Introduction
The advancement in telecommunication and satellite communication in the recent years has experienced many fold development in India in IT enabled services, BPOs, Overseas communication, rural telephony, and also in the field of medicine. Telemedicine is the new buzz word amongst the healthcare administrators around the world and the buzz is catching fast in India too.
In the last decade leading hospitals and healthcare providers in India have used telemedicine as a medium of communication between medical fraternity in seeking opinion for rendering better patient care services and sharing of knowledge base to the fellow counterparts.
Making healthcare accessible reduces investment in health thus contributing to overall economic and social development. India faces various problems in the provision of medical services and health care, including funds, expertise and resources. To meet this challenge, the governments and private health care providers must make use of existing resources and the benefits of modern technology. Also with limited medical expertise and resources, telecommunication services have the potential to provide a solution to some of these problems. Telemedicine has the potential to improve both the quality and the access to health care regardless of the geography. It enables medical and health care expertise to be accessed from under served locations.
In India only one-third of households are in urban areas, with two-thirds in rural areas but majority of healthcare activities and availability of healthcare facilities are present in urban areas. The advancements in healthcare and making healthcare available to many in these rural areas are still grim. The third NFHS Survey (2005 -06) reports that Sixty-eight percent of households (56% of rural households and 93% of urban households) have electricity. Fifty- five percent of households have no toilet facilities. Three-fourths of rural households have no toilet facilities. Eighty-eight percent of households use an improved source of drinking water (95% of urban households and 85% of rural households), but only 25 percent have water piped into their dwelling, yard, or plot. One-third of households treat their drinking water to make it potable; half of those that treat their water strain the water through a cloth, and almost one-third boil the water.
The non-availability of basic facilities for maintaining lifestyle like safe drinking water, sanitation, hygienic conditions should we talk about telemedicine as an alternate source of accessing healthcare? The limitation to access healthcare by the rural population is faced with many challenges like that of the availability of doctors and trained paramedics, nurses, drugs, equipments & instruments and above all availability of a health facility with basic facilities in their neighbourhood. The RMPs and quacks will are the only source in their illness and some still depend on orthodox methods of ancient believes. Today in India while the aggregate number of doctors is 0.7 million is not very low for a developing country, only 28% of them are located in the rural areas. The government though being the single largest healthcare provider and having the largest network with many initiatives to bring about change in the health status of the country’s population falls short of making healthcare accessible to a whooping 1.1 billion Indians.
With 83% of the total health expenditure being in the private sector, the dominant influence in the health system has been the private sector. The private sector, driven more by the impulse to maximize profit, has further skewed a system already dominated by curative initiatives, increasingly dependent on high cost and high-tech diagnostic support.
Background
The idea is to demonstrate how telemedicine and its benefits being made available to the community in the rural and remote areas at large in a cost effective way to provide health assistance to people who are in need the most.
Non availability of adequate number of resources and the challenge to overcome can possibly be done by (a) Making specialist services available in rural / remote healthcare settings and (b) Making critical care accessible to rural / remote areas.
a. Making Specialist Services available in rural / remote healthcare settings: We can overcome the healthcare accessibility factor by building health infrastructures and manpower to meet the unmet needs, but it involves huge investment of both time and money. It also requires participation from both government and private healthcare players investing in healthcare activities individually or jointly. Redistribution of healthcare professionals at primary care is not possible due to non-availability of any legislation to direct physicians in private sectors to relocate to fulfil the absence in the rural areas. The concept of telemedicine is centred on this idea of seeking a specialist opinion available to both doctors in need for the some guidance and also to the patients. Telemedicine enables access to specialists for seeking their opinion in shorter time with accuracy, efficiency and precision.
b. Making Critical Care accessible to rural areas / remote healthcare areas: The concept of telemedicine can be utilised in rendering quality patient care services with accuracy and efficiency for those suffering with life threatening situation.
Methodology
In a country like India it is essential to acknowledge the fact that making healthcare accessible to all in its vast geographic, social –economic is difficult. Concrete steps in this direction needs to be taken by both government and private healthcare providers.
Indian Space Research Organisation has done pioneering work by partnering with leading healthcare providers, various state governments in making healthcare accessible in the rural and remote parts of the country. With the advent of communication technology especially the Satellite Communication (Sat-Com) combined with Information Technology, enables benefiting from the advanced medical sciences to reach even the remote and inaccessible areas. Indian Space Research Organisation (ISRO) as a part of application of space technology for Health care and education, under GRAMSAT (rural satellite) programme, has initiated number of Telemedicine pilot projects which are very specific to the needs of development of the society.
