This is the first report on Telehealth in India, and was authored in 2011 by Rajendra Pratap Gupta for Telemedicine Society of India , when he chaired the Organising Committee of the International Telemedicine Congress 2011 at Mumbai
This report gives a detailed overview of where India stands and what is the scope in future
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Telehealth Report - India
1.
2. International Telemedicine Congress - 2011
Foreword 1
Editorial 2
Executive Summary 4
Telemedicon 2011 5
Telemedicine Concept 6
Telemedicine in India 17
Initiatives 32
Opportunities and Challenges 45
Industry Speaks 53
Business Models 58
Learning and Resources 60
Continua Health Alliance 65
Roadmap Ahead 67
References 71
Telehealth Report - 2011
with proceedings of
Contents
3. Rajendra Pratap Gupta
International Healthcare Expert &
Chairman, Organizing Committee
International Telemedicine Congress – Telemedicon’11
Telehealth Report - 2011
with proceedings of
International Telemedicine Congress - 2011
1Foreword
India is presently building on its healthcare system, and the 12th Five Year Plan has been referred to as
the ‘Plan for Health’ ! Now is the right time for the policy makers to ensure that technology is embedded
in all programs that the Government is planning to rollout for healthcare delivery. In specific, mHealth
has tremendous potential to reduce costs, improve the reach and access to healthcare, make the
healthcare system more outcome driven, and more importantly, help in establishing an ‘empowered
patient’.
With approximately 900+ million cell phones, healthcare in India will converge to mHealth, and
ultimately, this is where all practitioners, payers and users will converge too! It is time to look at
mHealth as a tool for ‘Inclusive Healthcare’ . Without mHealth,‘Universal Healthcare’ will just remain a
dream !
Being personally involved in many mHealth & Telemedicine ventures and policy initiatives, I have
always felt that when it comes to Telemedicine & mHealth, there is no concrete report that can fill in the
readers with the detailed and up-to-date information, and so this attempt to come out with the first
‘Telehealth Report’- 2011. We have done our best to ensure that the report is accurate and full of facts
from the users, policy makers and industry point of view. Still, this report could have inadvertent errors
or short comings, as it usually happens with the so called ‘First Timers’. Please feel free to write back for
any suggestions you might have .
I do hope that this report will be of immense help to users, providers and policy makers for mhealth &
eHealth - not just in India, but across the world . I do look forward to your comments & feed back.
Yours in good health
Member, Healthcare, Quality Council of India
President, Disease Management Association of India
Chairman, Board of Directors, HIMSS Asia Pacific India Chapter
Co-Chair, Sub-Group on Chronic Diseases, Confederation of Indian Industry
Member, Governing Council, Telemedicine Society of India
Member, Board of Directors, Care Continuum Alliance, Washington, USA
Email : chairman@telemedicinecongress.com
www.telemedicinecongress.com
4. Dr. Sam Pitroda
Advisor to the Prime Minister of India
on Public Information and Innovations
Telehealth Report - 2011
with proceedings of
International Telemedicine Congress - 2011
2 Editorial
Technological advancements have come a long way from the time of the great Industrial Revolution.
What was initially feared for its negative consequences on society has emerged to be the culture of
‘Technological Utopianism’. Whether the technology boom can actually help realise this utopian
environment or not, it sure has come to address many major issues across industries.
Industrialization has been marked by the coming together of two advancements, telecommunication
and Information Technology, for bridging the technology gap between developed and the developing
world. These powerhouses of global economy have been greatly accepted into the healthcare industry
to aid in cure delivery, while paralleling the dynamic achievements made in medical sciences. As a form
of Information and Communication Technologies (ICT), Telemedicine and mobile health are being
largely employed across the globe to bridge the urban rural disparity in receiving care services.
Telemedicine is best suited for nations like Africa and India, which have large populations in rural areas,
devoid of quality care services and separated by great distances. Yet the adoption of these technologies
is in its infancy. The industry as a whole needs to take the next step forward from the numerous pilot
programs now underway to finding means of encouraging widespread roll out of Telemedicine and
mHealth. The increasing use of internet and mobile phones across the globe, two of the basic
requirements of Telemedicine, provides the industry ample impetus to advance this approach of care
to a higher level. Improvements and advancements in telecommunication infrastructure and
technology, the advent of high speed internet, improved connectivity, increased computer literacy and
reduction in telecom service cost will further drive the industry. Furthermore, better privacy and
security of confidential patient data and standardization of regulatory policies will form the pillars to
remote provision of care services.
With so much interest being induced in this emerging area of healthcare, hopefully Telemedicine will
transform itself into a self-sustaining economic environment. This congress, featuring the pioneers and
innovators in the field of Telemedicine, was a platform for ideas and experiences to open into
opportunities for immense growth and development in this area of healthcare that has already shown
great potential and promise. I would like to congratulate Rajendra Pratap Gupta from the Telemedicine
Society of India for organizing an event of this magnitude and coming out with India’s First Telehealth
Report
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Telehealth Report - 2011
with proceedings of
International Telemedicine Congress - 2011
Executive Summary
Despite a steady increase in the number of medical establishments and improvement in India’s
healthcare infrastructure, much remains to be accomplished. There still remains a severe shortage of
sub centres, primary health centres, and community health centres. While Telemedicine offers great
opportunities in general, it could be even more beneficial for underserved and developing countries
like India, where access to basic care is of primary concern. One of the biggest opportunities
Telemedicine presents is increased access to health care. Providing populations in these underserved
countries with the means to access health care has the potential to help meet previously unmet needs
and positively impact health services.
Telemedicine applications have successfully improved the quality and accessibility to medical care by
allowing distant providers to evaluate, diagnose, treat, and provide follow-up care to patients in less-economically
developed countries. They can provide efficient means for accessing tertiary care advice
in underserved areas. By increasing the accessibility of medical care, Telemedicine can enable patients
to seek treatment earlier and adhere better to their prescribed treatments, and improve the quality of
life for patients with chronic conditions.
