Telemedicine for All : Shivaram Malavalli, President, TeleVital India Pvt. Ltd.

Q. The experience of serving different customer bases such as an army hospital, health insurance firm and rural villages must be very different from each other. What has been the level of success in each of these areas?
A. Yes, TeleVital has the largest installation base reaching out to different customer bases, each with their different requirements and approach. The Army’s requirements are clearly defined and cater to the networking of secondary and speciality hospitals for enhancing the specialist support to secondary hospitals and catering to the healthcare requirements of soldiers in the remote border areas like Siachin. They have a strong protocol and high level of discipline achieving high level of success.

In case of Healthcare Insurance firms, it is in the initial level of acceptance and adoption. It is primarily based on the concept of sickness management but if it takes a paradigm shift from sickness management to wellness management there will be a high level of success.

Only 25% of India’s specialist physicians reside in semi-urban areas, and a mere 3% live in rural areas. As a result, rural areas, with a population approaching 700 million, continue to be deprived of proper healthcare facilities. Further the availability of hospital facility is very low in rural areas.

However, the early successes of telemedicine pioneers have led to increased acceptance and proliferation of telemedicine.

Healthcare is a state subject in any country, especially so in a developing country like India. The role of the Government both state and federal is high. They have to be a facilitator rather than an implementer. The State of Karnataka has become the role model in the country implementing telemedicine, networking all districts. At this juncture we have to commend the role played by ISRO in creating and sustaining the movement of speciality healthcare support to rural areas through telemedicine. Now it has spread to other states in the country. The success and popularity of the concept has now reached even Africa. TeleVital through Telecommunication Corporation of India Limited (TCIL) is implementing the Pan-African telemedicine project. Success, especially in providing healthcare cannot be measured by sporadic success but by reaching out to each one of the rural populace where there are no healthcare facilities and providing healthcare support consistently and effectively. This will be achieved by high level of acceptance by Doctors, providing higher bandwidth at the point of care and outsourcing maintenance to eliminate downtime, which cannot be accepted while delivering Healthcare.

Q. You have recently been assigned to establish eHealth Technology Business Incubator (TBI) promoting Technocrat Entrepreneurs in the areas of ICT solutions for healthcare. Please elaborate on the nature of this project.
A. I was involved in the establishment of India’s first Science and Technology Entrepreneurs Park (STEP), in my capacity as its first Director, which went on to bag the BEST STEP award instituted by the Department of Science and Technology (DST) Government of India. Based on this valuable experience and the support of DST we prepared a blueprint that would see the launch of Indias first-of-its-kind Technology Business Incubator (TBI) in the health space soon.

The e-Health TBI is an industry-institute partnership that is aimed at leveraging the earlier experience of nurturing entrepreneurs. The STEP experience has helped in preparing and formulating the e-Health TBI.

e-Health TBI will operate out of the PESIT Tech Park in Bangalore, where a centralised facility of 1,500 sq ft, consisting of facilities for R&D, Testing and Quality Assurance is being established to be utilised by aspiring Technocrat Entrepreneurs. Apart from this each entrepreneur will be supported and mentored by strategic, business and team building inputs. Though eHealth TBI will encourage ideas, entrepreneurs would be required to make an initial investment, to pledge their commitment and take it to the Proof-of-Concept stage. We do have idea-level incubation, wherein, the direct funding option can be exercised but we have to make the model a sustainable one. For this, 2% of the profit will have to be ploughed back by the entrepreneur. eHealth TBI seeks to nurture entrepreneurs, both on campus and off campus, by mentoring them. It will also facilitate venture capital linkage, as the projects attain the maturity stage. The uniqueness of this TBI is that, it will be manned by entrepreneurs.

Q. TeleVital has several successful telemedicine projects running the world over. What are the unique challenges you face in operating in India? What are the challenges related to some of the peripheral requirements for the implementation of telemedicine here?
A. For effective telemedicine, IT use in hospitals should be increased to improve computer literacy. Telemedicine systems should be integrated into the traditional working environment. Adequate training should be provided, and key personnel should be trained. Telemedicine is meant to augment – and not replace – traditional practices and channels of medicine, but several doctors tend to feel threatened by such new technology-based approaches. Legal liability issues, especially for trans-border communications, are not easily resolved.

