Telemedicine Paving its way…

In India there is an acute shortage of doctors with 1 doctor for every 1,000 population. In such an inadequate healthcare system, Telemedicine has come out as a boon to the rural patients.   

Seated before their laptop in the super-specialty hospitals of the country, these surgeons now couldn’t miss a consultation with a patient who lives hundreds of kilometers away, even away from the country. Between surgeries and hospital rounds, they in a much better way manage to give their time and suggestions to the patients who need them but couldn’t reach them personally. This is what, Technology driven healthcare has given us, ‘Power of ‘Telemedicine’.

Telemedicine, in simple words, means use of Information and Communication Technologies (ICT) to provide medical services from distant locations. Tele pathology, tele-radiology, tele-ophthalmology are some ways of accurately diagnosing diseases from a distance.

Today, every super-specialty hospital has emerged as e-health provider, which stated that they want to change how healthcare is delivered in India, and address the industry’s two biggest problems: accessibility and lack of manpower.

According to a 2012 report by accounting firm PricewaterhouseCoopers (PwC), in India still patients travel about 20 kilometers to see a doctor.  Even the worst, we have 0.7 physicians per 1,000 people — BRIC peers Russia (5), Brazil (1.5) and China (1.5) have better ratios.

India is a country where major population still resides in the remote areas and for them accessing basic healthcare is so tough that they can’t even think of visiting the metro cities, having direct interaction and spending out-of-pocket for healthcare. However, in cities as well, health workers say hectic lifestyles and longer commutes make it tough to visit the doctor.

For us doctors are second God and medical is heaven on earth. Doctors may not be the panacea for all problems, but the fact remains that they definitely can provide cure for all diseases. In their view, early detection and timely intervention can cure several life-threatening diseases. Nonetheless, patients living in metro cities have this benefit while India’s major rural population, has been deprived of such medical facilities and infrastructure.

More to the point, doctors’ shyness to serve in the backwoods is also creating a spot on India’s health care landscape. While, a total of 74 percent of the qualified doctors inhabit urban areas, serving only 28 percent of the national population, the rural population remains mostly neglected.

‘Digital India’ is not an elite concept anymore. We have to use this idea to revolutionize health and education in India. Use broadband for education for rural areas, and telemedicine for the poor,” PM Modi was quoted as saying in many national dailies.

Nevertheless, the condition of public health system is not just pathetic but also under-utilized and bungling. On the contrary, private sector is quite prevalent in India’s healthcare system. Nearly 80 percent of total spending on healthcare in India comes from the private sector.

As a matter of fact, there is a high degree of disparity in quality and access to health care service between urban and rural regions. The quality of patient care and access to healthcare services are disproportionately low in rural areas. In such a scenario, telemedicine has come as a boon for all—to improve the country’s healthcare system.

Telemedicine in India

With nearly 900 million mobile phone connections and over 200 million internet users, experts say wireless technology can be harnessed to decentralize India’s healthcare industry, which is expected to touch $250 billion by 2020.

The Indian Space Research Organization (ISRO) is also delivering health care services to the remote, distant and underserved regions of the country through a satellite communication- based telemedicine network. The Government of India has initiated and executed various national- level projects and also taken telemedicine services to South Asian and African countries. Department of Information Technology (DIT), Ministry of Health and Family Welfare, state governments, premier medical and technical institutions of India have taken various game-changing and executable initiatives in recent years.. A number of institutions which have been actively involved in telemedicine activities are also running curriculum and non-curriculum telemedicine courses.

Further, to increase the availability and accessibility of telemedicine in the country, the Department of Information Technology has set the standards for telemedicine systems and the Ministry of Health and Family Welfare has formed the National Telemedicine Task Force.

Several state governments such as Maharashtra and Andhra Pradesh have launched free medical help lines. There also are private companies, such as Mediphone, Truworth. Started in 2011, the paid service has more than 1,000 phone calls each day seeking medical advice, with 33 percent of the calls coming from Bihar, one of India’s most underdeveloped states.

Newer and smarter health devices are also helping the industry’s growth. Heart and blood pressure monitors can now wirelessly transmit the patient’s data to mobile phones or a central online database accessed by telemedicine centers.

Almost all the big manufacturers are looking at developing devices with mobile functionality. Telemedicine centres have started picking up in the last one year because of these devices.

Hospital operators such as Medanta, Apollo, Asian Heart Foundation, Apollo Hospitals, SGRH, Fortis, Max, Rockland, Columbia Asia and Fortis are also stepping into telemedicine, lured by lower costs and a pan-India reach. It is estimated that 1.5 lakh people are benefited from telemedicine every year.

Market

With the sudden spurt of telemedicine network within the country, the market for medical diagnostic, healthcare providers, drug manufacturers, telecom equipment manufacturers, software has increased manifold. According to a study by Technopak Advisors, the Indian telemedicine market is valued at $7.5 million and is expected to grow at a CAGR of 20 percent over the next five years to around $18.7 million by 2017. A London-based market intelligence firm, Infiniti Research in its report published in 2009, titled “Global Telemedicine Market:2008-2012”, pegged the size of the global telemedicine market in 2008 at US$9 billion. As per this report, Asia is the fastest growing region for the telemedicine market with India and China leading the growth.

India is an ideal setting for telemedicine activities. Here, telemedicine is not only trumpeted as a bucolic boon but also as a boom sector for various stakeholders.

Still challenges linger

Despite the fact that telemedicine deployment is moving at a steep rate in India, it hasn’t yet gone on a giant scale. Around 75 percent of our rural population is reeling under lack of computer knowledge. For the implementation of telemedicine one must be computer literate. Moreover, rural India faces power cuts of 12 to 15 hours a day, where even a battery backup system does not work out.

The problem is to say the least enormous. Providing “better healthcare” to 700 mil- lion Indians living in rural India requires radical exponential transformations not routine incremental changes. Technology-based 21st century solutions are required. WiFI and WIMax is not the answer. Shortage of dedicated medical and healthcare staff exclusively for telemedicine, late response time showed by some types of telemedicine, and inadequate estimation are some of the challenges faced by the global telemedicine industry.

Language and communication is another impediment. In India with over 22 officially recognized languages and over 1,600 mother tongues, linguistic diversity is a major hurdle for patients living in one region being able to talk to a doctor in another region.

Though telemedicine technology advantages and benefits are well recognized but still many healthcare professionals are unenthusiastic to engage in telemedicine practices due to unsettled legal and ethical concerns. Last but not the least, most of the government and private doctors are not willing to participate in telemedicine activities since they view it as a direct challenge to their livelihood.

Conclusion

Telemedicine technology can bring revolution to the field of medicine. Using a number of high-speed satellite and terrestrial telecommunications links, centralization and coordination of resources, and support of government, it has been possible to reach and access the Indian population spread out in heterogeneous geography and thus achieve the goal of health for all. India has taken a lead in this field among the developing countries. However, all the activities need to be evaluated in a national framework, and many issues, such as national e-health policy, and legal/ethical issues need to be addressed.

India deserves kudos for setting up the Pan Africa Network and South Asian Association for Regional Cooperation (SAARC) telemedicine network, but the public expenditure on health which is counted as one of the lowest globally cannot be ignored.  While the Indian medical community and private hospital networks may take pride in country’s medical tourism and rare surgeries that save precious lives, but the fact remains that rural India is prodigiously deprived of this very advantage.

Ultimately there needs to be a mass revolution from the bottom of the pyramid demanding healthcare as a birth right. Thrusting ‘better’ healthcare from the top will not be enough. Finally one size does not fit all. Multiple ever- changing solutions will be required.