Telemedicine, despite being in practice for a very long time in forms such as health consultation over telephone, has recently seen lot of action and development. The development in various fields including telecommunications, Information Technology have further aided in providing healthcare to the poor and the needy, which in turn is creating new market opportunities for the players.
The first reference to telemedicine is probably the famous ‘Radio Doctor’ cover image of the 1924 Radio News Magazine. One of the first telemedicine applications reported in the scientific literature was probably the project for transmission of radiologic images by telephone between West Chester and Philadelphia, Pennsylvania, a distance of 24 miles.
In the 1970s the number of telemedicine projects started to grow and first real-time applications are mentioned. The STARPAHC Project, for example, tried to introduce telemedicine in the rural Papago Indian Reservation in Arizona.
Throughout the 1980s telemedicine, specialty specific applications started to emerge, for example telepathology, which was first mentioned in 1986. The field of radiology saw the development of the first standard on digital medical imaging which culminated in the release of the DICOM specifications in 1992.
The number of telemedicine applications started to grow rapidly in the 1990s due to availability of Internet and affordable computers and digital imaging solution. The technical breakthrough of telemedicine was probably the first transatlantic robotic operation which was performed in 2001 by a surgeon in New York on a patient in Strasbourg.
Telemedicine is the use of Information and Communication Technologies (ICT) to exchange medical information for the purpose of healthcare and health education. It is a field in health science with effective fusion of ICT with Medical Science having enormous potential in meeting the challenges of healthcare delivery to rural and remote areas besides several other applications in education, training and management in health sector. In the context of developing countries, good healthcare facilities are concentrated in the urban cities, while they still lack in rural communities with lower economies. Telemedicine provides a best solution to solve this disparity of health sectors between urban and rural areas.
Telemedicine or telehealth (videoconferencing for healthcare) has opened a world of speciality health services to people who are otherwise unable to access appropriate care. It may be as simple as two health professionals discussing medical problems of a patient and seeking advice over a simple telephone to as complex as transmission of electronic medical records of clinical information, diagnostic tests such as ECG, radiological images etc. and carrying out real time interactive medical video conference with the help of IT-based hardware and software, video-conference using broadband telecommunication media provided by satellite and terrestrial network. In rural areas of developing countries, a reliable communication link for telemedicine is one of the key challenges.
Real time telemedicine could be as simple as a telephone call or as complex as telemedical video conference and tele-robotic surgery. It requires the presence of both parties at the same time and a telecommunication link between them that allows a real time interaction to take place. Video-conferencing equipment is one of the most common forms of technology used in synchronous telemedicine.
This involves acquiring medical data (like medical history, images, etc.) and then transmitting it to a doctor or medical specialist at a convenient time later for assessment offline. It does not require the presence of both parties at the same time. Examples are tele-pathology, tele-radiology, tele-dermatolgy.
India with its vast population, of which 70 per cent are poor and often live in difficult to reach and inhospitable terrain, along with inadequate healthcare network faces a daunting challenge of providing quality healthcare to its citizens. Here, the average per capita spend on healthcare is one of the lowest in the world and various healthcare indicators are also lower than the global average.
In order to provide quality and affordable healthcare to all, Telemedicine, has provided an impetus to the government’s vision of quality health for all by helping in delivering quality healthcare and in controlling the spiralling medical costs. With Telemedicine, more than 300,000 people have already benefited.
Telemedicine in India has a market of more than $500mn and has been implemented in places far and wide under the Public-Private Partnership (PPP) model. As the reach of Telemedicine increases, the market for medical diagnostic, healthcare providers, drug manufactures, telecom equipment manufacturers, software vendors is bound to increase.
Telemedicine, however, is not a panacea for India’s healthcare problems. It is instead a great facilitator in bridging the healthcare divide, representing an early opportunity in the sector which has 5.2 per cent share in the Indian GDP. The future for Telemedicine at the moment looks promising with governmental backing and private initiative. An early move by private enterprise in PPP is highly recommended in the sector.
The telemedicine units located in suburban and rural India and the telemedicine units functioning in tertiary care hospitals are only the beginning. The 625 million Indians living in rural areas have access to less than 20 per cent of the available doctors which itself is only 1:2000. India spends only 0.9 per cent of GDP on health, of which only 0.09 per cent reaches rural India. However there has been an unprecedented growth and development in Information Technology. Pilot studies with hospitals on wheels with telemedicine facilities are being carried out. ISDN lines, broadband high speed internet and VSAT’s are used for connectivity. The Government of India is embarking on a major e-governance project with 110,000 multipurpose internet kiosks in villages. Plans are afoot to provide basic healthcare using these kiosks. Tele education for medical personnel has taken off in a big way. The Ministry of Health now has a major all India programme wherein doctors can listen to lectures and interact with eminent doctors remotely. The Ministry of Information Technology has drawn up standards on telemedicine and these will eventually be implemented. GSAT-4, also known as HEALTHSAT, was an experimental communication and navigation satellite launched in April 2010 but failed to reach its orbit.
Telemedicine is not new for India. There are many telemedicine systems running, several of which are described in this section. In India, telemedicine programmes are supported by both governmental and private parties. In this system, doctors do not have to go to the telemedicine centres; rather, the doctors can use their laptops through the Internet to check up their patient at remote a telemedicine center assisted by a nurse from anywhere.
