Telemedicine offers a matchless way of synergising the advances of modern communication technology, and information technology, with biomedical engineering and medical sciences to deliver the healthcare services on an anytime, anywhere basis. In a geographically diverse country like India, where large number of people living in rural areas lack access to quality healthcare facilities, telemedicine is being looked upon as a system that can have seminal impact on healthcare delivery and patient outcomes.

There is no dearth of medical providers and specialities that can deploy telemedicine solutions for enhancing the scope of their healthcare services. For instance, dermatology and radiology are medical specialties that tap into telemedicine solutions. These solutions can also be used by healthcare specialists to remotely monitor patients with chronic conditions, and provide remote consultations for patients in rural areas.

We interacted with a select group of eminent healthcare specialists who are actively engaged in expanding the reach of telemedicine solutions. The series of interviews that follow provide us with a succinct glimpse into the world of telemedicine in India and the promises that this field holds for millions of Indians who are looking for low-cost and quality healthcare.

Ciscos Samudaya Project

Dr Arjun Kalyanpur, MD, DABR, CEO and Chief Radiologist, Teleradiology Solutions

Having worked in teleradiology arena for 10 years, telemedicine was a natural extension for us as a group. We helped operationalise a telemedicine centre in a low income district in Raichur in North Karnataka, as part of Ciscos Samudaya project, using Ciscos technology.  Telemedicine consultations have been provided by Telerad RxDx doctors to the rural villages in Raichur like Gillesgur and Bichalle since 2010. This experience led us to a deeper understanding of the needs and solutions needed for remote parts of India. This year, we became Ciscos managed service provider in India for the health presence platform.

 Giant strides for Telemedicine in India

Telemedicine is being promoted as the great healthcare hope for rural India, a technology that can transform the health statistics of remote India, the innovator that will be the game changer in medical practices in the decades to come

Dr Sunita Maheshwari, ABP, ABPC (USA), Senior Consultant Paediatric Cardiologist and Chief Dreamer, RXDX and Teleradiology Solutions

The advantages of telemedicine are manifold. Telemedicine is a system for taking a doctor to an area where there is no doctor; it provides medical help to patients where no medical help existed before; it can diagnose a medical condition before it becomes untreatable. Tele-pathology, teleradiology, tele-ophthalmology-are all ways of accurately diagnosing diseases from a distance. They have moved beyond the pilot stage to actual implementation in different parts of the world, including India.

High level of satisfaction in patients

Telemedicine consultations where a doctor remotely talks to a patient and advises, is typically done via a video conference link up. The system, according to us is working very well, but it is not without its share of controversies. If you cant touch a patient, how can you accurately diagnose his condition? Can a patient and doctor who see each other on a TV screen actually bond? Does the patient feel he got a real consultation from his doctor? Is the doctor at the other end legally liable for the patient seen on a telemedicine link?

Several studies have been done to assess these issues. A recent study in the United States had patients answer a questionnaire at the end of the telemedicine consultation. Eighty five percent of patients felt satisfied with the consultation. A survey conducted by SGPGIMS (UP) tele-follow up programme for the patients in Orissa revealed that 99 percent patients were satisfied with using telemedicine technology. So clearly a telemedicine consultation can achieve a high satisfaction level with patients if done well.

The use of newer technologies like telemedicine boxes and software, rather than just a video conferencing link, can lead to increase in the scientific value of the telemedicine consultation. Modern tools like digital stethoscope (to listen to the heart and lungs), digital otoscopes (to see the inside of the ear), oxygen saturation probes (to assess the oxygen level in the patient), blood pressure monitors, are serving the purpose of making telemedicine consultation more scientific and data based.

Initiatives from companies like Cisco

Teleradiology Solutions initially helped operationalise a telemedicine centre in a low income district in Raichur, North Karnataka, using Ciscos technology.  Telemedicine consultations have been provided by Telerad RxDx doctors to the rural villages in Raichur since 2010. As we are now the managed service provider for Ciscos telemedicine in India, several such projects are in the pipeline. The Ciscos HealthPresence solution is especially promising.

In a vast country such as ours where large tracts of the country have patients, but no doctors, telemedicine has the potential of changing the lives of patients. In order to expand the reach of telemedicine in India, a solution has to be found to the Infrastructural issues such as poor bandwidth in some areas, expensive bandwidth in others. Although ISRO does provide free V-sat link to those centres that offer to do free telemedicine consultation, how they pick those centres and not others is not clear to everyone. Thus, this free V-sat link is not available to all of the centres in India and so it has not been exploited to the maximum.

Telemedicine for Better Health

Mr. Vishal Gupta,
VP- Global Healthcare Solutions Unit
CISCO Systems (India) Private Limited, offers a perspective on the role that Cisco is playing in the field of telemedicine

Tell us about your HealthPresence solution.

