Telemedicine Still Not Reaching Rural India

Sudha Nagaraj Bharadwaj, Journalist | 12/4/2012 | 21 comments

Sudha Nagaraj Bharadwaj
Building brick-and-mortar hospitals to cater to a country that accounts for more than a sixth of the world’s population is a near impossibility. At present, 65 percent of India’s population lacks access to modern medicine. Less than 10 percent have access to a hospital, and only 13 percent have access to a primary care center. Add a poor doctor-to-patient ratio of 1:2000, and it becomes clear that telemedicine is the way to improve the country’s healthcare system.

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. Telemedicine -- the use of technological aids like videoconferencing, mobile phones, and the Internet for consultations and monitoring patient data -- has already started in India. Some of the initiatives include:

  • Indian Space Research Organisation: ISRO’s telemedicine network has enabled 382 hospitals to practice telemedicine. Facilities are available across 306 remote, rural, and district hospitals and health centers. Sixteen mobile telemedicine units are connected to 60 super specialty hospitals located across major cities. Mobile vans are extensively used for tele-ophthalmology, diabetic screening, mammography, childcare, and community health. Services have been tailored to prevent outbreak of diseases during religious events like the Maha Kumbh Mela and natural disasters like the 2004 Tsunami.

  • Narayana Hrudayalaya: With a fully-operational, yet simple, telemedicine set-up, the hospital network uses both Skype and the ISRO network for screenings, emergencies, continuing medical education programs, and teleconsultations. The installation of indigenous software-equipped Trans Telephonic ECG machines installed free of cost at clinics helps doctors tranmit ECGs directly to specialists at hospitals. Similarly, district post offices have been equipped with Internet and software apps that allow for uploading reports, angiograms, and ECGs to the hospital for analysis. The network has treated over 53,000 patients over a decade through telemedicine facilities, including those in Malaysia, Tanzania, Nigeria, Burundi, Zambia, and Bangladesh.

  • Apollo Telemedicine Networking Foundation: Apollo started with the world’s first VSAT-enabled hospital commissioned by then US President Bill Clinton; it now boasts 135 centers, including 10 overseas. Having provided 71,000 teleconsultations across 25 specialties, the Apollo Group of Hospitals has now floated a commercial arm, Apollo Tele Health Services. It proposes to offer services through mobile phones and tablets and is launching a pilot across five tertiary care hospitals in Hyderabad and Chennai.

There are also several innovative new programs and experiments coming very soon. The Defence Research and Development Organisation has developed bio-medical data acquisitions systems and sensor jackets for remotely monitoring the health of soldiers. And ReMeDi, a remote diagnostic device, ensures medical consultations and videoconferencing at Internet bandwidths as low as 32Kbp/s and operates on less than 2 watts of battery power. The non-profit organization, World Health Partners, has deployed this device in Uttar Pradesh and Bihar.

But regardless of the progress, there is much to be done on the policy front. While attempts have been made to set guidelines and standards for telemedicine, India does not have a policy in place. Individual efforts to maintain electronic health records are being used at various hospitals, but there is no move to create a common EMR.

India has won accolades for setting up the Pan Africa Network and the South Asian Association for Regional Co-operation (SAARC) telemedicine network, but public expenditure on health in the country is just above 1 percent of the GDP and is counted as one of the lowest globally.

So while stories about medical tourism, rare surgeries that save precious lives, and transcontinental teleconsultations continue to make headlines for the Indian medical community and private hospital networks, the truth is that rural India is largely deprived of this very advantage. If CIOs are going to fix this, it is going to be through telemedicine.

View Comments: Newest First | Oldest First | Threaded View
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Rich Krajewski   Telemedicine Still Not Reaching Rural India   4/20/2013 3:34:42 PM
Re: If No One's Said It
"but this days Doctors run away from CANADA"

I understand your point. You probably won't be surprised to learn that it's hard to get care for the handicapped in the US. It's forcing me to look overseas for handicapped care. And the problem is not just in finding care, but in future physicians finding training that doesn't practically guarantee they will not be able to accept poor patients. Telemedicine isn't helping, so far.
MDMConsult   Telemedicine Still Not Reaching Rural India   4/20/2013 8:06:07 AM
Re: If No One's Said It
Regulatory barriers are difficult in cost of obtaining, challenging malpractice protection, etc al. Lack of acceptance by government hinders on the healthcare system. Professional and cultural barriers occur from decreased lack of desire or physicians not being able to adapt internally for telemedicine.
batye   Telemedicine Still Not Reaching Rural India   1/2/2013 1:35:45 AM
Re: If No One's Said It
it would be nice... but this days Doctors run away from CANADA... as per disagrement with gov. over pay...
Rich Krajewski   Telemedicine Still Not Reaching Rural India   1/2/2013 1:25:57 AM
Re: If No One's Said It
It would be nice to be able to increase the number of physicians by using more technology, rather than just trying to increase the reach of the current number of physicians by using telemedicine.
batye   Telemedicine Still Not Reaching Rural India   1/1/2013 11:27:30 PM
Re: If No One's Said It
I live in Canada and in my rural area we have problem to get access to doctor... some area in my city still have only option dial up for internet...