Indian Telemedicine has come a long way since India's first Telemedicine centre at Apollo Aragonda
Hospital was inaugurated in 2000. With its large medical and IT manpower and expertise in these areas,
India holds great promise and has emerged as a leader in the field of Telemedicine. Key growth drivers
include low cost of Telemedicine and wide reach over satellite or fiber optic bandwidth, lack of
healthcare facilities in far-off regions, reduced technology cost and availability of qualified technical
personnel, shortage of qualified medical professionals, and growth of ICT as a sector
Although there are many factors that are encouraging the adoption of Telemedicine as a medium of
healthcare service, there are few challenges as well faced by the industry. Issues such as absence of
global regulatory framework, lack of basic IT infrastructure, reimbursement policies, and legal
constraints hinder the growth of the Telemedicine market. Lack of common standards and
classification could pose a challenge to the growth of this market.
7. 5
Telemedicon 2011
Telehealth Report - 2011
with proceedings of
International Telemedicine Congress - 2011
Telemedicine Society of India organized the 7th International Telemedicine Congress, Telemedicon’11
from 11-13th November at Hotel Westin in Mumbai.
Telemedicon’11 was the ‘Biggest Healthcare Congress that has ever happened in India’. The event had
an overwhelming response from one and all, which can be judged from the fact that all the exhibitor
space was sold out weeks before the congress. The organizing committee members had to stop the
registration process few days before the congress. Over 500 delegates from over 20 countries
participated in the Telemedicine congress event held at Hotel Westin, Mumbai in India. Distinguished
guests/speakers like Mr. Aneesh Chopra, CTO and Assistant to the President of USA; Shri Sachin Pilot,
Hon’ble Minster of State for IT, Government of India; Dr. Prathap Reddy, Chairman, Apollo Hospitals
Group; Shri Shankar Aggarwal, Additional Secretary, DIT, Government of India; Lord Nigel Crisp, Dr.
Dale Alverson and a host of global healthcare leaders made this event a memorable one, and one of the
biggest and most successful events in the Healthcare Industry. The entire Telemedicine ecosystem
(telecom operators, telecom equipment manufacturers, mobile handset manufacturers, software
vendors, policy makers, healthcare professionals) was present under one roof.
Telemedicon’11 has become an iconic conference in many ways as it has also launched the Continua
Health Alliance on 13thNovember 2011, followed by an interoperability workshop, for the first time in
India. About 40 Exhibition stalls were organized by the top players in Telemedicine to demonstrate their
products/services.
8. Telehealth Report - 2011
In the current environment of Ÿ shortage of healthcare professionals and greater incidence of chronic
conditions, and rising healthcare costs, are driving the need to develop tools and solutions to
improve healthcare delivery. One such tool is the electronic exchange of medical information, which
is commonly referred to as Health Information Technology (“Health IT”). Health IT plays a key role in
digitizing and transmitting health information electronically that can improve patient outcomes.
Health IT processes can also include:
ŸUse of electronic health records by patients, physicians, insurers, hospitals and clinics
ŸHealth information exchange across industries and geographies
ŸUse of electronic health information to detect trends in population and public
health
ŸTransmission of medication refills and a patient’s prescription history.
A key part of Health IT is increasing the frequency and use of technology-driven remote monitoring and
consultation to treat patients. This area of Health IT is commonly referred to as “Telemedicine.” There
is no universally accepted definition of Telemedicine.However, the American Telemedicine Association
(ATA) defines the term as follows :
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Telemedicine Concept
with proceedings of
International Telemedicine Congress - 2011
What is Telemedicine?
“Telemedicine is the use of medical information
exchanged from one site to another via electronic
communications to improve patients’ health status”
It is a broad term within Health Information Technology that encompasses methods for electronically
transmitting medical information. These methods can include store-and-forward technology for
documents and images, remote monitoring of a patient’s vital signs, secure messaging, e-mail
exchange of data, alerts and reminders between physicians and patients, and the ability to observe,
diagnose and recommend treatment via videoconference. Telemedicine can eliminate distance
barriers and can improve access to medical services that would often not be consistently available in
distant rural communities.
Closely associated with Telemedicine is the term ‘telehealth,’ with the former restricted to service
delivery by physicians only, and the latter signifying services provided by health professionals in general,
(including nurses, pharmacists, and others). Videoconferencing, transmission of still images, e-health
including patient portals, remote monitoring of vital signs, continuing medical education and nursing
call centers are all considered part of Telemedicine.
Major areas of Telemedicine include Teleradiology, Teleconsulting, Telemonitoring, & Telesurgery
Ÿ Teleradiology, is the transmission of radiological patient images, such as x-rays, CTs,
and MRIs, from one location to another, for the purposes of sharing studies with other radiologists
and physicians. Teleradiology is a growth technology given that imaging procedures are growing
approximately 15% annually against an increase of only 2% in the Radiologist population
Ÿ Teleconsulting, is using Telemedicine for medical consultation.
Ÿ Telemonitoring, can be defined as the use of information technology to monitor patients at a
distance.
Ÿ Telesurgery, (also known as remote surgery) is the capability for a doctor to perform surgery on a
patient even though they are not physically in the same location. It is a form of telepresence.
9. Telehealth Report - 2011
mHealth
mHealth is a new area emerging within the field of Telemedicine. mHealth or
mobile health is a term used in reference to using mobile communication
devices, such as mobile phones and PDAs, for health services and information.
Nigel Crisp, Former CEO of NHS & Member, House of Lords
mHealth applications include the use of mobile devices in collecting community and clinical health data,
delivery of healthcare information to practitioners, researchers, and patients, real-time monitoring of
patient vital signs and direct provision of care.
Products and Service Offerings
There are multiple industries that are involved in developing various applications of Telemedicine,
including IT vendors, medical device manufacturers, pharmacies, hospitals, nursing homes, and
venture capitalists. Accordingly, there are numerous products and services comprising Telemedicine.