Integrated Telemedicine Tele-health Project is the first-of-its-kind initiative jointly sponsored by Indian Space Research Organisation (ISRO), Asia Heart Foundation in Kolkata and Narayana Hrudayalaya in Bangalore was initiated in 2001. With the inception of the program, it has been implemented in the remote areas of north eastern states of Tripura, Nagaland and in south Indian state of Karnataka in its tribal belt.
ISRO’s satellite based Telemedicine network, which started in 2001 on an experimental basis has linked remote/rural district hospitals with super-speciality hospitals in major cities via INSAT. While ISRO provides the software, hardware and communication equipment as well as satellite bandwidth, the speciality hospitals provide the infrastructure, manpower and maintain the system. ISRO’s telemedicine network has matured into an operational system and now covers 165 hospitals – 132 remote/rural/district hospitals/health centres connected to 33 speciality hospitals located in major cities.
Apart from ISRO’s telemedicine network association, Asia Heart Foundation and Narayana Hrudayalaya have initiated telemedicine activities with the help of high speed telephone connectivity or Integrated Services Digital Network (ISDN) connectivity to connect remote Intensive Care Units to provide critical care to cardiac patients admitted in government district level or sub-divisional hospitals in the remote areas of West Bengal, Assam, Bihar, Jharkhand and tribal belts of Karnataka. AHF & NH have created a network of 4-5 Intensive Care Units and 20 telemedicine centres providing 24 hour support in treating the patients and also rendering outpatient consultation in all available specialities. The organisations undertakes this mammoth task by identifying the remote locations with the help of state governments or a local partner, trains and employs local manpower like doctors, technicians, nurses to run the intensive care units or telemedicine centres with the help of the partner.
AHF & NH have devised innovative ways and means to reduce the cost of installation of telemedicine without compromising on the quality of care. ISDN and telephone line connectivity is easily available from BSNL in very remote areas. Moreover, it enables in transfer of data and making video calls at very long distances with ease. Secondly, a good video-conferencing camera is available in the market from various manufacturers with lot of options.
Expensive Telemedicine Software and high tech gadgets like digital cameras, online microscopes, medical scanners used in transfer and storage of medical data like X-Rays, CT Scans & MRIs can be eliminated in centres where there is no facility for a patient to access and undergo such high-tech examinations in the first place. Dr. Devi Shetty, renowned cardiac surgeon and Chairman, Asia Heart Foundation & Narayana Hrudayalaya as he rightly points out that “The beauty of telemedicine is that it makes ordinary people do extra-ordinary things”. He says that in his experience of practicing telemedicine in these many years has brought him face to face with situations where ordinary MBBS doctors and para-medics in district hospitals of Bankura and Siliguri in West Bengal, Chamrajnagar in Karnataka, Udaipur in Agartala have treated patients suffering with Myocardial Infarction, Ischemia, Unstable Anginas successfully with assistance from senior cardiologists in the hub hospitals in AHF, Kolkata and NH, Bangalore. Further he mentions that he himself and his colleagues conducts outpatient consultation to 100 patients over telemedicine from various remote centres every day free of cost.
The organisations have started an innovative venture by developing indigenous software to transmit ECGs with the help of Trans Telephonic ECG Machines. These TT ECG machines are distributed free of cost to General Practitioners. These GPs who finds difficulty in assessing ECGs utilises the service free of cost by transferring the ECG to the hub hospitals in Bangalore and Kolkata. Cardiologist in these centres reports back the ECG and also further course of action to the GP. This entire process takes just 15-20 mins and it builds confidence of the GP in treating patients and patients also relies on the treatment of his local physician.
Conclusion
Telemedicine offers solutions for emergency medical assistance, long-distance consultation, administration and logistics, supervision and quality assurance and education and training for health care professionals and providers. Telemedicine needs to be implemented carefully and managed well. The impact of telemedicine on health care structures can be significant. In this respect, telemedicine can be seen as a tool that is being used to build up new health care horizon. However, there are also concerns about liability, confidentiality and other policy, regulatory issues and pricing. Hence the adoption of sound policies and strategic plans that guarantee the provision of high quality, sustained and integrated health care services to the population are required to be developed in order to make healthcare more accessible to the rural and remote areas with few entrepreneurs to lead.
By Vijay Pratap Raghuvanshi
References
1 National Family Health Survey of India (NHFS) 3 – 2005 -06
2 National Family Health Survey of India (NHFS) 3 – 2005 -06
3 National Knowledge Commission 2005
4. www.isro.gov.in/pressrelease/May16_2006.htm
5. www.laico.org/v2020resource/files/remote_rural_population.htm