TeleRadiology Solutions has become both a customer and a partner for Ciscos HealthPresence solutions in India. They first leveraged HealthPresence as a customer and have done over 1500 consultations for PHCs (Primary Health Centres) in Karnataka with their doctors from RxDx. They are now one of the key managed services partner for HealthPresence.  TeleRadiology Solutions can market HealthPresence as an end to end solution, which enables hospitals, NGOs and corporate clinics to adopt the exciting HealthPresence technology without capital expenditure or IT resources.

What is the overall market size of your telemedicine business in India? What is the growth rate that you are expecting?

Telemedicine business in India is still in early stages, but it is expected to grow at a high rate of growth. The overall market for healthcare in India is about $50 billion and if 2 percent of the money is spent on ICT, the ICT spend will be roughly $1 billion a year. We believe Telemedicine is one of the 5-6 key ICT areas. We expect a growth rate of 25 percent a year for the next 3-5 years.

What is the most important area of healthcare that telemedicine must focus on?

Telemedicine should create a level playing field where access to quality and affordable healthcare can become a right for every Indian just like right to Education. The most important thing is to enable healthcare for the over 600 million Indians who live in villages.  The primary Health Centres (Over 60,000 in India) that support villages are not able to attract doctors and the problem is especially acute for specialists. Telehealth is proven to solve this problem which cannot be solved by any other means.

What kind of response do your telemedicine solutions see from rural areas?

We are seeing excellent response from rural areas in India, China, Jordan, US and a number of countries in Africa and Europe. In India, in one of the districts where we have deployed HealthPresence, our efforts combined with those of the government are seeing children and mothers mortality rates fall significantly. This is very encouraging development for us. Also the survey shows over 95 percent satisfaction rates from patients and doctors using this technology.

As of now how many hospitals in urban and rural areas are using your telemedicine solutions? Are you systems gaining popularity with the population?

We have deployments in both private sector hospitals like RxDx, as well as in numerous districts in Karnataka and MP, where primary health centres connect to district hospital doctors using HealthPresence.  Over million people have access to healthcare in India using our technology in the districts of Karnataka and Madhya Pradesh alone.

 What can the government do to facilitate telemedicine in the country?

We believe the government has to take two actions to enable a breakthrough for Healthcare in India. One, the government will need to accelerate the rollout of Broadband in Villages so that critical applications in telemedicine, education, e-Governance can run on broadband infrastructure. Two, the government needs to enable public and private partnerships to enable sustainable rollout of care at a distance technology in rural and semi urban areas.

 Telemedicine Improves Patient Care

If private providers are allowed to utilize National Knowledge Network, State Wide Area Network, end-users will benefit as high quality of healthcare will become available at an affordable cost, says Dr Suryanath Gudidevuni, AVP & Head Healthcare Services, Apollo Tele Health Services (ATHS), in an exclusive interview…

 Please tell us about your plans for development of telemedicine in Indian market. What is the next milestone for you as far as the telemedicine operations are concerned?

Apollo Telemedicine is has been operational from more than a decade. It has provided about 70 thousand telemedicine consultations so far. Our next milestone is to have 1000 telemedicine centres within next couple of years. We are aggressively working in the fields of Wearable Health Monitoring Systems, Tele ICUs, Robots, Virtual visits etc.We are looking forward to utilising telemedicine technology to bring about a closer interaction between the doctors and patients even when they are geographically separated. The care in telemedicine can be provided without compromising on quality of care and without an increase in cost for the patient.

Give us a brief overview of how telemedicine industry is evolving in India?

Challenges in regards to geographical accessibility and a healthcare providers preferences for cities are the main drivers of telemedicine development in India. Other contributing factors are timely healthcare, cost containment, enhanced connectivity, and much else.Initially, telemedicine services were being provided through ISDN and satellite connectivity and were mainly limited to video conferencing. Government, through ISRO, has played a major role in promoting these services.

Pan-African e-Network is another good example. Awareness and availability of EMR, ability to send large files online have also the scenario for better.Initiatives from NRHM, State Governments etc. are further helping the situation.

In your view what is the most important area of healthcare that telemedicine must focus on?

Outcomes from primary care, preventive care and wellness management will be most beneficial. Focus on health education, both for people and healthcare providers will also help in enhancing health status of population.

Rural areas in India are especially lacking in quality healthcare facilities. What kind of response do your telemedicine solutions see from rural areas?

In general we have a good response to our telemedicine solution. Probably, we have provided highest number of tele-consultations in the country from a single organisation. We are one of the tele-consultation providers for Pan-African e-Network initiatives. We are the only organisation in the world that has provided 550 specialty consultations within duration of 14 hours, during recent camp in Ajmer (February 2012).

 As of now how many hospitals in urban and rural areas are using your telemedicine solutions? Are you systems gaining popularity with the population?

