Challenges for Telemedicine in India

It has always been heard that doctors are the biggest impediments for use of technology; on the contrary it is the doctors community that is fast becoming tech savvy and forward looking when it comes to technology. Perhaps what is worrying them is the transmission of reports securely and without error or loss. Once the industry is able to give clinical evidence, eHealth and mHealth market will explode!

Telemedicine in IndiaFor healthcare to reach masses and to support the growing demand of healthcare services in India, Indias mHealth infrastructure needs to undergo drastic changes. Government has taken up some initiatives aimed at providing affordable and quality healthcare services through setting up of primary health centres (PHC) all over the country.

However, the communications at these PHCs are not reliable and the internet speed, 33.6 kbps, at which these PHCs get connected to the district or state level hospitals, is inadequate. Thus, PHCs are unable to provide instant healthcare solutions to patients in remote villages through basic online information exchange or more advanced video transmission for telemedicine. There is a need to build sustainable, cost effective infrastructure and ecosystem for implementing mHealth throughout the country. mHealth will transform the lives of common people if there are adequate initiatives from both the private and the public sector for development of ICT technologies in healthcare.

The cost of this infrastructure is a big concern as there are not enough funds available for providing healthcare services to the masses. One solution is to pool resources from different government schemes and to create a fast and robust technology infrastructure fund that serves multiple verticals such as healthcare, education, finance, etc. This will not only help in overcoming high infrastructure costs but also create a synergy between different verticals while ensuring maximum utilization of existing infrastructure.

More than 44 percent of rural India faces power cuts of 12 to 15 hours a day, where even a battery backup system does not work-out. Thus, while most modern technologies designed for developed countries assume continuous availability of power and telecom connectivity, it takes time and cost to customise them to address such gaps. Another barrier to rapid delivery of equitable care is linguistic diversity. For example in India with over 22 officially recognised languages and over 1600 mother tongues, linguistic diversity seems a major barrier in the way of a patient in one region being able to talk to a doctor in another region.

Incentivising all the stakeholders involved is a major challenge and raises the question of who will pay the bill, as the cost of infrastructure, medical drugs, fees of doctors, and other operating cost could go very high. Hence there is a need to divide these costs among different entities which include third party financing solution. There is a chance that people may deceive system by duplicity of the same procedure over and over again, which would lead to unnecessary cost overrun. A physician must be motivated and incentivised in order to share medical records of his/her patient with other practitioners, as they might jeopardise bond of faith between a patient and a doctor. Initial investment which usually is fairly large must be borne by government, and this may raise return required by those parties who are going to get there returns on a longer time horizon.

Cost Containment: Cost of providing healthcare to population of India is a huge task and introducing ICT would require extra upfront investment. Hence, there is a need to manage the cost in such a way that overall cost of healthcare goes down. If a bigger share is given to ICT spending in overall healthcare budget, this could be achieved. It is also required to look at generating volume beneficiaries for costs to be justified.

Information Exchange: Health information exchange needs to be demanded and driven with proper access and control mechanism in place. Challenge is to motivate and encourage key stakeholders like patient, medical service provider, insurance companies and government to pull as well as push right kind of information from the system.

Adoption and Resistance: In India and across the globe there is a problem of reluctance on the part of patient as well as doctors in adopting mHealth. There is a need to bring in the right kind of technology in the right way so patients as well doctors feel comfortable in using them. This could work as an ultimate test of technology, as companies not only have to prepare best technological systems but also make sure that they are easy to understand and use. It is also required to run multiple awareness programmes for benefits of mHealth.

Staffing at different levels: mHealth is not just about having technology in place, it should also have an identifiable, approachable and well qualified human interface to interact with. Getting the right kind of people to use these technologies in order to provide proper healthcare services is very important. Hence, there is a need to hire right kind of people and train them properly so that they are well equipped to carry out the task of providing healthcare in remote areas.

uation: uation of the processes needs to be fair and done by an independent third party observer. There is a need to have benchmark so as to compare against them. These could be taken from best practices from local projects or from global examples such as Sweden, Singapore, etc. An independent body could be created for this purpose which provides rating as well as guidance on how to lay down dependable framework for mHealth.

Power Sharing: The entire system of healthcare should be such that it can be driven from both central and state government. Power, responsibility, accountability, rewards and risks must be well defined in advance so as to avoid any conflict of interest.

Managing Information: All the information that has been collected should be media rich (containing video, image, text, etc.). This information should be properly archived, accessible, retrievable, secure and readable from remote location using different technology platforms. One patient-one record needs to be implemented, so as to avoid duplication of information. Innovative and cost effective health informatics solutions need to be created for the purpose.

Education: mHealth is not just about providing healthcare service when someone is unwell, but it should also be used to promote preventive healthcare to improve the standard of living and reduce the cost in the medium to long term. This will also help in improving and enabling higher productivity. But achieving this requires bringing people into the system and educating them about the different preventive measures to avoid disease outbreaks like Swine-flu or other seasonal diseases.


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