I hope one day everywhere in the world people could get access to health care via telemedicine or in person...
Gigi   Telemedicine Still Not Reaching Rural India   12/10/2012 4:13:07 AM
Gigi
Re: Telemedicine
Sudha that I agree. But I think the scenario will be getting improved within a couple of years. In one of the southern state (Kerala), ISRO and Amrita medical college have started telemedicine centers across the state, atleast one location in all districts. Once if its success, they have similar plans for other states too.
Rich Krajewski   Telemedicine Still Not Reaching Rural India   12/7/2012 3:59:44 PM
Re: If No One's Said It
I can sympathize because I've run into a reluctance among physicians in the US to treat severely autistic adults, because these patients are difficult to manage and often rely on low-paying Medicaid insurance. This seems similar to the problem where physicians in India do not want to serve in rural areas where perhaps pay would not be very good. Perhaps telemedicine would be better than nothing where it is nearly impossible to get a patient into a doctor's office (because the patient is nearly uncontrollable).

Making healthcare more available, by whatever means, is an important problem for me and is one that I hope to be able to help solve.
Sudha N Bharadwaj   Telemedicine Still Not Reaching Rural India   12/7/2012 1:01:47 PM
Re: If No One's Said It
@ Rich I understand your point...it seems much like the "eat cake, if there is no bread" solution! Emigration of the finest doctors to countries like the US and UK, reluctance of doctors to serve in villages and poorly-equipped primary/community health centres are all adding to the misery of the rural population. The total absence of specialists further deprives them of timely advice in case of a life-threatening affliction, which is what can be avoided with use of technology. There is a requirement that students on qualifying as doctosr should serve in rural areas for a year, failing which there is a heavy penalty. Soon after specializing, doctors leave for "further studies" abroad and invariably settle down there --often, and ironically--serving in rural areas there!The government has recently taken a decision to ask doctors who go abroad to give a bond that they would return on completion of higher education.But the moot point is wil that help to get them to work in villages? There is no dearth of corporate hospitals in cities ...and so continues the vicious cycle. Granted, telemedicine is no elixir for the ills of rural folks, but it would be foolish not to use technology to overcome part of the problem at the least. You will be surprised to know there is a serious debate among policy-makers to usher in M-health (through mobile phones). I will save that for another post on E2 India. I hasten to add it is more of a "leave no stone unturned" approach.
Sudha N Bharadwaj   Telemedicine Still Not Reaching Rural India   12/7/2012 12:30:46 PM
Re: Telemedicine
You are right. There are such mobile clinics is some states and they do alleviate healhtcare issues where the primary health centers are not located nearby. These vans help in eyecare to some extent; also some hospitals in collaboration with NGOs hold medical camps in villages and take along mobile units that are better equipped than the basic healthcare centers are. However telemedicine as in specialist consultations (which the poor cannot afford) are more an urban phenomenon.
Rich Krajewski   Telemedicine Still Not Reaching Rural India   12/6/2012 12:06:17 PM
If No One's Said It
If no one's said it, I will.

Or if someone has, then I add my voice to that opinion:

Telemedicine should be a backup, or an emergency measure, not a primary delivery mechanism. It should be an emergency measure the way the holographic doctor on Star Trek: Voyager was an emergency measure. It's ridiculous for us to think society is incapable of training enough physicians, and has to resort to what one could sarcastically portray as "medicine over a phone." It's as nonsensical as the idea that companies can no longer find skilled labor.

I know this is the "Enterprise Efficiency" website, where explorations of these kinds of systems is good and proper, but I hope we can keep perspective and realize that these systems should be developed as adjuncts to primary care, and not AS primary care.

Maybe IT can focus as much energy on delivering medical training more efficiently as it does on delivering telemedicine. Then we wouldn't have to worry as much about whether there is enough telemedicine in rural areas, because there will be real medicine there, instead.
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