Products : Many medical devices capable of collecting and electronically transmitting information can
be digitized to be used in Telemedicine applications. These include blood gluc ose meters, pulse
oximeters, blood pressure cuffs, spirometers, CT scanners, and MRI machines. Some of these devices
are targeted towards home healthcare and the needs of patients interested in closely monitoring their
health status, while others facilitate the exchange of information between hospitals, clinics and
physicians.
Services : The use of medical products with electronic exchange capabilities allows for the provision of a
wide range of Telemedicine-related services. These include st ore-and-forward technology for
documents and images, remote monitoring of a patient’s vital signs, secure messaging, e-mail
exchange of data, alerts and reminders between physicians and patients, and having a specialist
remotely available by videoconference to observe and diagnose a patient’s condition and recommend
treatment. Electronic exchange of prescription information between physicians, pharmacies and
consumers is an additional service. Other Telemedicine services include transmitting information to
alert communities about pandemics, and other widespread health threats.
Evolution of Telemedicine
Due to the recent advances in ICT, interest in Telemedicine has increased in the last few years. The
concept is not new. The first reference of the subject is probably the famous “Radio Doctor” cover
image of the 1924 Radion News Magazine. One of the first Telemedicine applications reported in
the scientific literature was the project for transmission of radiologic images by telephone
between West Chester and Philadelphia, Pennsylvania, covering a distance of 24 miles.
NASA used Telemedicine in the 1960s as a way to monitor astronaut health on space missions.
Today, it’s used to electronically exchange medical information among patients, clients and health
providers, creating greater access to medical evaluation and improving patient care.
In the 1970s, the number of Telemedicine projects started to grow and the first real-time applications
were mentioned. The STARPAHC Project 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
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“In UK, National Health Service (NHS) Direct started free
health advice service over telephone. It has over six million
subscribers, over 10% of the Country’s population.”
Telemedicine Concept
with proceedings of
International Telemedicine Congress - 2011
Health IT
Telemedicine
mHealth
Chart 1: Health IT vs.
Telemedicine vs. mHealth
10. 8
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 the availability
of internet, affordable computers and digital
imaging solution. The lat est technical
breakthrough in Telemedicine was probably the
first transatlantic robotic operation which was
performed in 2001 by a surgeon in New York on a
patient in Strasbourg.
At present, electronic medical data, such as high
resolution images and live video, are transferred
through a v ariety of t elecommunication
technologies, from fiber optics and satellites, to a
simple telephone line. A growing number of
medical specialties rely on Telemedicine to serve
patients in areas such as adult rehabilitation,
dermatology, emergency services, home
healthcare, nephrology, pathology, paediatrics,
perinatology, primary care, psychiatry, and
radiology.
Current Deployment Scenario
In 2010, World Health Organization (WHO)
conducted a survey to obtain an impression of the
current state of Telemedicine service provision as
well as four of the most popular and established
areas of Telemedicine. Respondents were asked
to indicate whether or not their country offered a
service in each field, and if so, to give its level of
development. Levels of development were
classified as ‘established’ (continuous service
supported through funds from government or
other sources), ‘pilot’ (testing and evaluation of
the service in a given situation), ‘informal’
(services not part of an organized program) or ‘no
stage provided’ (services not part of any platform).
The survey examined four fields of Telemedicine :
1.Tele -radiology: Use of ICT to transmit digital
radiological images (e.g. X-ray images) from
one location to another for the purpose of
interpretation and/or consultation.
2.Tele-pathology: Use of ICT to transmit digitized
pathological results (e.g. microscopic images of
cells) for the purpose of interpretation and/or
consultation
Telemedicine Concept
Telemedicine
The idea of performing medical examinations
and evaluations through the
telecommunication network is not new.
Shortly after the invention of the telephone,
attempts were made to transmit heart and
lung sounds to a trained expert who could
assess the state of the organs. However, poor
transmission systems made the attempts a
failure.
Ÿ1906 ECG Transmission: Einthoven, the
father of electrocardiography, first
investigated on ECG transmission over
telephone lines in 1906
Ÿ1920s Help for ships: Telemedicine dates
back to the 1920s. During this time, radios
were used to link physicians standing
watch at shore stations to assist ships at
sea that had medical emergencies
Ÿ1924 The first exposition of Telecare:
Perhaps it was the cover of "Radio News"
magazine of April 1924. The article even
includes a spoof electronic circuit diagram
which combined all the gadgets of the day
into this latest marvel
Ÿ1955 Telepsychiatry: The Nebraska
Psychiatric Institute was one of the first
facilities in the country to have closed-circuit
television in 1955. In 1971, the
Nebraska Medical Centre was linked with
the Omaha Veterans Administration
Hospital and VA facilities in two other
towns
Ÿ1967 Massachussetts General Hospital :
This station was established in 1967 to
provide occupational health services to
airport employees and to deliver
emergency care and medical attention to
travellers
Ÿ1970s Satellite Telemedicine: Via ATS-6
satellites. In these projects, paramedics in
remote Alaskan and Canadian villages
were linked with hospitals in distant towns
or cities
Telehealth Report - 2011
with proceedings of
International Telemedicine Congress - 2011
11. Telehealth Report - 2011
International Telemedicine Congress - 2011
Telemedicine Concept
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3.Tele-dermatology: Use of ICT to transmit medical information concerning skin conditions (e.g.
tumours of skin) for the purpose of interpretation and/ or consultation.
4.Tele-psychiatry: Use of ICT for psychiatric evaluations and / or consultation via video and telephone.
Table 1: Teleradiology – Most developed
Service areas in Telemedicine Established Pilot Informal No Stage Provided Total
Teleradiology 33% 20% 7% 2% 62%
Telepathology 17% 11% 9% 4% 41%
Teledermatology 16% 12% 7% 3% 38%
Telepsychiatry 13% 5% 5% 1% 24%
Tele-radiology is currently the most developed Telemedicine service area globally, with 62% of
responding countries offering some form of service and 33% of countries having an established service
(Table 1). While the proportion of countries with any form of service ranged from almost 41% for
teledermatology and telepathology, to 24% for telepsychiatry, the proportion of countries with
established services in those three areas was comparable at approximately 15%.