Indian Space Research Organisation (ISRO) is a government organisation dealing with space technologies in India. ISRO started a telemedicine project in 2001 to introduce the facility to rural areas. ISRO mainly uses INSAT Satellites as a means of communication for telemedicine. Satellites provide two main advantages: (1) They are reliable and (2) easy to reach in remote places. Although this is a costly solution, government support has made it possible. Using satellite, ISRO’s Telemedicine Network has connected 306 rural hospitals and 16 mobile telemedicine units to 60 super specialty hospitals located in metropolitan cities.
It is myth that to establish a telemedicine platform is expensive. The basic system needs hardware, software and telecommunication link. Most of these costs are well within the reach of most of the hospitals, and can be recovered by nominal charge to the patients and students (in case of tele-education) which would be much less than physical travel.
Although information technology has reached in all corner of the country but the accessibility of people living in remote and rural area to the nearest health center (PHCs, CHCs or district hospital) may not be easy due to poor infrastructure of road and transport. It may be possible that the available telemedicine system in the health centers may not function because of the interruption in power supply.
Some healthcare professionals have doubt about the quality of images transmitted for tele-consultation and tele-diagnois. In tele-radiology, telepathology, tele-dermatology the quality of image (colour, resolution, field of view, etc) should be international standards to avoid any wrong interpretation and mis-diagnosis. The delay in transmission of data may be of critical importance in tele-mentoring and robotic surgery and have to be reduced to the minimum.
There should be a format to calculate the investment and recurring cost of the telemedicine system. The insurance companies have to decide whether the cost of tele-healthcare should be reimburse or not.
There is lack of training facilities with regards to application of IT in the field of medicine. Most of the healthcare and IT professionals are not familiar with the terms commonly used in telemedicine such as HIS, EMR, PACS, etc. Telemedicine is also not the part of course curriculum of medical schools.
Telemedicine technology has been proved and established and its advantages and benefits are well known but still many healthcare professionals are reluctant to engage in such practices due to unresolved legal and ethical concerns. In case of a cross-border tele-consultation which country’s litigation laws will be applied in case– those of the country in which the patient is living or those of the remote physician?
There are many issues that should be considered regarding the security, privacy and confidentiality of patient data, in telemedicine consultations. How are patients’ rights of confidentiality of their personal data ensured and protected? How to ensure security of the data and restrict its availability to only those for whom it is intended and who are authorised and entitled to view it? How to prevent misuse and even abuse of electronic records in the form of unauthorised interception and / or disclosure?
It is the use of information and communication technology for prevention, promotion and to provide healthcare facilities across distance. It can be divided into activities like - Teleconsultation and Telefollow-up.
Tele-education should be understood as the development of the process of distance education (regulated or unregulated), based on the use of information and telecommunication technologies, that make interactive, flexible and accessible learning possible for any potential recipient.
Telemedicine can play an important role to provide healthcare facilities to the victims of natural disasters such as an earthquake, tsunami or atornado and man-made disaster such as war, riots, etc. During a disaster, most of the terrestrial communication links either do not work properly or get damaged so a mobile and portable telemedicine system with satellite connectivity and customised telemedicine software is ideal for disaster relief.
Telemedicine technology can be applied to provide home healthcare for the elderly or underserved, homebound patients with chronic illness. It allows home healthcare professionals to monitor patients from a central station rather than traveling to remote areas chronically ill or recuperating patients for routine check-ups. Remote patient monitoring is less expensive, more time saving, and an efficient methodology. Tele-home care virtual visits might lead to improved home healthcare quality at reduced costs, greater patient satisfaction, increased access to healthcare providers and fewer patients needing transfer to higher, more expensive levels of care. A Computer Telephone Integrated (CTI) system can monitor vital functions of patients twenty four hours a day and give immediate warnings.
The main objective of telemedicine is to cross geographical barriers and provide healthcare facilities to rural and remote areas so that it is beneficial for the population living in isolated communities. Besides this, other advantages telemedicine are:
The practice of telemedicine – through transmission of digitised data, audio, video and images – is getting popular all over the world as it provides hitherto unavailable access to tertiary level specialist healthcare even in geographically remote areas without displacement of the patient, physician or the equipment.
Healthcare in India is in the midst of a major market transition and technology is making a tremendous impact on the way healthcare is delivered. Telemedicine, despite being in practice from a very long time in forms such as health consultation over telephone, has recently seen lot of action and development. Government has long realised that given the constraints, it is difficult to reach everyone to provide quality healthcare. The PPP model in Telemedicine is helping in delivering quality healthcare to wider set of citizens who earlier could not be reached. The development in various fields including telecommunications, Information Technology have further aided in providing healthcare to the poor and the needy, which in turn is creating new market opportunities for the market players. The urban population has always had the benefit of specialist healthcare; Telemedicine is fulfilling the promise for rural population as well.
Rashi Agarwal has been providing consulting services to hospitals in India, UAE, Africa in areas of hospital planning, operational management, quality, human resource, medical tourism etc. She is also a visiting faculty and examiner to several health administration programs in India and has helped plan out educational programs for health administration. She has recieved her Master in Healthcare Administration from Washington University, St. Louis, USA and is a keen academician above her consulting business of healthcare practices.