I. (n.d.). E-health: effect on health system
efficiency of Pakistan. Annals od saudi Medicine, 34(1), 59–64.
doi:10.5144/0256-4947.2014.59
2.4 Copyright Form Perrin, P., Rybarczyk, B., S Pierce, B., A Jones , H., Shaffer, C., & Islam, L. (2020,
Junaray ). Rapid telepsychology deployment during the COVID-19
pandemic: A special issue commentary and lessons from primary
care psychology training. 76(6), 1173-1185. doi:10.1002/jclp.22969
REFERENCES Rana, W., Mukhtar, S., & Mukhtar, S. (2020, Apirl 07). Mental health of medical
Abdul , W., Khan, A. U., Ali, M., Ali, A., & Baset, A. (2020, May). COVID-19 workers in Pakistan during the pandemic COVID-19 outbreak. Asian
outbreak: current scenario of Pakistan. New Microbes and New Journal of Psychiatry, 510. doi:10.1016/j.ajp.2020.102080
Infections, 350(20), S2052-2975. doi:Waris, A.; Atta, U.K.; Ali, M.;
Asmat, A.; Baset, A. (2020). COVID-19 outbreak: current Xiao, C. (2020, Feburary 25). A Novel Approach of Consultation on 2019 Novel
scenari10.1016/j.nmni.2020.100681 Coronavirus (COVID-19)-Related Psychological and Mental
Problems: Structured Letter Therapy. Piachatry Investigation, 17(2),
APA. (2013). American Psychological Association. Retrieved from 175–176. doi:10.30773/pi.2020.0047
https://www.apa.org/practice/guidelines/telepsychology

Banerjee, D. (2020, March 20). The COVID-19 outbreak: Crucial role the
psychiatrists can play. Asian journal of psychiatry, 50, 102014.
doi:10.1016/j.ajp.2020.102014

Christian G, M., & Thirumalaisamy P., V. (2020, March). The COVID‐19 epidemic.
Tropical Medicine and International Health, 25(3), 278–280.

IJSER
doi:10.1111/tmi.13383

Domenico , C., & Maurizio , V. (2020, March 19). WHO Declares COVID-19 a
Pandemic. Acta Bio Medica: Atenei Parmensis, 91(1), 157-160.
doi:10.23750/abm.v91i1.9397

Hind , B., & Sarah , A. (2021, April 19). The role of eHealth, telehealth, and
telemedicine for chronic disease patients during COVID-19
pandemic: A rapid systematic review. DIGITAL HEALTH.
doi:10.1177/20552076211009396

Imam, E. (2020, July 20). Marham: Find, Book & Consult Doctors. Retrieved
from MIT Technology Review Pakistan:
http://www.technologyreview.pk/is-telehealth-the-future-of-
medicine-in-pakistan/

Jose A. , B., Matthew A., R., Ashley, Z., Jon R, B., & Michael , M. (2020, October 01).
The Impact of COVID-19 on Telemedicine Utilization Across Multiple
Service Lines in the United States. In Health Care, 8(4), 380.
doi:10.3390/healthcare8040380

Khalid, A., & Shahid, K. K. (2020, July 20). Is telehealth the future of medicine in
Pakistan? Retrieved from MIT Technology Review:
http://www.technologyreview.pk/is-telehealth-the-future-of-
medicine-in-pakistan/

Khan, U. Z. (2020, Sep-Oct). Telemedicine in the COVID-19 Era: A chance to

make a better tomorrow. Pakistan journal of medical sciences,

————————————————
 Zainab Muhammad Ullah is currently pursuing Mphil degree program in
Applied Psychology in Quaid-i-Azam University Islamabad, Pakistan, E-
mail: [email protected]
 Mudassar Hussain is currently pursuing Mphil degree program in Applied
Psychology in Quaid-i-Azam University Islamabad, Pakistan, E-mail:
[email protected]
Salwa is currently pursuing Mphil degree program in Applied Psychology
in Quaid-i-Azam University Islamabad, Pakistan, E-mail:
[email protected]
Asfa Hanif is currently pursuing Mphil degree program in Applied Psy-
chology in Quaid-i-Azam University Islamabad, Pakistan, E-mail:
[email protected]
Faryal Fazal is currently pursuing Mphil degree program in Applied Psy-
chology in Quaid-i-Azam University Islamabad, Pakistan, E-mail: IJSER © 2021
http://www.ijser.org
[email protected]