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K.G. Kumar

LAST week the Regional Cancer Centre (RCC) launched a Rs.2.35-crore telemedicine project - labelled `ONCONET' - to broad-base diagnostic evaluation and consultation services for cancer patients across the State.

The Indian Space Research Organization (ISRO) will provide the high-bandwidth V-SAT facility for ONCONET, as well as Rs 36 lakh in financial aid. The Department of Information Technology (DIT) of the Union Government will pump in Rs 1.79 crores for the project, which will be technically supported by the Centre for Development of Advanced Computing (CDAC).

ONCONET - expected to be completed in two years - envisages telemedicine nodal centres in Thiruvananthapuram, Kollam, Kozhencherry, Ernakulam, Palakkad and Kannur. A couple of months ago, the DIT had announced plans for a National Telemedicine Network to bridge the gap between the haves and have-nots in health care.

All these moves are in keeping with global trends. Pioneered by the US National Aeronautics and Space Administration (NASA) and popularized by science fiction, telemedicine aims to deliver access to medical specialists to the most remote communities.

In 1999, Peter Leitner, CEO of Waterford Telemedicine Partners, Inc., and founder and chairman of Waterford Advisors Inc, the creators of the Waterford Telemedicine Index, forecast that the global telemedicine industry would grow 40 per cent annually over the next 10 years.

In 1998, the telemedicine industry grew worldwide to $13.8 billion from the previous year's $6.8 billion. "Increasing consumerism, changing demographics, hardware price deflation and the proliferation of the Internet are the driving factors behind its rapid growth," claimed Leitner. "Over the next decade, the telemedicine industry will expand into new markets and service areas," Leitner added. "Furthermore, its rapid rise will have a profound impact on the delivery and quality of medical care worldwide. In the US alone, we expect telemedicine will represent at least 15 per cent of all health care expenditures by 2010.

"Another estimate says that the US Federal Government will spend close to one billion dollars this year on research, activities and grants related to telemedicine, telehealth and informatics. As budgets expand to fight bioterrorism, more money will be needed to provide important surveillance equipment, health alert networks and infrastructure development.

Telemedicine and computer-assisted medicine is still in its infancy. Current applications focus on traditional video conferencing models to deliver video visitation and video consultation. In video visitation, patients who need care but not hospitalization consult with doctors in home healthcare applications.

In video consultation, a doctor (or a nurse/practitioner) consults with one or more specialists while examining a patient, typically in cases where the diagnosis is uncertain. Industry experts say that medical specialization has made it virtually impossible for a community of fewer than 500,000 people to support all of the types of doctors that the residents require.

Remote communities and the developing nations will be the driving force for the delivery of high quality healthcare consultation using video-enhanced medical equipment. Future developments will incorporate video and data capture and streaming into medical devices.

During the Gulf War, the US Navy's Fleet Hospital used a newly developed hardware solution to support a hospital with up to 500 beds, operating rooms and ancillary services. The system fit into four rugged cases. The new technology was part of a strategy to treat injured people outside a traditional hospital setting in the first `golden hour' when care may mean the difference between life and death. It included the concept of `forward surgery' to swiftly treat the wounded instead of just stabilizing them and transporting them back to a carrier.

This is a long way indeed from the case of Zhu Ling, a young female student of Peking University. On 10 April 1995, an SOS e-mail message was sent from the university through the Internet to ask for help for Zhu Ling, suffering an unknown but severe disease.

The message spread rapidly over the Internet and the Zhu Ling case, which involved physicians, telemedicine researchers and many others in North America, Europe and mainland China, has become a classic example of how far telemedicine can be taken to bridge the cultural, linguistic, and even political gulfs between a country like China and the Western world.

And now Kerala can do its bit too.

The writer can be contacted at kg@tug.org.in

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