India is an unusual country. It is enjoying booming software exports and is a major destination for business process outsourcing (BPO). As a result its economy is on the rise, and it is at the crossroads of being transformed into an IT leader. However, the demographics of its population are not reflecting this IT and BPO revolution. It is changing, but at a leisurely pace. And that is one of the reasons why despite being a global hotspot in information technology, diffusion of information age tools like telemedicine and e-Health in India are still far-fetched dreams.
Spectacular strides in mobile communications, rapid developments in Internet technology, application of efficient information management techniques and widespread adoption of information technology have propelled healthcare delivery systems from clinics and hospitals right into the households of its consumers. One of the key factors responsible for this paradigm shift in the nature of the healthcare delivery organizations is the changing demographics of the consumers. Agrarian societies have transformed into industrialized societies, which in turn are upgrading to information societies. Owing to this milieu of technological and societal changes, the demand for timely, accurate and portable health information is on the rise. The concept of ‘pervasive healthcare’ i.e. healthcare for anyone, anytime and anywhere is gaining ground. This is not fiction, in fact we are talking about pragmatic traits of information age healthcare delivery systems, which are already servicing the privileged populace in Scandinavia, North America, western Europe and even in a couple of countries in the Far East i.e. the developed world.
However, we should not get too carried away by this rosy picture so as to forget the teeming multitude of have nots,who are lying on the other side of digital divide. Their gloomy world is characterized by looming threat of pandemics; limited medical personnel;unrealistic expectations due to strict economic regime; exodus of medical professionals; faltering social infrastructure coupled with unreliable means within their own frontiers; all of which are averting their progress on the healthcare highway, and making their access to affordable medicine a highly challenging issue for them.
The above mentioned imageries are a depiction that acutely matches the ground realities in developing countries with respect to their healthcare services. Solutions for these daunting challenges have to be extraordinary from all perspectives and one of those definitely is e-Health. However, there are some pragmatic problems towards the success of e-Health technologies in a typical developing country like India.
India is an unusual country. It is enjoying booming software exports and is a major destination for business process outsourcing (BPO). It is at the crossroads of being transformed into an IT leader. However, the demographics of its population are not reflecting this IT and BPO revolution. It is changing, but at a leisurely pace. And that is one of the reasons why despite being a global hotspot in information technology, diffusion of information age tools like telemedicine and e-Health in India are still far-fetched dreams. It has been close to a decade that first attempts to embrace telemedicine were made in India, but still their positive outcomes for the Indian healthcare industry are at a nascent stage. However, considering the state of IT in India a decade earlier, the introduction of telemedicine in India was nothing short of commendable.
In 1998, PC penetration in India was 1 per 1000 and teledensity was 1.2 per 100. High speed data transfer services like ISDN were commissioned only in 12 cities. Tariff for a national long distance (beyond 1000 kilometers) telephone call was hovering around 0.7 USD, an international telephone call to the US costed close to 1.5 USD. Depending on such an underdeveloped IT infrastructure, the launch of telemedicine almost a decade earlier was a commendable task for the then Ministry of Information Technology.
Commendable progress in implementation
Despite roadblocks, India has witnessed some noteworthy progress in telemedicine, as far as the implementation of telemedicine infrastructure across the country is concerned. Between then and now, launch of e-Health initiatives in India have been gaining ground, in both the public and the private sector. Pioneering national telemedicine project funded by the Department of IT, Ministry of Communications and IT, saw its completion, wherein the information superhighway was laid between three tertiary level hospitals (AIIMS at New Delhi; PGIMER, Chandigarh and SGPGI, Lucknow). Indian Space Research Organisation (ISRO), with its initiative of space-based telemedicine launched in 2001, has surfaced as another flag bearer for telemedicine in India. Today ISRO takes pride in providing satellite-based linkages to around 200 healthcare set ups across India.
In order to build up on this foundation for practicing telemedicine in India, the agenda for e-Health was shared by His Excellency President Kalam in his address, while inaugurating Commonwealth Connects: International e-Partnership Summit on 23rd March 2007 in New Delhi. His vision paints a promising IT infrastructure for Indian healthcare. Indian Ministry of Health and Family Welfare too has opened up to e-Health; a task force for telemedicine has been set up to advise on key aspects.
The scene has been equally encouraging in the corporate healthcare sector. Very few, even amongst those who have been following the evolution of telemedicine in India for almost a decade, know that the cardiologists at Escorts Heart Institute and Research Centre Institute in Delhi are the unsung heroes. They have implemented telemedicine in their practice. It is intriguing to note that while Indian telemedicine pioneers were drafting proposals for their maiden telemedicine projects, the cardiologists at this world-class super specialty healthcare set up had already published their experiences as telemedicine practitioners, while using Escorts Heart Alert Service (EHAS) i.e. a trans-telephonic ECG system that enabled them to receive SOS signals from ailing hearts. The case of Apollo’s Aragonda (2000) has been good enough to impress President Clinton, who praised Apollo for its efforts to provide healthcare services by using hi-tech medicine, for the population of this Indian village in Andhra Pradesh. Since then Apollo’s telemedicine network has spread across the length and breadth of India.
Today, India can take pride in hosting 500 telemedicine nodes across the country and many more are in the pipeline. This seems to be an unparalleled accomplishment in the developing world. Presently, India experiences the following with respect to telemedicine :
Development of indigenous telemedicine technology
Test beds for clinical trials
Availability of world-class platforms (technological and clinical) for enabling and practicing telemedicine
Laying guidelines and standards for practicing telemedicine in India
Finalizing framework for IT infrastructure for healthcare
Availability for expertise for task forces
International conferences, etc.
In other words, from time to time, policy makers, administrators and implementers’ in the government sector have been synergizing their efforts to come up with a reasonably good foundation for establishing telemedicine infrastructure in India. As a result telemedicine in India has grown up to take some load off from country’s historically dilapidated healthcare delivery system, by extending the reach of clinical practitioners’ expertise to isolated communities languishing in far flung areas. However, though implementation of telemedicine in India has been a success story, the positive outcomes for its practitioners are limited. Unfortunately, successful outcomes still elude Indian telemedicine practitioners in the public sector in a big way. Announcements about successful outcomes, proportionate to the intellectual and financial investments, are yet awaited.
There are a few instances of using off-the shelf components for tele-education and video conferencing, but this has never been the prime objective of setting up pricey telemedicine nodes, which are progressively mushrooming in the world’s most populous and biggest democracy. True character of telemedicine lies in telediagnosis and teleconsultation that is centered around exchange of clinical information. If we browse through the telemedicine practitioners’ & users’ literature or read clinicians’ account of e-Health in India, we find that these are highly promising and future oriented accounts stuffed with sweet dreams, but with very little or no evidence of success in their real life e-Health endeavours.
Owing to their observations, many clinicians have come to the realization that telemedicine potential in India is largely underutilized. The technology that was all set to display an enormous network-effect in India appears to have missed something. Implementers too have been waiting untiringly to witness the outcomes of their efforts. Considering these facts, it may not be highly challenging to find an answer to the query whether the first decade of telemedicine in India belongs to the implementers or the practitioners. Time has come for all the stakeholders to look back, introspect and ensure that Indian telemedicine doesn’t go the Indian cricket way; something that could not fire despite world-class ingredients.