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Vinson Kurian

THIRUVANANTHAPURAM, June 16

TELEMEDICINE in India is still in a nascent stage what with many existing initiatives in the sector having been sponsored by the Government for increasing the spread of healthcare in rural areas. According to a study conducted by Wipro Consulting and Apollo Healthstreet in association with Kerala State IT Mission, the commercial viability of telemedicine is still uncertain for various reasons.

Kerala has good healthcare infrastructure for treating cardio vascular and gastro diseases and houses around six telemedicine installations. These strengths can be explored to find if there is a business potential in domestic telemedicine, the study, which was carried out to assess the State's potential as a prospective healthcare BPO destination, pointed out.

For telemedicine to happen, infrastructure must be set up on both the sides of the encounter. A network of four consultation centres and a speciality centre is required to sustain this business model. Performance of each entity is strongly linked to another.

In an encounter-based revenue model, commercial success for the consultation and speciality centres does not come at the same time. For the speciality centre, the real value of telemedicine is not in encounters. The real value of the encounter can be realised when the telemedicine patient visits his specialist for a more complicated treatment.

A bypass surgery costs Rs 2 lakh on an average. If through the various telemedicine encounters, the doctor and the patient develop a relationship strong enough for the patient to choose the same doctor for the surgery, the hospital immediately gets revenue of Rs 2 lakh. Even two such incidents in a year from its telemedicine network can bring down the pay back period of the investments in the speciality telemedicine centre to two years.

For telemedicine to succeed commercially, a very strong marketing network should be in place that binds the speciality centre to the consultation centres. Also, the speciality centre should not depend on the encounters for profits.

Viewed from a larger national perspective, there are a lot of imponderables that India must cross to tap telemedicine opportunities - technology barriers, market access barriers, financial barriers and legal barriers. As for technology barriers, though the country had close to 1.5 Gbps of bandwidth in 2002, only 700 Mpbs was actually used by the ISPs. This was primarily due to the high license overheads ISPs had to incur. Telecom bandwidth continues to be very expensive in the country.

Market access barriers come into play in telemedicine requiring an agreement between the healthcare provider in India and a healthcare provider in the client country to strike up business. In future, such agreements can be between telemedicine centres, which need not be associated with a healthcare provider.

It requires a lot of time to establish such agreements for the following reasons; (i) there isn't enough information about the number of healthcare facilities in the client countries under consideration (ii) the medical fraternities in both the countries are yet to acknowledge the capabilities of each other before they can let a foreigner operate in their respective healthcare industries (iii) the business rules to enter into such agreements are not very clear yet.

As for financial barriers, the Indian rupee is not yet fully convertible. Indian service providers have to incur a 1.5 per cent conversion charge from banks today. There's a charge for electronic payments, too. Both these put together, the earnings may be reduced by almost three per cent.

When considering the legal aspects, it becomes clear that there are no universal telemedicine guidelines yet that can be enforced in any country for a telemedicine encounter. Neither is there a proper redressal mechanism, should something go wrong in a telemedicine encounter.

Very few countries today have a legal framework to protect the privacy and confidentiality of health information. There is no mechanism to stop either of the parties in an encounter from misusing the health information of a patient.

Only when all these barriers are cleared can one easily offer telemedicine to the countries that India can ideally develop a telemedicine relationship with (Asia Pacific, Africa and the Middle East), the study said.

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