Doc's prescription for tele-medicine

Shashwat Chaturvedi

It was an amazing promise made quite a few years back: a promise of a healthy life to the teeming millions residing in the innumerable villages dotting the Indian landscape.

Tele-medicine promised to change the way healthcare was to be delivered to the common man, be it Jhumritaliya in Jharkhand or Ganganagar in Rajasthan. No more, would the rural janta have to travel to nearby metros or state capitals to avail of specialty treatment as most of the healthcare facilities would be available at the public health centers (PHC) connected to the main hospital via dedicated communication channels -- be it ISDN line or even a VSAT.

Scores of pilot projects were launched and everyone waited with bated breath. Yet the promised remained unfulfilled. Progress has been excruciatingly slow for a variety of reasons, be it paucity of capital or infrastructure issues.

But now, Telemedicine has got a new lease of life, thanks to the spread of the Internet. With the number of Internet users growing by leaps and bounds (numbering over 50 million as of December 2005, according to Internetworldstats.com) and broadband set to explode into Indian homes, the World Wide Web might just be the medicine that the doctor had prescribed for an ailing tele-medicine.

Telemedicine, the beginnings

The idea of telemedicine has been around for a few decades. Globally, many European nations and the US have made substantial investment in the technology. These countries seemed to have crossed the initial hiccups to attain maturity.

India's case can at best be termed as quite peculiar. With over 70 per cent of the population residing in rural areas and a very skewed average of doctors per people (approximately 1:1916), tele-medicine was poised to play a very important role in the country. Also, the geographic vastness makes a pretty good case too. For instance, it would be well neigh impossible to find cardiologist in Tawang (Arunachal Pradesh) or in Basti (Uttar Pradesh).

There has been a lot of action from both public and private sector players, but most of them were in fits and starts. Sanjay Sood, a healthcare technologist specializing in telemedicine and Head, C-DAC School of Computing, Mauritius, feels that most of the projects in India are still fragmented and uncoordinated.

"If telemedicine has to live up to its potential and gain widespread diffusion in the healthcare industry, the evolving systems need to interoperable with each other. Such an integration would require active participation by all stakeholders, in private as well as public sectors," he said.

According to TR Madan Mohan, Director (Consulting, Information Communication and Technology Practice), Frost & Sullivan, "Most of the pilots were done around 2001-`02 in states like Karnataka, Himachal Pradesh, Andhra Pradesh, Tamil Nadu, Andaman Nicobar, etc. While many of them may not have delivered on their promises, quite a few have. Projects like GB Pant in Andaman linked with Ramachandra Hospital in Chennai or the Narayana Hrudalaya in Bangalore are some of the successful ones."

Mohan does not fail to highlight the importance of telemedicine in India. "There is immense values in telemedicine in India, considering that the government spends only about 0.9 per cent of GDP on health, of which only 0.09 per cent reaches around 625 million rural users. With our supply constraints, market limitations as more than 70 per cent doctors are based in cities; access to medicine through technology becomes inevitable."

500 and counting

Sood estimates that India has around 500 operational telemedicine nodes. "My estimates are based on the following calculation. ISRO is responsible for around 165 telemedicine nodes, Apollo Hospital accounts for around 100 nodes (excluding the telemedicine services being available through 240 Reliance WebWorlds across the country), Indian defense forces, specially Army and Navy, have their own telemedicine networks. There are also numerous regional networks like OnciNET in Kerala and then tertiary hospitals like Post Graduate Institute of Medical Education and Research (PGIMER) at Chandigarh, All India Institute of Medical Sciences (AIIMS) at New Delhi and Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI) at Lucknow, etc. serve their own telemedicine nodes besides unknown number of nodes being managed by other private healthcare service providers like Escorts, Fortis, Tata, etc. Furthermore, medical specialist services are being provided by radiologists in Bangalore to over 40 hospitals in the US."

Net effect

One of the main reasons why telemedicine did not deliver was due to the high investment required in setting up the systems, i.e., dedicated communication network and high-end computing equipment. Internet has the potential to change all that and more, as it reduces communication costs.

Sanjay Kapoor, CIO, Fortis, said, "Internet has opened up new vistas for telemedicine. Now, doctors can be reached through video-conferencing, e-mails, etc. and patients can research on health related subjects and more."

Fortis has connected its 12 hospitals (hubs) to numerous nodes. Currently, three centers in Mohali, Noida, Vasantkunj (New Delhi) are interconnected via the Internet and used for hi-tech monitoring of critical care patients.

The advent of the Internet in healthcare has divided the field into two distinct approaches: eHealth and telemedicine. eHealth mainly deals with dissemination of information over the Internet. Telemedicine deals with the provision of actual treatment through e-consultation and videoconferencing.

Sood, who has worked with WHO as a telemedicine consultant, added, "Communications technology is the spine of telemedicine and thus Internet can be termed as the backbone. Communications scene in India is progressively evolving and broadband is finally making a long-awaited appearance, this will all boost telemedicine."

There are over 1.5 million broadband subscribers in India and with the advent of IP TV, the broadband service providers are aiming for a minimum of 35 million Indian households with an interim target of 10 million by 2010.

"Broadband IP networks shall hopefully catalyze healthcare and telemedicine shall thus be one of the leading applications of broadband after IP TV and perhaps online gaming by 2015, " he asserted.

Telemedicinal applications

There is a gamut of applications well suited for Internet for medical streams like pathology, radiology, etc. "Teleradiology and telepathology are driving the applications. For instance, patients can send their pathology reports like a slide of blood tissue to specialists for consultations," Kapoor said.

The trend is more or less similar in other countries as well. Majority of the telemedicine applications in India pertain to teleradiology, telepathology and telecardiology.

"Based on the infrastructural facilities available in India, two specialties popular in countries like the US are virtually non-existent in India. They are telepsychology and application of telemedicine at correctional facilities," Sood said.

There are also the high-tech and high-cost applications like telesurgery (remote telesurgery through the use of robots), but the pre-requisite for those applications are highly efficient communications channel and peripherals.

"As of now in India, we do not have adequate infrastructure to venture such applications," Sood stated.

In conclusion

Sometime back, Reliance WebWorld has tied-up with Apollo Hospitals to provide telemedicine through its 240 locations spread across India. But, the facility is currently concentrated largely in southern India and has not really caught up the way it ought to.

Political machinations have also affected telemedicine. For instance, ISRO was supposed to launch a satellite specifically for telemedicine. Yet, that has not happened, due to reasons unknown. Most of the projects have also floundered due to financial constraints, brought about due to changing governments at the central and state levels.

Though, it must be highlighted that the Indian telemedicine initiatives are highly regarded in the developing nations. Recently, President Dr APJ Abdul Kalam signed an agreement for an Indian hospitals-supported Pan African network of telemedicine.

Sridhar Sangareddy, doctoral candidate in Management Information Systems, University of Illinois at Chicago, felt that connectivity is not the only issue. There is also the question of using the medium effectively. "Accessibility is only first-order digital-divide. How do we ensure that the Internet would be used effectively once we provide access? This is where the concept of social inclusion comes into picture."

Let's cross our fingers and hope that Internet will give a fillip to telemedicine in India, and help heal millions who otherwise would be hard pressed for a cure. For their sake, let's hope that this promise (of curing millions through telemedicine) is not meant to be broken.

   Report sourced from www.ciol.com