“Telemedicine has done well, but the difference is not visible to the
audience. In order to make the difference visible, we need to bring
examples of real health and economic benefits that Telemedicine
provides”
Nigel Crisp
Former CEO of NHS and Member, House of Lords
Telemedicine in developing countries
While Telemedicine offers great opportunities in general, it could be even more beneficial for
underserved and developing countries where access to basic care is of primary concern. One of the
biggest opportunities Telemedicine presents is increased access to health care. Providing populations
in these underserved countries with the means to access health care has the potential to help meet
previously unmet needs and positively impact health services.
Telemedicine applications have successfully improved the quality, and accessibility to medical care by
allowing distant providers to evaluate, diagnose, treat, and provide follow-up care to patients in less-economically
developed countries. They can provide efficient means for accessing tertiary care advice
in underserved areas. By increasing the accessibility of medical care, Telemedicine can enable patients
to seek treatment earlier and adhere better to their prescribed treatments, and improve the quality of
life for patients with chronic conditions.
Telemedicine has been advocated in situations wherein the health professional on duty has little or no
access to expert help, with need to offer remote physician access to otherwise unavailable specialist
opinions, thereby providing reassurance to both doctors and patients. Telemedicine programs have
been shown to directly and indirectly decrease the number of referrals to off-site facilities and reduce
the need for patient transfers. Remote care and diagnosis via Telemedicine in less-economically
developed countries thus benefits both patients and the health care system by reducing the distance
travelled for specialist care and the related expenses, time, and stress. Furthermore, Telemedicine
programs have the potential to motivate rural practitioners to remain in rural practice through
augmentation of professional support and opportunities for continuing professional development.
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12. Telehealth Report - 2011
With progress in technology, the expansion of Telemedicine in developing countries is promising, one
factor being the falling costs of ICTs. Other factors include increasing computing speeds, options for
high-speed bandwidth and the falling costs of digital storage. Already basic store-and-forward e-mail-based
Telemedicine requires minimal investment in hardware and software where network
connectivity is available, and allows for detailed exchanges by enabling the transfer of images as
attachments, making it an effective solution for low-resource settings. The growing development of
Internet-based conferencing (particularly through no-cost software) increases the accessibility and
portability of conferencing and counters the need for expensive video conferencing equipment that
may be limited by availability. Low bandwidth, Internet-based Telemedicine (e.g., store and forward, e-mail-
based consultations) has also proven to be a cost-effective technology that can efficiently and
effectively pre-screen patients living in remote areas. By enhancing the information communication
technology infrastructure and developing better communication facilities, Telemedicine can also add
to the better management of scarce medical resources and day-to-day activities in the developing
world.
What is holding Telemedicine in developing countries?
Barriers in realizing true potential
Infrastructure in developing countries is largely insufficient to utilize the most current Internet
technologies. This lack and inadequate access to computing are barriers to Telemedicine uptake for
many developing countries. At the most fundamental level, the variability of electric power supplies,
widespread unavailability of internet connectivity beyond large cities, and information and
communication equipment that is not suitable for tropical climates impose limitations on where
Telemedicine can be implemented. Unreliable connectivity, computer viruses, and limited bandwidth
continue to present challenges when and where Internet access is available. Internet congestion can
lead to delayed imaging; poor image resolution may limit the efficacy of remote diagnosis; and slow
bandwidth can prohibit the use of real-time videoconferencing. Even when basic infrastructure is in
place, widespread interoperability standards for software are lacking and equipment or computer
system failure remains an ever-present possibility.
Financial cost also poses both a real and perceived barrier to the application and adoption of
Telemedicine in developing countries. Equipment, transport, maintenance, and training costs of local
staff can be daunting for countries with little income or limited funding for the implementation and
maintenance of Telemedicine initiatives. Moreover, convincing evidence to support the overall cost-effectiveness
of particular Telemedicine strategies may be weak, while the economic implications of
such strategies in different settings may not yet be known.
Local skills, knowledge, and resources may also limit the application of Telemedicine in developing
countries. A lack of computer literate workers with expertise in managing computer services, combined
with the lengthy process required to master computer-based peripheral medical instruments, can
hinder uptake. While there may be a demand for distance learning, meeting local educational needs
can be difficult due to differences in the diagnostic and therapeutic resources available, as well as the
literacy and language skills across multiple sites. Moreover, while Telemedicine may enhance expert
diagnosis, treatment options available are constrained by logistical challenges, including the training of
local medical personnel, availability of medical equipment and supplies, and getting medicines to
patients.
Socio-cultural differences between sites can limit the pertinence of Telemedicine collaborations in the
developing world and challenge cultural perspectives related to health and wellness. A major
contributing factor to Telemedicine failure is the oversight of incompatible cultural subsystems that
prevent the transfer of knowledge from one cultural context to another. Medical professionals in the
industrialized world may be unfamiliar with the available facilities and alternative management
strategies in remote areas and vice versa. Telemedicine, therefore, risks the exchange of inappropriate
or inadequate medical information. Without a good understanding of the local context, it may be
difficult to integrate Telemedicine in a useful way.
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International Telemedicine Congress - 2011
Lack of information available regarding legal policies, guidelines, or minimum standards concerning
the use of Telemedicine in the clinical context can also prevent the adoption of such technologies.
Cross-border legalities are a concern for developing countries that use Telemedicine services to
connect with health professionals from more than one country. An overall lack of evaluation data, trials,
and published results concerning Telemedicine initiatives in developing countries has limited the
amount of evidence on the impact and effectiveness of Telemedicine.
Complete evaluation is vital to systematically document best practices and lessons learnt from country-specific
Telemedicine networks. Such evaluations will show which networks demonstrably alter health
outcomes, prove to be cost-effective and are sustainable. These can then provide a model for other
countries to adapt in their own contexts. Critical success factors include; clear program goals, garnering
government and institutional support, adapting existing user-friendly interfaces, determining
accessibility and connectivity constraints, implementing standards and protocols, and disseminating
evaluation findings.
