The innovation seems to reside at entrepreneurs brains and so do the story featuring latest innovations and tie ups in the telemedicine sector By Shally Makin, ENN

Watched by a doctor on the other side of the Indian subcontinent, a man leans back as far as he can before he feels the arthritis pain. Where does it hurt? a rheumatologist asks. The scene is similar to that of any conventional medical consultation, with one fundamental difference: the doctor and patient are nearly 2000 miles apart. This could be the future for healthcare in India, where both the public- and the private health sectors are devoting substantial amounts of money and effort to mainstream telemedicine. Proponents of telemedicine see it as a solution to some of the deficiencies in the countrys health sector.

India faces shortage of doctors, particularly in rural areas, where nearly 70 percent of the population lives. Doctors and hospitals are largely concentrated in cities, and as a consequence, health care in rural India is inadequate or absent. In the developing world, however, India is not the only country that is experimenting with this new technology. Pilot projects have been initiated in Mozambique, Uganda, Senegal, and Kenya. The Chinese Government, too, has become interested in the potential of the technology, initiating a large-scale project linking its vast rural population with medical expertise in its cities. Telemedicine in India is, however, generally seen as being more advanced than in these countries and technologically on a par with the developed countries. Indian Telemedicine market is estimated to be USD 7.5 million and is expected to grow at a CAGR of around 20 per cent over the next five years. It is estimated that 1.5 lakh people are benefited of  elemedicine every year. Increased use of wireless and web-based services and adoption of  G and HSPA has given a boost to the market in recent years making it key growth drivers.

S K Mishra, Nodal Officer, School of Telemedicine & Biomedical
Informatics & Head, Department of Surgery,
SGPGIMS, Lucknow

Live streaming of videos from Kumbh Mela region to other places and streaming operation theatre videos from SGPGIMS and multipoint conferencing were made possible through the school of telemedicine hub 

Tele-innovations
The telemedicine industry gets the encouragement from the schools such as the Mobile Telemedicine System (MTS). Blueprint of this system was developed and designed under the supervision of S K Mishra nodal officer of School of Telemedicine & Biomedical Informatics & Head, Department of Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow. MTS has four sections, one for driver and passenger seats, second for ICT section equipped with video conferencing system for visual communication with doctors in remote places, a public address system used for mass awareness among rural population using projection system and external tuning with projectors. The third section has Xray units and an operation table to perform minor surgical operations. Section IV has a laboratory equipped with devices used for capturing vital parameters and ophthalmic imaging and for laboratory tests. It is a fully independent unit equipped with generator and UPS, apart from regular power source with multiple connectivity options that has BSNL WIMAX connectivity linkage and can connect to any of the telemedicine-enabled medical hospital and super-specialty hospital for expert opinion.

Balaji Utla,
CEO HMRI

Arogya Vani -The helpline ensures that people get basic information on their health conditions and the available medical facilities through a process which is easy and accessible, throughout the year.

There is a sharp increase in the acceptance of such technology among the students. Academic activities in Patna University (PU) went hi-tech with the organisation of a lecture series on bioinformatics and database through videoconferencing. Taking the level higher, portable devices for serving telemedicine purpose is what the next generation is looking at. 3nethra is a low cost, portable, and highly integrated ophthalmology device for pre-screening and  identification of potential eye diseases. It has a retinal camera with inbuilt refractometer that captures the images of the retina and, through its image processing algorithm, generates an automatic report about the problem it has detected. The ruggedised system, which can easily be transported to rural communities for a temporary eye-check clinic, works by scanning both the anterior and posterior segments of the eye in five minutes, without dilation. The system also connects primary care centers to secondary or tertiary care centers over telemedicine for remote diagnosis. Moreover the device is low-cost and hence greatly reduces direct and indirect cost of screening, making it available to rural populations. A huge foundation like Piramal Foundations Swasthya Project, Health Management and Research Institute (HMRI), has signed an agreement of service with the Government of Karnataka that aims to provide health information help line services in the state through 104 BSNL telephone number. This service is being named as Arogya Vani which will assist people living in rural areas of the state, who face difficulty in accessing a qualified doctor. To achieve this objective, Government of Karnataka, with HMRI as nodal agency, is establishing this 100 seat facility at IT Park at Hubli, and plans to scale it upto 300 seats soon. The Government of Maharashtra has also approved the establishment and operation of Primary Health Centers (PHC) in the tribal areas of Thane District, equipped with facilities for telemedicine. HMRI has been handed the responsibility of implementing  the telemedicine solution in these 10 PHCs of Thane District by linking them to the Health Advice Call Center operated by HMRI from Pune.

Dr Anand Vinekar,
Program Director, Karnataka Internet Assisted
Diagnosis of Retinopathy of Prematurity (KIDROP

Since 2009, KIDROP covers more than 75 percent of the State of Karnataka in multiple zones. Thus far over 31,000 imaging sessions, with over 844 babies have undergone laser treatment preventing blindness in them 

Karnataka Internet Assisted Diagnosis of Retinopathy of Prematurity (KIDROP) is Indias first and now the worlds largest telemedicine network to tackle infant blindness. Using cutting edge technology, an award winning, indigenously developed, customized tele-ophthalmology platform, KIDROP screens the retinae (the nerve of the eye, which lies at the back) of babies a few days old in their rural hospitals, provides remote diagnosis of these images by experts and provides for treatment
of these babies in the periphery without the need for these babies to travel to the city. Two million are at risk each year, in India alone. Every day.

