During the recently held Belief (Bringing Europe’s eLectronic Infrastructures to Expanding Frontiers) eInfrastructures Conference, which was held during 14-15 December 2006 at the Grand New Delhi Hotel, Swarnendu Biswas, Assistant Editor of eHealth, had a fruitful conversation with Prof. Saroj Kanta Mishra, the Head of the Department of Endocrine Surgery at the Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow. Here is an excerpt of an interview with him as presented below:
Â Â What is the ambit of e-Health in India?
Â e-Health is not only about telemedicine. One needs to clear the air about theÂ popular but mistaken notion ofÂ connecting e-Health only with telemedicine. Besides telemedicine, in India the ambit of e-Health comprises an array of services, including hospital information management system, customer service through Internet, medical transcription, and health awareness through portals.
Â Â How do you gauge the potential of e-Health in India?
India has awesome potential in the field of e-Health. Presently India already has 400 hospitals with telemedicine facilities, with many more to come. Commendable work has been done by ISRO, C-DAC, AIIMS, and of course, by SGPGIMS, in furthering the network of e-Health across India. Today ISRO’s telemedicine network covers 165 hospitals, which include 132Â district/rural hospitals and 33 super-specialty hospitals.
Â Â Kindly elaborate on some of the other prominent e-Health initiatives taken in the recent times by the government.
There are myriad e-Health initiatives by the Department of Information Technology, which includes among other measures, the development of Teleoncology network in Kerala and Tamil Nadu, and networking of district hospitals of Mizoram and Sikkim with Apollo Hospital, Delhi. Presently the DIT telemedicine network covers 75 nodes. The Integrated Disease Surveillance Project, and the All India Regional Cancer Network-oncoNET India- of the Ministry of Health and Family Welfare also deserves a mention in this context.
Â Â e-Health is still by and large an elite concept, and its penetration in the rural India is still negligible. What are your comments regarding this.
I agree that e-Health’s penetration in the village level has still been far from satisfactory. However, one should not get unusually disturbed over this, for we have to remember that in India the concept and practice of e-health is still in its nascent stage. Gradually its benefits are percolating down from the research institutions to the district and village levels with a top-down approach.
Â Â Kindly elaborate on the problems, which are impeding the spread of e-Health in India.
The major problem is of developing a cost-effective satellite infrastructure. However, with the introduction of WIMAX technology, there would be an exponential growth in telemedicine across India, as it will enable to bring the districts and villages within a cost-effective ‘e’ network. But in the same breath, I must say that satellite connectivity will not alone ensure the growth and spread of e-Health network in the Indian interiors.
Besides the age-old inhibitions and prejudices, which impede the adoption of an innovative technology, it is also difficult for the poor people in the rural areas to borne the consultation charges of theÂ specialists in Indian metros or abroad.In fact, cost is a major inhibitor to world class medical care, and telemedicine is unlikely to change the equations overnight.
Then there is the acute lack of skilled and technical manpower to man the referral clinics, which compounds the problem in the percolation of e-Health. After all, e-Health in itself is not a magic wand, which will solve all the health problems of India; we have to give adequate ascent to the issues of health infrastructure also to ensure the success of e-Health networkÂ Â Â in India.
Furthermore, the tangle of legal and licensing issues are other thorny factors,Â that may threaten the smooth progress of e-Health in India. Suppose a doctor from USA prescribes a particular medication to a doctor/health worker associated with a district-level referral clinic or hospital, and if something unfortunate happens to the patient; then who is to be held accountable? Of course, if there is some blunder being committed in the execution stage, then the said health worker/doctor in the referral clinic is accountable, but if wrong medication is administered across thousands of miles, then how on earth can we hold the US doctor accountable without comprehensive regulations?
Â Â What are the achievements ofÂ Sanjay Gandhi Postgraduate Institute of Medical Sciences in the field of e-Health?
Commendable work is being carried out by Sanjay Gandhi Postgraduate Institute ofÂ Medical Sciences. The institute happens to be the first tertiary care hospital in public healthcare sector in India to adopt information technology (IT) for healthcare delivery. The institution joined the digital revolution in 1998, when it introduced the Hospital Information System (HIS) for the purpose of recording, storing, processing and retrieving health related data of its patients.
What’s more, the software was developed in-house, in collaboration with Center for Development of Advanced Computing (C- DAC), Pune. In 1999, telemedicine was introduced at the institute, and in 2001, a comprehensive telemedicine infrastructure was in place. The HIS database, which is managed throughÂ Oracle, boasted patient records of 2,47,201 patients till 31 March 2005, and every day, 250 new registrations are done on the system, on an average.
Â Â e-Health scenario in India is characterised by acute paucity of skilled manpower. What is SGPGIMS doing to address this issue?
At Sanjay Gandhi Postgraduate Institute of Medical Sciences, we give considerable ascent on training of skilled manpower for e-Health. Doctors of other medical colleges and community centers are also being educated about the tele-healthcare and tele-educational services at SGPGIMS. For the last seven years, we are also involved in the application-oriented research in telemedicine; research works which are in tune with the Indian context.Â In this regard, the institute’s endeavour to set up the School of Telemedicine & Biomedical Informatics deserves a special mention. The school is expected to do a yeomen service to the healthcare industry by imparting training for all kinds of ICT applications in healthcare. Overall, these telemedicine awareness activities of SGPGIMS for healthcare providers and other stake holders will definitely help in catering to the extreme paucity of trained human resource in the field of e-Health, in India.
Â Â Has the institute established telemedicine networks with other medical institutions of India? What are the e-Health activities the institute is presently engaged in?
Over the years, the gamut of work done by SGPGIMS in the field of e-Health has been impressive to say the least. The institute has established telemedicine networks with reputed medical institutions across India, which include among others, AIIMS, PGI Chandigarh, AIMS Kochi and SRMC Chennai. Tele-consultation and distant education in medicine, tele-mentoring, research and product development in tele-health, in collaboration with industry are only some of the productive e-Health activities that SGPGIMS is presently engaged in. Besides, we are also doing consultancy, project planning and implementation of telemedicine network in the states of Orissa, Uttaranchal, Uttar Pradesh and the North-East states.
One of the recent feathers in the cap of SGPGIMS is the innovative usage of telemedicine infrastructure to effectively monitor the health problems cropping up among the people in the makeshiftÂ townships of the recently held Khumbh Mela.Â We established exhaustive telemedicine networks, connecting State Administration Health Secretariat at Lucknow, the field hospitals at the makeshift townships, and the nearest hospital from the mela site.
This ensured that devotees thronging to the Khumbh Mela got a decent medical care, at par with a resident in Lucknow. By achieving success in this regard, we proved that like timeless faith, timelyÂ care too doesn’t believe in distance. Specially if you are ever willing to walk that extra mile.