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.
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.
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 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.
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.
Sudha, as of now telemedicine's are not common with most the rural areas. But obliviously it will happen within a couple of years. Apart from the three you mentioned, some other telemedicine activities like mobile vans with telemedicine facility is introduced, which will roam around rural/urban regions. Government is also planning for telemedicine facility through NIC and NKN.
It's sad that this isn't getting more attention in India and the media. While there's nothing wrong with featuring or covering the good stuff (ie. miracle surgeries and the like), the fact of the matter is that these 'ordinary' concerns are major ones that will impact more people than the former. Attention should be brought to this and swift action taken to ensure that India does not fall behind when it comes to telemedicine.
Actually there are many innovative projects, but they are all in pockets and have not scaled. Some adopt the PPP model such as the vision care project --with the Tripura state government, IL&FS and Arvind Eyecare as partners. But that is what is frustrating, people around the world read about these showcase projects and are quite aghast when they visit India and witness the reality.
@Sudha Well it's good to know that the e-governance plan is including healthcare, but like you, I hope that greater advancements in rural healthcare will happen soon and won't have to wait for the larger e-governance program to be completed.
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