Telemedicine takes world-class healthcare to rural India

In a hospital-strapped country such as India, telemedicine is proving to be a boon. Over 270 hospitals have adopted telemedicine and the sector is estimated to grow at over 21 percent per annum till 2014.

In telemedicine, clinical and medical services or information is provided via communication networks such as the telephone and Internet.

Yogender Peddinti, senior manager at Apollo Telemedicine, told ZDNet Asia in an e-mail interview: "Every day, we treat around 100 patients, spread across India in various specialties through the Apollo Telemedicine Networking Foundation (ATNF)."

The Apollo Hospitals Group, the largest healthcare provider in Asia, began its foray into telemedicine in 1999. Today, the ATNF (the group's telemedicine arm) has successfully set up over 120 telemedicine locations, of which, seven are in countries outside India, including Pakistan, Sri Lanka, Oman, the Maldives and Nepal.

According to Peddinti, a tele-consultation ranges between 15 minutes and 30 minutes.

Yugal Sharma, regional director for India and SAARC (South Asian Association for Regional Cooperation) at Polycom, told ZDNet Asia in an e-mail interview: "Telemedicine may change the face of healthcare in India by improving access to experts, specialized medical information, diagnostic tools and consultations."

Apollo Telemedicine Networking Foundation treats some 100 patients across India each day.

Polycom, a provider of unified communications and collaboration, videoconferencing, data and Web communications products, has installed several telemedicine products in India and overseas. Hospitals such as the Apollo Group, Escorts, Sanjay Gandhi Post Graduate Institute of Medical Sciences and Fortis, are using Polycom products.

Telemedicine is most relevant to India as it faces a scarcity of both hospitals and medical specialists. According to the Planning Commission, India is short of 600,000 doctors, 1 million nurses and 200,000 dental surgeons--for every 10,000 Indians, there is barely one doctor available.

A large majority of India's population (nearly 72 percent) still lives in villages, where healthcare facilities are poor. Most specialists are unwilling to practise in rural areas. According to statistics, 80 percent of doctors in India, 75 percent of dispensaries and 60 percent of hospitals, are situated in urban areas.

Krishnakumar Sankaranarayanan, managing consultant at PricewaterhouseCoopers India, told ZDNet Asia in an e-mail: "When it comes to healthcare, India gets divided into two. Urban India has healthcare centers of excellence, while much of rural India has no access to basic healthcare."

As a result, for decades, most patients in small towns and villages have had to travel to the larger cities for treatment.

Telemedicine can be used effectively to bridge the healthcare divide. "The National Health Policy 2002 lists equitable access to healthcare as its overriding goal. And telemedicine will go a long way in ensuring that the inequities are mitigated to a large extent," Sankaranarayanan added.

According to research firm Frost & Sullivan, India's telemedicine market is worth US$3.4 million and is estimated to grow at a 21.6 percent compound annual growth rate (CAGR) between 2007 and 2014.

The Indian central government, many state governments and private players are taking to telemedicine in a big way with the Indian Space Research Organization (ISRO) playing the role of a catalyst.

Bringing healthcare to all
Rajarshi Sengupta, executive director and head of healthcare practice at PricewaterhouseCoopers India, told ZDNet Asia in an e-mail interview: "With the lead taken by the ISRO, telemedicine in India has picked up quite well, as compared to other developing countries."

The ISRO, an Indian government body that develops space technology and its applications for national tasks, provides hopsitals with telemedicine systems including software, hardware and communication equipment and satellite bandwidth. The state governments and specialty hospitals have to allocate funds for their part of infrastructure, manpower and maintenance.

As of 2007, 278 hospitals in India had been provided with telemedicine facilities, with 235 small hospitals including those in remote and rural areas and medical college hospitals, connected to 43 specialty hospitals.

Sharma said: "We have seen large-scale deployment wherein thousands of patients located in remote parts of the country benefit from the solution. In time, this number is going to multiply."

Polycom now has plans to reach out to the masses and create awareness about telemedicine through alliances with various service providers, such as Reliance World, which has retail outlets that leverage Reliance Communications' optic fiber network to offer digital services, including teleconferencing.

According to Peddinti, the cost of setting up a telemedicine facility ranges between US$2,105 and US$5,848.

Through telemedicine, doctors are available 24 by 7 to patients in rural India.

"Telemedicine is largely used for primary consultation in neurology, cardiology, rheumatology, gastroenterology, oncology, and infectious diseases," he said. "The method saves time and money for both the patient as well as the doctor. Through telemedicine, super-specialty opinion can reach any area at a minimal cost."

Sankaranarayanan said: "Drivers for the adoption of telemedicine are different for developing and developed countries."

He explained that in developing countries such as India, the objective is to improve access to healthcare for large sections of the population and bridge the urban-rural divide.

"Developed countries such as the United Kingdom, on the other hand, use telemedicine as a means to reduce the cost of chronic care in hospitals," Sankaranarayanan added. In these countries, patients with chronic conditions that require long periods of hospitalization are encouraged to move to a home equipped with telemedicine facilities, where information about the patient's condition can be sent real-time to medical specialists.

Today, new telemedicine concepts are taking birth in India. For instance, the government of Rajasthan plans to introduce mobile telemedicine vans in the state with an instant, multi-way high-capacity communication link between hospitals and remote sites.

For the patient, telemedicine is a big boon.

Sharma said: "Statistics have shown that only 15 percent of the patients treated through telemedicine actually had to come to hospitals for further treatment."

According to Peddinti, telemedicine "frees up doctors to a large extent as they can give multiple consultations simultaneously". Doctors can focus on patients in remote locations during their respective time slots, and are also available for advice online for emergencies on a 24 by 7 basis.

For hospitals, it reduces the crowds in the outpatient department, thereby reducing infrastructure costs.

Peddinti told ZDNet Asia that Apollo Hospitals is in the process of developing a Web site that will provide content validated by Apollo doctors, so people can avail of healthcare advice from their homes.

"The actual impediments to the growth of telemedicine today are less in terms of the connectivity, and more in terms of trained manpower to run rural centers," Peddinti said.

In addition, he said, a lack of common standards governing medical information and legal issues pertaining to medical advice given via teleconferencing, are bigger impediments to growth.

Swati Prasad is a freelance IT writer based in India.