Consultation just a Click Away!
Setting up an excellent telecommunication infrastructure in suburban and rural areas would improve the reach of the limited number of urban specialists
In the last six years, thanks to the relentless work done by several groups of committed champions of telemedicine like Apollo Hospitals, a beginning has been made. Patients can now be examined, investigated, monitored and treated, with the patient and the doctor located in different places.
Expertise, not the patient, is transferred using telecommunications and IT. Unnecessary traveling is eliminated. Patients do not have to come back for review to the metros. These can be done at the comfort of the nearest telemedicine center.
Telemedicine is now an integral part of healthcare services in many countries. Once the virtual presence of a specialist is acknowledged, a patient can access resources in a tertiary referral centre without constraints of distance. Theoretically, it is easier to set up an excellent telecommunication infrastruc-ture in suburban and rural areas and increase the reach of the limited number of urban specialists. There has been an unprecedented growth and development in IT in India. India no longer has to follow the advanced countries, we do not even have to piggy back, we can leap frog!
Today, there are about 300 telemedicine units located in suburban and rural India and about 25 in tertiary care hospitals. However, 70 per cent of the population residing in rural areas have access to less than 20 per cent of the available doctors, which itself is only 1:2,000. Only 0.09 per cent of the GDP reaches 625 million in rural areas.
India, though considered a developing country, is a paradox. We produce and launch our own satellites. Preliminary information is being gathered regarding the feasibility of launching a HEALTHSAT – a satellite exclusively for providing healthcare.
All transitions offer great opportunities and still greater challenges. Using ICT to redefine the delivery of healthcare in urban and rural India is one such challenge. The teledensity of India is approaching 22 per cent. It is easier to set up an excellent telecommunication infrastruc-ture, than to place medical specialists in suburban and rural India.
India has joined the band of nations who have recognised the potential of telemedicine. The National Task Force on Telemedicine, a Planning Commission working group on Telemedicine, The Telemedicine Society of India and a National Institute of Medical Informatics and Telemedicine, a possible Telehealth Act for India, all speak for themselves. Apollo Telemedicine Networking Foundation and Anna University are now jointly conducting formal courses on telehealth technology. International conferences on telemedicine are now being organised in India.
Mobile telemedicine is now a reality in India. There are about 10 active mobile telemedicine units in India today that go to different villages every day. A villager gets into an air-conditioned mobile truck with ultrasound, X-Ray, ECG, biochemistry laboratory, ophthalmic equipment etc. A VSAT on the truck transmits the images through satellite technology. Emergency technicians in ambulances in the future will use digital cameras and cellular telephones to transmit pictures of accident scenes to the local emergency departments. Pre-hospital management will eventually be of the highest standard.
PDA and Telemedicine
Ambulance drivers using a GPS in a palm top can quickly reach an accident site. Automated voice message (AVM) systems could be used as an adjunct to primary care for diabetic patients. An AVM monitoring protocol can inquire about patients’ glucose, foot care, diet and medication adherence. Patients have the option to listen to health promotion messages. Hand-held simputers are being used by midwives and public health nurses in pilot projects in India.
The necessity of home telecare systems is growing due to increase in chronic diseases, aged population (living alone) and medical expenses. A video visit to the patient’s home will be more cost-effective. Tabletop sensors can monitor blood pressure, cardiac rhythms, blood sugar etc. A home-bound patient will use a digital camera to take a picture of his post-operative wound or bed sore and will upload the photo directly to the medical record via e-mail for his surgeon to see. A video surveillance unit can watch an old man take his pills, look at his bed sore, and even ensure that the refrigerator and pantry is adequately stocked. Implanted devices will directly relay vital parameters through satellite telephones enabling monitoring from a distance. The Indians-dominated touch lab at MIT in Boston is working hard to ensure that within a few years, even the sensation of touch can be perceived remotely.
Social and Ethical Issues
Politics, social organisations and human factors, and not technology, will be the reasons for failure of telemedicine systems. Issues in implementing telemedicine include acceptance of this modality by society, patients, family physicians, specialists, administrators and the Government. E-health as a new and innovative technology, may encourage depersonalisation and diminish the trust and intimacy that defined the traditional relationship between patients and their physicians. Real growth will take place only when society realises that distance is meaningless today, and that telemedicine can bridge the gap between the ‘haves’ and the ‘have nots’, at least where access to healthcare is concerned.
Shopping around will be easy in the world of telemedicine. Traditionally, healthcare has taken into account social, cultural, ethnic beliefs, education, socio-economic group, geographical location and age, assuming that the healer and the healed hail from the same region. This will no longer be so.
For the healing encounter to attain its ultimate goal of patient benefit, there must be a carefully balanced
coalition of knowledge, clinical skill, and effective communication.
It is our dream and hope that within the next few years there will be telemedicine units in most parts of suburban and rural India. Eventually no Indian will be deprived of a specialist consultation wherever he/ she is.
Head of the Apollo Telemedicine Networking Foundation