About 63 non-Apollo hospitals are utilizing our telemedicine solution. Yes we are gaining popularity.

Many analysts have expressed the opinion that one of the most exciting areas where telemedicine might have a potential role to play is disaster responses. Please tell about your views on this. Have you developed solutions that can facilitate relief work during disasters?

It is true that telemedicine has very high potential in disaster management. It can provide quality healthcare, on time and on site, thereby minimising avoidable travel, overcrowding of healthcare facilities and hardships thereof. Early medical intervention can be life saving in many such cases. In general, that is all what majority of victims would need. Apollo has solutions and systems to meet disasters at a very short notice. We have telemedicine vehicles of different magnitude and laptop based solutions, which can be quickly deployed at site, in addition to having helipad on our tertiary care hospital to receive victims.

 What can the government do to facilitate growth of telemedicine in the country?

One of the challenges is to retain healthcare professionals in remote healthcare centres like PHCs. One thing Government can do is to outsource consultation for patients from those centres. This will not only provide healthcare when and where needed, but the software (EMR) used will provide Government with accurate and online statistics of healthcare services that are being provided.  Government should also promote public and private partnerships. Telemedicine needs different breed of healthcare professionals. New type courses, recognition and employment opportunities will encourage growth in number of such professionals.

Telemedicine is Growing Faster than Anybodys Imagination

Rohit Kumar, CEO, GTI Infotel, a Telecom & IT company that is also providing telemedicine solutions, has offered his views on issues related to telemedicine in India

Tell us about GTI Infotel plans for development of telemedicine in Indian market.

GTI Infotel has ambitious plan to introduce telemedicine in various state governments. We have already submitted our tender for telemedicine to the government of Bihar. GTI Infotel is also planning to set up our own telemedicine centre at Noida. The Noida centre will have the unique system of providing affordable healthcare by combination of Allopathic, Ayurveda and Homeopathic.

In your view what is the most important area of healthcare that telemedicine must focus on?

Most important area is providing affordable healthcare at affordable price on 24/7 basis.

What benefits do telemedicine solutions offer in rural areas?

It is true the doctors educated from urban medical colleges are accustomed to urban way of life and would not like to go to rural areas. With innovative IT solutions, it can be possible for those in rural areas to utilize the expertise of eminent doctors based in city hospitals.

As of now how many hospitals in urban and rural areas are using your telemedicine solutions? Are you systems gaining popularity with the population?

Presently our Remote Call Centre Solution is being used by the JPNATC and AIIMS.  Our Tele-Medicine solution is being used by Lavanya Ayurveda in its Urban & Rural centres for Ayurvedic treatment and S. Lal Hospital, New Delhi, for Allopathic treatment. The response is excellent.

How fast do you expect the telemedicine vertical to grow?

Now that the centre and the various state governments have started promoting telemedicine in rural areas, the sector is likely to grow very fast. The fast growth in the telecom industry is also contributing to the popularity of telemedicine.

Indian Telemedicine Industry is at The Cusp of Its Evolution

Marc Alexis Remond, Global Director, Government Solution and Market “ Polycom, provides his insights on telemedicine sector in India

Tell us about Polycoms initiatives in Indias telemedicine space.

Polycoms telemedicine solutions are designed to accelerate the quality and delivery of patient care and are vital for healthcare systems. We enable the use of communication technologies in the practice of medicine. We have been working with the likes of Escorts, Narayana Hryudayalaya, Apollo and TeleVital to deliver telemedicine solutions that break down the barriers of distance and facilitate communication between patients, practitioners, specialists, and healthcare administrators.

Give us an example of a situation where your telemedicine solution has been used?

Recently doctors became part of an operation conducted by the Live International Otolaryngology Network (LION) on a patient with a mid-ear ailment.  While the operation was conducted in the Netherlands, Polycom India office in Gurgaon enabled a live Telepresence interaction that allowed doctors from 19 countries to access the surgery and interact with the surgeons as they performed the operation.  Approximately 20 Indian doctors attended the session. Going forward, our mission is to recreate similar live sessions that contribute significantly to training and the exchange of medical knowledge to and from India. This solution can also be used to train existing healthcare professionals in remote locations on a large scale allowing specialists to regularly consult with each other and exchange notes on best practices.

Give us a brief overview of how telemedicine is evolving in India?

The use of communication technologies in the practice of medicine is changing the face of healthcare in India, as it is constantly improving access to quality and affordable medical services, regardless of location or time. With rural India accounting for over 70 percent of the Indian population the opportunity for telemedicine solutions to grow is enormous. Add to that the governments recent proposal for all students pursuing MBBS, nursing and paramedical services, in both government and private colleges, to extend their services in rural areas will add to the positive momentum.

What is the most important area of healthcare that telemedicine must focus on?

