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Raja Simhan T.E.

Telemedicine offers immense scope to bring people under the health cover but more must be done to make it effective.

OVER 600 million Indians live in rural areas. Access to medical specialists operating in urban areas is a distant dream for them. Statistics show that there is only one hospital bed for about 1,300 Indians, and one doctor per 15,500 people. Less than 9 per cent of the country's billion plus population is covered under health schemes.

So, what could be an ideal solution to reach the 600 million plus Indians in rural areas in terms of medical help? Telemedicine could be a very possible answer, say experts in the healthcare and IT industries.

In the last few years, a lot has been talked about telemedicine. However, despite the awareness, it is yet to take off in a big way. The concept is still restricted to some of the large corporates, considering the cost involved in creating the necessary infrastructure, feel sources in the healthcare and IT industry.

Telemedicine remains effective. Yet at best it connects only tertiary-care hospitals to the selected primary-care centres. Unless there is a national initiative and government support, telemedicine will not be effective in providing specialised care to distant satellite centres. Tertiary hospitals in the private and public sector would continue to be overcrowded, says Prashanth Prakash, Founder and Chief Strategy Officer, Netkraft Private Ltd, a Bangalore-based firm and provider of IT solutions in healthcare.

Says Dr Sunil Shroff, Professor and head of department, Urology and Renal Transplantation, Sri Ramachandra Medical College and Research Institute, Chennai, "Tele-medicine is going to entirely change the way we practise medicine. The day is not far away when a patient in Chennai is likely to have his general practitioner in Mumbai or London, or a specialist in Australia may help a surgeon in Aurangabad to perform a difficult surgery. However, Indian IT companies need to create cost-effective applications suited for the domestic sector."

The Indian Space Research Organisation (ISRO) used its INSAT (Indian National Satellite) and IRS (Indian remote Sensing) satellites for various applications, including telemedicine.

A recent application of space technology initiated by ISRO was in telemedicine to provide expert medical services to rural areas. Under the telemedicine project, hospitals/health centres in remote locations are linked through INSAT satellites with super specialty hospitals at major towns/cities, bringing in connectivity between patients at remote ends with specialist doctors for medical consultations and treatment.

There are over 30 telemedicine centres in the country linked with ISRO's INSAT, including the Andaman Islands, says Dr Shroff, who is also the President, Medical Computer Society of India.

Telemedicine helps patients in distant and rural areas to avail timely consultations of specialist doctors without travelling long distances. The facility caters normally for transmission of patient's medical images, records, output from medical devices and sound files, besides live two-way audio. With the help of these, a specialist doctor could advise a doctor or a paramedic at the patient's end, online, on medical care or even guide the doctor during a surgery.

Telemedicine systems consists of customised medical software integrated with computer hardware, along with medical diagnostic instruments connected to the commercial VSAT (Very Small Aperture Terminal) at each location. Generally, the medical record/history of the patient is sent to the specialist doctors, who in turn, study and provide diagnosis and treatment during videoconference with the patient's end.

ISRO's facility serves the telemedicine project at a larger scale. However, deploying it at a smaller scale and at smaller hospitals could be costly. Only large hospitals can afford to spend a few lakh rupees, feel experts in the IT and healthcare industries.

For instance, using ISRO's satellite, the Apollo Hospitals provides expert opinion from its tertiary level hospitals in bigger cities to those in the far-flung towns of India on various medical issues. Similarly, Sankara Nethralaya has spent about Rs 1crore on telemedicine, of which Rs 75 lakh has been provided by ISRO for a mobile van and equipment.

Says an official of a large IT firm, telemedicine need not necessarily need large investments. With just a personal computer, a modem, a scanner, a Web camera and a telephone line, all costing less than Rs 50,000, a telemedicine project can be up and running.

For instance, using a 64 kbps line, a patient's reports can be sent through text, voice, images or even video, and medical advice can be offered from a remote location. Using this solution, successful pilot tests have been conducted at various places in Tami Nadu, the official says. "Cost-effective telemedicine solutions could be spread across the country. We are not looking at conducting surgeries through telemedicine. We are only looking at diagnosing patients' disease and advising them accordingly," he says.

Says Dr Praveen Soti, Consultant, Health Care Practice, Domain Competency Group, Infosys Technologies, there have been pilot projects on telemedicine by some large corporate hospital groups and the response has been mixed. Though some projects have been successful, success has been seen in larger tertiary-care settings for focussed disease conditions. This has helped doctors understand the patient condition better and plan treatment accordingly. Considering the patient load on doctors, it would be too early to comment on possibilities of telemedicine in primary care settings in India. Improvements in infrastructure and systems for capture of complete patient details (History and Investigations) and standardised referral mechanisms will help needy patients to benefit from telemedicine.

For better utilisation of telemedicine services, awareness needs to be spread at the end-user level, says Mohan Narayanan, Vice-President, Health Care and Life Sciences Practice, of Cognizant Technology Solutions. Telemedicine in India is still in the embryonic stages and will soon catch up. There are success stories where telemedicine has played a major role in saving lives in instances of natural disasters, he says.

raja@thehindu.co.in

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