Information and communications technologies tend to be dismissed as expensive – but a well-developed solution using these technologies is sometimes the only economically viable solution.

Sustainability of telemedicine projects – many of which do not go beyond a pilot project stage – is a key concern, and care needs to be taken to ensure private sector participation in such issues.

Some of the peripheral requirements for the implementation of telemedicine are proper bandwidth for streaming videos and DICOM Images; awareness among beneficiaries; high level of acceptance among the medical community and trained manpower availability in the region to sustain the activity.

Q. There are 258 telemedicine centres, with 215 remote hospitals, including 8 mobile units, connected to 43 speciality hospitals in India today. What are your expectations from the government for further promotion of telemedicine in India?
A. Apart from acting as a facilitator the central Government should have a national strategy that would establish near and long-term national goals and objectives to ensure the cost-effective development and use of telemedicine. In addition, the proposed strategy should include approaches and actions needed to

  • Establish a means to formally exchange information or technology among the Central government, state organisations, and private sector; Foster collaborative partnerships to take advantage of other investments;
  • Identify necessary technologies that are not being developed by the public or private sector;
  • Promote interoperable system designs that would enable telemedicine technologies to be compatible, regardless of where they are developed;
  • Encourage adoption of appropriate standardised medical records and data systems so that information may be exchanged among sectors;
  • Encourage Central Government agencies and State departments to develop and implement individual strategic plans to support national goals and objectives.
  • Create awareness among private sector healthcare providers that reaching out healthcare to rural areas through telemedicine is no longer philanthropy but is a business model enhancing traffic to their hospital. Encourage them to work in tandem with health insurance providers to come out with innovative insurance products with a paradigm shift from sickness management to wellness management.

Q.  What new areas do you see TeleVital providing its telemedicine solutions to? How do see the scope of telemedicine grow in this region in the next five years?
A. The healthcare segments contribution to the economy has been on the rise and is expected to continue doing so for the next couple of years. Indias healthcare industry contributed 5% to the GDP and employed approximately 4 million people during 2002. By 2012, this industry is projected to contribute 8.5% of GDP. Healthcare spending is expected to double over the next 10 years. It is expected that private healthcare will form a large chunk of this spending, rising from US$ 14.8 billion to US$ 33.6 billion in 2012 (Source:

An enormous amount of private capital will be required in the coming years to enhance and expand Indias healthcare infrastructure to meet the needs of a growing population and an influx of medical tourists. Currently India has approximately 860 beds per million population. This is only one-fifth of the world average, which is 3,960, according to the World Health Organization. It is estimated that 450,000 additional hospital beds will be required by 2010an investment estimated at $25.7 billion. The government is expected to contribute only 15-20% of the total, providing an enormous opportunity for private players to fill the gap. (Emerging Market Report: Health in India 2007 PricewaterhouseCoopers).

Further, the Insurance Regulatory and Development Authority (IRDA) eliminated tariffs on general insurance as of January 1, 2007, and this move is expected to drive additional growth of private insurance products. In the wake of liberalisation, health insurance is projected to grow to US$ 5.75 billion by 2010, according to a study by the New Delhi-based PHD Chamber of Commerce and Industry. The IRDA believes that eliminating tariffs will encourage scientific rating and adoption of better risk management practices, and lead to independent pricing for each line of business, so that premiums will be based on actual risks and costs. The implementation of the new policy also will encourage the development of innovative practices and customer-friendly options for policyholders, boosting penetration.

Indias thriving economy is driving urbanisation and creating an expanding middle class, with more disposable income to spend on healthcare. While per capita income was US$ 620 in 2005, over 150 million. Indians have annual incomes of more than US$ 1,000, and many who work in the business services sector earn as much as US$ 20,000 a year. While this is a fraction of the income that their US peers earn, it is the equivalent of more than US$ 100,000 per year when adjusted for purchasing power parity.

These factors give new direction to Televital to focus on transition from Doctor centric approach to Citizen centric approach in providing IT solutions to Healthcare Delivery leading to Home care reaching the health care/wellness options at the doorsteps of the individuals and family.

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