Dr Ajay Bakshi,
CEO, Max Healthcare

There are very few successful and scalable models of delivery of primary health in India so far. We believe that our partnership with eHP will demonstrate successful use of technology and social entrepreneurship can lead to a massively scalable model to provide clean water and primary healthcare services from a single point of contact in a village or a small town

 First in the Market

Arjun Kalyanpur,
Director, MD, DABR, CEO/Chief Radiologist/ Chief Pusher,
Teleradiology Solutions

Brief us about the latest solutions introduced in the market of telemedicine. 
Among the solutions introduced in the telemedicine market, a plethora of hardware applications can be appended to a web-based telemedicine platform that include digital stethoscope, otoscope, ophthalmoscope, and digital BP, Oximeter and EKG apparatus.

the technicians visit neonatal care units in remote villages with a portable digital camera and image the eye of new-born infants, which is also less stressful for the baby boy or girl at that stage. Then the images are uploaded via e-mails to a dedicated server, maintained by a Bangalorebased company, with a simple data card attached to his camera device. As the technician moves from one centre to another, these live images of infants eyes get reported and doctors viewing them online are able to the advise the parents of the babies, through the technicians.

These today allow for every aspect of the patient medical examination to be performed remotely with the exception of palpation. We have been using Ciscos health presence telemedicine platform which is integrated with Telrad techs teleradiology software (RadSpa).
Workflow tools and schedulers that optimise the utilisation of physician time are a timely new addition. In teleradiology the use of mobile devices such as the iPad and iPhone is revolutionising image access and collaboration on the part of both radiologists and clinicians. The use of the Internet cloud as a repository for imaging data is a welcome trend as it promotes universal access to images (while still preserving security), and also allows for a pay per click teleradiology model, such as we offer through Radspa, which can significantly reduce startup costs.

Given that teleradiology is at the forefront of the telemedicine revolution and US is far ahead of the rest of the world in its utilisation, this indicates that the corresponding numbers in other parts of the world would be proportionately lower. There is a lot of opportunity for providers and  As many as 81 neonatal centres in as many hospitals in Karnataka have been linked as part of this network, Dr Vinekar, has trained 18 government teams to work on this model.

Many hospitals have taken initiatives towards developing on a healthcare delivery model that could be made cost-efficient at all levels “ village, mid-, secondary care and super-specialty. ITbased, tele-medicine and mobile health will be the most vital links from ground
up. Hospitals are partnering with telecom partners to offer tele-medicine services and will soon be getting into mobile tele-medicine. Apart from Indian  that the future of telemedicine is bright.

How is new technology providing greater accountability for providers?

MIS systems and QA/Peer review modules forms a part of the latest teleradiology workflow solutions that are geared to provide data to teleradiology providers allowing them to track their report quality, report turnaround time, and other key performance indicators.
As the telemedicine market becomes more competitive, such indicators will be shared with clients, creating an environment of greater transparency and accountability.

Do you think remote healthcare can strengthen the market and in turn the healthcare delivery?

Absolutely, by reducing cost of care and improving service level efficiencies. In many places, teleradiology has raised the bar for radiology report quality and turnaround time, and onsite providers have been obligated to step up their own services to meet the new benchmarks and standards of care. players, foreign telemedicine providers like SHL are also offering services to Indian hospitals.

The MOU signed between Max Healthcare and HealthPoint Services India Pvt. Ltd will be available for rural patients of Punjab via eHP telemedicine network. HealthPoint Services India Pvt. Ltd has established the E Health Point (EHP) model which is a rapidly growing chain of rural health kiosks that targets millions of low-income people who currently lack reliable access to safe drinking water
and legitimate healthcare services by leveraging technology. This model

Vivek Sharma,
Regional Vice President, Greater China and South Asia Region,
India Operations Director, India Design Centers, STMicroelectronics

Body Gateway “is an integrated remote monitoring solution from ST for an advanced telemedicine platform. It is a lightweight and low-power electronic system for the measurement of physiological parameters within the body, such as heart rate and breathing rate, eye pressure monitoring, blood analysis and insulin therapy. The body gateway supports, among others, a wearable patient monitoring system in a tiny module that can be taped to the patients chest. This telemonitoring approach is particularly beneficial for elderly patients, patients in nursing homes in remote locations. with no access to a hospital or nursing home who need to be watched or monitored closely.

The remote monitoring solutions from ST based on the most innovative MEMs devices, detect even the slightest physiological movements which are processed by an internal microcontroller, and sent via bluetooth, zigbee, Internet, GSM or local network etc to a control station for monitoring, diagnosis and urgent life support therapy has been created to cater to the twin objectives of preventive and curative services and creates a high social impact whereby clearly delivering economic, health and financial benefits for low-income communities.

Amit Jain,
CEO of HealthPoint Services India Pvt Ltd

We appreciate the efforts of Max Group to expand their high quality healthcare expertise to low-income and underserved rural communities. This collaboration is expected to close the gap in achieving the public health goal

Though the cost of telemedicine is often lower, the infrastructure cost to provide telemedicine facility is
often high. This high cost acts as a hindrance to the development of the market along with the lack of interest from patients and doctors restraints the growth of the market. There are still certain legal hassles in telemedicine which have not yet been solved. Major roadblocks for telemedicine would be shortage of computer savvy healthcare personnel, high capital requirement (approximately USD 10,000) and less replicability.

The BRIC report suggests telemedicine market is expected to grow with a CAGR of 15 percent. Another driving factor for the telemedicine market is the requirement of medical facilities in rural areas. Rural areas lack good medical facilities and hence the concept of telemedicine is very well accepted in the developing areas. The Indian Government has been investing in telemedicine in a bid to make health care more accessible to the countrys rural communities. But sceptics are wary about the limitations of the technology when it comes to diagnosis, care, and surgery. The opportunity lies in developing a knowledge sharing platform to enhance the scope for telemedicine market. Also the support of the Government in promoting the telemedicine market would be crucial for its development. Increasing the awareness of patients about the advantages of telemedicine is crucial for sustained growth.

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