Where can Telemedicine help?
Application
The healthcare-at-a-distance concept has been adopted to overcome distance barriers and improve
access to healthcare services. Telemedicine is being applied to enable:
Remote consultation: With Telemedicine, rural areas benefit from the same specialized services
availed in urban areas. With the help of telecommunication and the internet, the technology has also
been used to deliver care services to workers at oil rigs, passengers on board public transport, patients
in transit, for medical tourism, and correctional systems.
Home care: This application of Telemedicine has been driven by the rise in chronic conditions, aging
populations, scarcity of hospital streambeds, and the current global focus of empowering patients with
their own health. In support of Telemedicine technology, the delivery of care has evolved to include
connected care; a care model that exploits the use of technology to provide healthcare remotely.
Telemedicine is between provider and recipient, and forms a medium by which information is
transmitted. This is facilitated by two basic approaches that are applied in various scenarios:
1. Real Time (synchronous), when the exchange of information is immediate, and both the provider
and recipient are present simultaneously at each of their ends. An example of the synchronous
type is the usage of video conferencing for Telemedicine application.
2. Store and Forward (asynchronous), where the information is acquired and stored in a particular
format before it is sent for expert consultation, as in the case of using e-mail for exchange of
information.
The clinical applications of Telemedicine can also be categorized according to the different levels of
technology maturity.
Mature: The most mature applications of Telemedicine are in the areas of teleradiology and
telepathology. The primary reason for these disciplines of medicine to adopt Telemedicine is the
similarity between the two. It is a known fact that radiologists and pathologists rely extensively on
imaging technology rather than direct contact to diagnose a condition. Hence, the practice of
diagnoses through Telemedicine would not substantially differ from conventional mode. This is one of
the most prominent reasons as to why radiologists and pathologists were the earliest adopters of this
technology.
Maturing: Maturing applications include telepsychiatry, teledermatology, telecardiology and
teleophthalamology. Although there has been significant research interest in these areas, they are yet
to receive institutional and professional acceptance globally, as there is a need for technology
development, testing and dissemination, clinical guidelines and standards.
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Emerging: The emerging applications have been telesurgery, telepediatrics and emergency medicine.
Telesurgery has been making steady progress in the areas of remote surgery and teleconsultatative
processes in view of advancements made in robotics and related technologies, as well as broadband.
This arm of Telemedicine has been researched for telemonitoring (surgical instructions), and
teleproctoring (overseeing a surgical procedure). Majority of research and the development in
telepediatrics is focused on treating children with chronic illness and special needs. School based
telepediatric services for underprivileged children is another area that has shown potential for
mainstream application.
How can Telemedicine help?
Rationale
There are several benefits that can be realized by an increased use of Telemedicine as also there are
multiple factors driving the need for Telemedicine. Benefits can range from increased compliance in
taking medications, to improved healthcare delivery in rural and underserved areas, to improved
delivery of healthcare services outside hospitals and clinics, and better utilization of healthcare
professionals.
Manage chronic diseases effectively: Chronic conditions such as diabetes, congestive heart failure,
and obstructive pulmonary disease, require long-term treatment and use of multiple specialists, all of
which significantly increase costs. Widespread Telemedicine adoption allows vital sign information
and monitoring to be gathered frequently (instead of only during periodic physician visits). Messages
can then be simultaneously transmitted to the treatment team, allowing for possible early intervention
(a physician or hospital visit) if a patient’s condition deteriorates.
Extend reach to underserved/rural communities: Many regions of the world (both urban and rural) do
not have a full range of healthcare services available. The presence of Telemedicine services in rural
areas has been shown to improve care by decreasing transportation costs, more efficiently deploying
healthcare professionals and specialists, and offering timely healthcare delivery without the obstacles
presented by lakes, forests and mountains.
Address shortages of healthcare professionals: Telemedicine services such as videoconferencing and
remote consultations, better utilize current staff, whether at a hospital, physician’s office, or via home-care.
The availability of Telemedicine technologies and procedures can also allevia te potential
shortages of healthcare professionals by enabling remote consultations by physicians and nurses for
patients located in other states or countries.
Improve competitiveness of industry by controlling healthcare costs: With rising healthcare costs,
Telemedicine can provide a tool for companies and insurers to better control and manage healthcare
spending by enabling greater use of remote monitoring of a patient’s condition to minimize the need
for acute care intervention, and more efficient deployment of healthcare professionals.
Empower patients regarding their own health: Raising the responsibility level of patients to take their
medicines and report basic health metrics to their physician by using Telemedicine represents an
opportunity for patients and caregivers to play a greater role in their own care.
Improve care of elderly, home-bound, and physically challenged patients: Use of Telemedicine to
reduce the frequency of visits to physician offices and hospital emergency rooms can potentially lead to
greater convenience and compliance for elderly and home-based patients.
Improve community and population health: Electronic sharing of image s and video consults, a
component of Telemedicine, permits easier exchange of information between public health services
about a rare or unusual health condition, better measure chronic diseases in a population, or address a
public health crisis.
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Reduce deaths, injuries, and infections: Increased use of Telemedicine across all settings could reduce
the incidence of adverse events caused by treatment and medication errors arising from piece-meal or
inaccurate patient information, leading to more consistent patient treatment by limiting the number of
hospital visits and reducing exposure to illness from other patients. In addition, electronic prescribing
can help reduce errors in dispensing medicines by eliminating the need to decipher handwritten
prescriptions.
Global Telemedicine market
The global Telemedicine industry has been growing remarkably and expanding virtually across all the
medical areas for the past few years. The global market for Telemedicine was valued at USD 9.8 billion in
2010, and it is expected to grow at a CAGR of 18.6% to reach USD 23 billion by 2015.