We feel that the most important area for innovation is the need for collaboration, amongst public and private entities to deliver solutions over the last mile. This will also include the need for interoperability of solutions that allow multiple vendors to work together to create a seamless solution. Polycom has been taking a lead in this direction by creating solutions that are based on open standards allowing healthcare institutions using other vendor products to communicate and collaborate. The company has made R&D investments to interoperate with other platforms such as Microsoft OCS/Lync, IBM Sametime and Cisco Telepresence Systems.

One of the most exciting areas for telemedicine is disaster responses. Are you developing solutions that facilitate relief work during disasters?

Absolutely, with Polycom® RealPresenceâ„ Mobile, government agencies can provide secure, instant, face-to-face access to people, information, and locations from anywhere to anywhere. Designed for easy transport, set-up, and use, RealPresence Mobile is the ideal application for extreme situations such as national disasters, terrorist threats, and healthcare emergencies. In fact, such solutions are already being implemented by the Beijing Ditan Hospital, using Polycoms comprehensive video collaboration solutions for healthcare. The hospital has built a telemedicine network to contain and prevent the spread of infectious diseases throughout China, saving precious time in the event of a health emergency, and ensuring the most productive use of resources.

What can the government do to facilitate telemedicine?

Managing and providing quality medical service to citizens is a key responsibility of government. To help government organisations achieve this objective, Polycom works closely with partners and customers such as government departments, Public and Private Healthcare providers and the Telemedicine Society of India. Through its solutions, Polycom enables and encourages the use of communication technologies in the practice of medicine and offers the best way for healthcare providers to increase their level of patient care, control costs, address staffing shortages and serve rural patients.

 Telemedicine for Better Health

In a Tªte- -Tªte Pankaj Vaish, President, HealthFore (Healthcare IT Division of Religare Technologies), offers his views on telemedicine in the country

What is the next milestone for HealthFore as far as the telemedicine operations are concerned?

Telemedicine is integral part of HealthFores overall mHealth offerings alongside TeleTriage (also commonly referred to as Health Helpline or doctor on phone or 104 service). We see it as a key enabler to bridge the healthcare access divide that exists in India. HealthFore is working closely with its partners to ensure that we are among the leading telemedicine solution and services provider in India and in Africa. We are offering both, low cost solutions that can be of use in the semi-urban and rural areas, and also more sophisticated solutions that cater to the urban market. Our focus is to offer solutions that have tight coupling with the backend healthcare provider systems for real-time doctor consult, EMR, scheduling, expert consultation, so on and so forth.

Tell us about your solutions for patients requiring chronic care.

India has a large aging population with millions suffering from chronic conditions like diabetes, hypertension and cardio. With ever escalating rates of detection of lifestyle ailments, and increasing awareness of treatment options, management of chronic ailments is assuming centre stage in the quest for a better quality of life. Through its MediLife offerings, HealthFore have created a bouquet of services to enable patients better manage their lifestyles through a combination of standardised monitoring, counselling and reminder services. Starting with Diabetes, Cardio and Hypertension, we intend to expand to other areas like Asthma, Obesity and Renal ailments.

Give us a brief overview of how telemedicine industry is evolving in India?

Telemedicine in India has been around for over a decade now. However, now the industry has started moving from an infancy stage to a more mature phase.  The primary reason for this is the huge improvements one has witnessed in connectivity (from dial up modem to ubiquitous 3G and broadband connectivity), availability of audio video equipment and clinically certified devices like digital stethoscope, microscope, 12 leads ECG, blood pressure, glucometer etc. and overall affordability, adoptability and acceptance of a telemedicine solution. We are anticipating an infinitely more advanced version of telemedicine in the coming years.

In your view what is the most important area of healthcare that telemedicine must focus on?

Primary care remains the most important area for application of telemedicine. There are still scores of PHCs running without medical professionals. Absenteeism is rampant. By and large, physicians do not want to work in rural and/ or remote areas; there are millions of people living in these areas with no access to healthcare and usually end up going to unqualified practitioners, or just ignoring their medical needs till too late. Telemedicine can help connect PHCs to other PHCs or CHCs, and offer medical advice to citizens. Both general and limited specialist consultations can be offered, with only few cases being referred for physical examination at the nearest hospital.

In what ways can telemedicine play a role in rural areas?

Doctor to patient ratio in India is 1:2000. 625 million Indians living in rural areas have access to less than 20 percent of the available doctors. This is an alarming problem. Telemedicine has the potential to fulfil this huge unmet healthcare need in the rural areas. The real advantage of telemedicine is to connect the rural and tribal areas with primary care in a cost effective manner. The time-lag between the occurrence of medical need and delivery of the medical services, makes the requirement of telemedicine facilities even more imperative. The response to our solutions in rural areas is very favourable from the pilots that we have done so far.

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Related April 2012