The global telehospitals/clinics market in 2009 was USD 5.6 billion and accounted for approximately
71% of the total Telemedicine market. This sector is valued at USD 6.9 billion in 2010 and is expected to
reach USD 15 billion in 2015, at a CAGR of 16.8%.
The telehome mark et, which
represented approximately 29% of
the Telemedicine market in 2009, is
expected to contribute 34.7% by
2015. This segment was valued at
nearly USD 2.9 billion in 2010 and is
expected to reach USD 7.9 billion in
2015 at a CAGR of 22.5%.
One of the key factors contributing
to this market growth is federal
grants offered in the USA. The
global Telemedicine market has
also been witnessing an increase in
strategic partnerships. Healthcare
o rga n i zat i o n s a re a d o p t i n g
Telemedicine technologies to cater to the demand for healthcare services. Other key growth drivers
include shortage of health professionals, ageing population, availability of application service provider
model, and affordable broadband internet access.
Growth prospects of the Telemedicine market vary according to geographies. USA and Europe
dominate the world Telemedicine market. USA has witnessed deployment of numerous federal grants
during the past few years, which has aided in the excessive growth of the Telemedicine market in the
country. Europe, on the other hand, has been witnessing a strong demand for Telemedicine products
due to the rise in aging population and enhanced requirements for home treatments.
Asia is the fastest growing region. It exhibits huge growth potential in the coming years as Telemedicine
demand in this region will be driven by rising healthcare costs. There is a substantial rise in demand for
Telemedicine in China and India. As governments and private players have stepped into the industry
across most of the geographical locations, the future prospects of the market show immense
opportunities to tap into.
Although there are many factors that are encouraging, the adoption of Telemedicine as a medium of
healthcare service, there are few challenges as well faced by the industry. Issues such as absence of
global regulatory framework, lack of basic IT infrastructure, reimbursement policies, and legal
constraints hinder the growth of the Telemedicine market. Lack of common standards and
classification could pose a challenge to the growth of this market.
Telemedicine Concept
CAGR 18.6%
(2010-2015 )
$Bn
25
20
15
10
5
2009 A 2010 A 2015 E
Telehospitals / clinics Telehome
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16. Telehealth Report - 2011
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As Telemedicine has the potential to improve both the quality and the access to health care regardless
of the geography; the rural market is driving the incessant growth of the Telemedicine market. Without
Telemedicine, access to primary care services would remain strained or nearly impossible for
numerous rural patients. In the coming years, Telemedicine will not only assuage the inaccessibility
that rural practitioners and patients experience, but it will also broaden the range of services to the
rural residents.
Other trends observed globally include adoption of 3G and High Speed Package Access (HSPA),
increasing use of wireless and web-based services, integration of various devices such as patient alert
devices and vital signs recording devices, and hospitals’ integrated approach to healthcare delivery.
Case Studies
Mobile phones for health
Application Area : Remote monitoring
In 2005, engineers at Loughborough University developed a mobile phone health monitoring system to
monitor diabetes and other diseases. The system allows doctors to use mobile phone networks to
monitor up to four key medical signals (electrocardiogram heart signal, blood pressure, levels of blood
glucose, and oxygen saturation levels) from patients who are on the move. Engineers from the UK and
India are working to ‘miniaturize the system’ so that sensors are small enough to be carried by patients
while procuring the necessary biomedical data. In Britain, the solution will be used to improve
healthcare delivery, while in India it will connect ‘centres of excellence’ to hospitals and clinics in more
remote areas. Over the next three years, clinical trials will occur in both the UK and India.
Ÿ UK-based Loughborough University's engineers entered into a partnership with India to
develop a unique mobile phone health monitoring system.
Ÿ The system, which was first unveiled in 2005, uses a mobile phone to transmit a person's
vital signs, including the complex electrocardiogram (ECG) heart signal, to a hospital or
clinic anywhere in the world.
Ÿ Presently, the system can transfer the signals pertaining to the ECG, blood pressure,
oxygen saturation and blood glucose level.
Ÿ IIT, Delhi, the All India Institute of Medical Sciences and Aligarh Muslim University and
London's Kingston University joined hands to further develop the system.
Ÿ The research team is aiming to miniaturize the system by designing sensors and mini-processors
that are small enough to be carried by patients, and at the same time procure
biomedical data. The network of sensors would be linked through a modem to mobile
networks and the Internet, and to a hospital computer. Then, doctors can use this device
to remotely monitor patients suffering from chronic diseases, like heart disease and
diabetes.
Ÿ The clinical trials of the system are going on in the UK and India.
Support to Promote Maternal and Newborn Health
The aim of the Telemedicine Support to Promote Maternal and Newborn Health in Remote Provinces of
Mongolia project is to reduce infant and maternal mortality while addressing the gap between urban
and rural healthcare services. The project started in September 2007 and continued till December
Telemedicine Concept
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17. Telehealth Report - 2011
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2010. Telemedicine services supported Aimags (province), with high-risk pregnancy consultations,
prenatal ultrasound diagnostics, foetal monitoring and screening for cervical abnormalities using
colposcopy. The services provided by the project were particularly important for women in remote
rural regions who do not have the funding to travel for expert opinion.
A total of 297 doctors, nurses and midwives were trained for this program between March and
December 2009. A total of 598 cases were referred in 2009. Of these, 64% were obstetrical, 21% were
gynaecological pathology and 15% were neonatal pathology. Only 36 of these cases were referred to
Ulaanbaatar for treatment following the diagnosis, substantially saving the resources of rural residents
that would otherwise have gone towards travel expenses.
Opportune Breast Cancer Screening and Diagnosis Program
In 2006, breast cancer became the leading cause of death among Mexican women between the age
groups of 50 to 69. The Opportune Breast Cancer Screening and Diagnosis Program (OBCSDP) was
meant to transcend economic and personnel barriers through the innovative deployment of ICTs.
Aimed to reduce the breast cancer mortality rate in women, the program increased the national
screening rates from 7.2% in 2007 to 21.6% by 2012.
The Telemedicine network has a goal to screen 1.3 million women in a 30 month period between May
2010 and December 2012. With over 34 million Mexican pesos (USD 2.8 million) of seed funding from
the federal and state governments as well as not-for-profit groups, 30 screening sites in 11 states were
linked by internet to two interpretation centers where results of the screenings could be viewed by
radiologists.
Due to challenges with internet connectivity in rural areas of Mexico, many Mexican communities lack
the necessary bandwidth for internet protocol-based image transmission (necessary to transmit
mammograms). To overcome this challenge, CDs were used for patient data transfer and long-term
data (backup) storage. (Each carried four patient images (a full mammography) and up to four patient
mammograms). CDs were privately or commercially couriered to the closest interpretation centre.
However, results with this method took up to three weeks to be returned to individuals.
Text to Change
Sponsoring Organization and Partners: Celtel, AIDs Information Centre (AIC), Merck, and the Dutch
Ministry of Foreign Affairs. Text to Change (TTC) program provided HIV/AIDS awareness via SMS based
quiz to 15,000 mobile phone subscribers during three months in Uganda. TTC was founded with the
goal of improving health education through the use of text messaging, which holds the advantages of
anonymity and strong uptake among the population. Partnering with the mobile carrier Celtel and the
local NGO AIDS Information Centre (AIC), TTC conducted a pilot program from February till April 2008 in
the Mbarra region of Uganda, with the objective of increasing public knowledge of and changing
behaviour regarding AIDS. The program aimed to encourage citizens to seek voluntary testing and
counselling for HIV/AIDS. Free airtime was offered to users to encourage participation in the program.
This was determined to be a powerful incentive since users could exchange the airtime with other
subscribers as a type of currency.
The quiz was interactive. When participants gave a wrong answer they received an SMS with the correct
answer from the cell phone provider. The uptake rate of the survey was 17.4%. The quiz focused on two
specific public health areas:
Ÿ General knowledge about HIV transmission, and
Ÿ Benefits of voluntary testing and counselling.
15
Telemedicine Concept
18. Telehealth Report - 2011
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At the end of the quiz, a final SMS was sent to motivate participants to go for voluntary testing and
counselling at the local health centre. Those who went to the centre were asked a final question: Was
this the first time they had an HIV test? After testing, participants were requested to leave their mobile
phone number so that post-test counselling could be arranged. For the people who came to the health
centres through TTC, HIV testing and counselling was free of charge. Initial grants from Merck, the US
pharmaceutical company and the Dutch Ministry of Foreign Affairs supported the program launch.
Bringing critical pediatric care to a rural hospital
Intel announced a comprehensive set of digital inclusion projects aimed at improving education,
healthcare and economic development for Nigeria's 140 million people in 2007. With the support of
the Federal Ministry of Health, Intel launched a pilot Telemedicine project that brings critical pediatric
care to a rural hospital serving a region of 4.5 million people. They are now able to consult in real time
with pediatric and surgical specialists in Abuja through the new Telemedicine system, which features
video conferencing and high-speed broadband connections through Wimax (a long-range wireless
technology). The pilot makes it possible for physicians to shorten both time and distance in getting to
patients to treat them. The system connects one of Nigeria's leading medical institutions, the National
Hospital in Abuja with the Federal Medical Centre in Bida, a rural 200-bed medical facility. Till now,
patients who needed referrals from Bida were forced to travel at least 250 kilometres to reach
specialists, a trip most could not afford. Bida has an acute need for care from pediatric medical
specialists. In the project's first phase, a foetal monitoring capability will permit pediatrician to
remotely and more quickly consult with medical staff and examine expectant mothers to monitor the
progress of their pregnancies. Intel is also training medical practitioners and technical specialists at
both hospitals to use the new technology tool.
Telemedicine Concept
16
19. Telemedicine in India
The healthcare model in India is a three tier system. At the first tier are the primary centres and sub-centres
that provide services at the village level. The secondary level comprises healthcare facilities
located at the district level, which includes district hospitals, private clinics and small nursing homes
with limited equipment and expertise. The third tier or tertiary level healthcare settings are through
medical college hospitals, specialty, and super specialty private chains of hospitals generally located in
urban areas. Besides, there are a few
advanced medical institutes of national
importance, having clinical, teaching and
research facilities in various super specialties.
Primary level includes Primary Healthcare
Centres (PHC’s) and sub-centres at the village
level equipped with a practitioner and
facilities to provide first-aid or basic medical
check-ups. However, many centres lack
qualified practitioners, adequate medical supply, specialty solutions, connectivity and medical beds,
etc. Secondary level includes District level hospitals, small private clinics and nursing homes with small
equipment and facilities limited to providing basic medical diagnosis. However, In India they too lack
specialty treatment facilities, high-end medical equipment and adequate number of beds.
17
Health care model in India
Primary centers and sub-centers that
provide services at the village level
Healthcare facilities located at the district level
including district hospitals, private clinics & small
nursing homes with limited equipment and expertise
Medical college hospitals, specialty, and
super specialty private chains of hospitals
generally located in urban areas
Tier-1
Tier-2
Tier-3
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Chart 4: Public spending as a %
of total healthcare spend, 2007
Tertiary level includes medical colleges, big private chains of hospitals and corporate hospitals situated
in large urban areas. Facilities include high-end medical equipment, well qualified medical staff, etc.
These institutions, however, service a small segment of the vast population of the country.
Despite a steady increase in the number of medical establishments and improvement in India’s
healthcare infrastructure, much remains to be accomplished. There still remains a severe shortage of
sub centres, primary health centres, and community health centres. Lack of adequate healthcare is also
reflected in the low density of healthcare personnel. India does not have a national health insurance
policy or any other national healthcare guarantee program for its citizens. The existing three tier health
care system is highly inadequate in providing quality healthcare services due to India’s increasing
population and the growing demand for healthcare services. Growth in physical infrastructure i.e.,
healthcare facilities and hospitals is not sufficient to meet the current demand.
The poor state of healthcare system in India may also be attributed to the lack of government funding
on healthcare initiatives. As estimates reveal, per capita spending on healthcare by the Indian
Government is far below international recommendations. The healthcare spend, when compared on
the basis of public-private contribution, also depicts a skewed picture. Private sector contribution to
the healthcare at approximately 74% is amongst the highest in the world. Public spending, on the other
hand, is amongst the lowest in the world and is approximately 26% points lower than the global average.
Indian Healthcare Market
The Indian healthcare sector represented a USD 40
billion industry in 2009. Hospitals accounted for
approximately 50% of the market, pharma contributed
25%,diagnostics with 10%, and medical equipment
accounted for roughly 15%. The industry is expected to
grow to USD 79 billion by 2012 and USD 280 billion by
2020 at a CAGR of 21.5%.
The Healthcare sector, in India, is at an inflection point and is poised for a healthy growth in the medium
term. Healthcare spending is expected to grow to 8% of the GDP in 2012.
A combination of demographic and economic factors is expected to bring increased healthcare
coverage in India which is expected to drive the growth of the sector. India‘s rising population and
income levels, along with a growing preference for private health services over public services, is
augmenting the growth of the healthcare delivery market. Population growth and increased disposable
income are expected to result in better healthcare awareness and more expenditure on healthcare.
Telemedicine in India
Indian healthcare
spend as a % of GDP is
less than half the
global average
Chart 3: Healthcare spending
as a % of GDP, 2007
%
20
15
10
5
0
US Brazil UK China India Global
Per Capita spending as
compared to other
Countries is also very
low in India
Chart 5: Per Capita Healthcare
spending, 2007
USD
8,000
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0
US UK Brazil China India Global
Public healthcare
spending in India is again
half the global average,
amongst the lowest in
the world
%
100
80
60
40
20
0
US Brazil UK China India Global
Chart 6: Healthcare industry in India
%
300
250
200
150
100
50
0
CAGR 21.5% (2010-2020 )
2010 A 2012 E 2020 E
21. Telehealth Report - 2011
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Healthcare expenditure (public and private) in India is expected to increase by 15%. India has the
potential to add nearly 1.74 million beds by 2025 with an investment of about USD 104 billion to fulfil
the unmet needs. The demand for quality healthcare in India is burgeoning and there exists a huge
supply gap. An additional 1.74 million beds are needed to achieve the target of two beds per 1,000
populations by 2025. An additional 700,000 doctors will be required by 2025 to reach a ratio of one
medical doctor per 1,000 individuals. To maintain the current doctor-to-nurse ratio of 2.2, an additional
1,600,000 nurses will have to be trained by 2025.
Population of India is expected to increase from about 1.21 billion in 2010-2011 to 1.4 billion by 2026. In
addition, an expected increase of geriatric population from current 96 million to around 168 million by
2026 represents a huge patient base and creates a market for preventive, curative and geriatric care
opportunities.
Households can benefit from an increase in disposable income from 14% in 2009-2010 to 26% in 2014-
2015 making healthcare more affordable. There is likely to be a marked increase in the incidence of
lifestyle-related diseases, such as cardiovascular, oncology and diabetes, when compared to the
communicable and infectious diseases. Growing general awareness, patient preferences and better
utilization of institutionalized care is expected as a result of increase in literacy rates. Lower direct taxes,
higher depreciation on medical equipment, income tax exemption for five years to hospitals in rural
areas, etc. are being provided by the Government to the sector to boost it. India is also emerging as a
major medical tourist destination with medical tourism market expected to reach USD 2 billion by 2012.
Telemedicine – Promising Future
Telemedicine can embrace modern technology to widen healthcare accessibility in rural India and
can be a solution for India’s healthcare woes. A vast country like India, with a population of over 1.2
billion across 29 states and 6 Union Territories and governed by a federal system, needs affordable
healthcare.
“It is a fact that has not been accepted by policy makers that it is nearly
impossible under the current rural infrastructure and payment terms to
get good doctors to work in rural India. In addition, building healthcare
facilities and maintaining them in rural India is financially unviable. So the
current healthcare system will always be an ad hoc arrangement and a
highly subsidized one while not being a lasting solution. Rural India needs
to extensively leverage the 3G and WIMAX technology and adopt
preventive care model to avoid pain, suffering and high cost of
healthcare”
Rajendra Pratap Gupta, Leading Global Healthcare Policy expert
Telemedicine today has given the ability to the doctors to provide healthcare to the needy. It is taking
modern healthcare to remote areas. Majority of diseases not requiring surgery are conducive to
Telemedicine. It allows training of medical personnel across the country to provide services to the
patients in remote areas. Over the last five years; both price and complexity of this technology has
decreased making Telemedicine economically viable. Telemedicine, as a branch of diagnosis and
treatment, should be encouraged and widely implemented to help ensure availability and accessibility
of care to all areas in spite of infrastructural inefficiencies.
19
Telemedicine in India
22. 20
Telemedicine is the convergence of communication technology,
information technology, biomedical engineering and medical
science.
In India, early forms of Telemedicine used telephone and radio
followed by communication through fiber optic cables. Lately,
Telemedicine has evolved to utilizing video telephony, advanced
diagnostic methods supported by distributed client/server
applications, and telemedical devices to support medical care at
homes. This evolution in Telemedicine is through satellite
communication developing from ‘Point to Point System’ (one
remote location connected to one main location) to ‘Point to Multi
Point System’ (one remote location at a time connected to many
main locations), and finally to ‘Multi Point to Multi Point System’
(several remote locations simultaneously connected to main
locations in different geographical locations).
Chart 7: Pillars of Telemedicine
Video Conferencing
District Hospital
Telemedicine
Specialty Hospital
Panel of Doctors
Chart 8: Representative Telemedicine structure
Remote Location
Ÿ Regional/secondary care hospitals
Ÿ Rural health care services
Ÿ Primary care
Ÿ Consultation and diagnosis
Ÿ Patient education and follow-up
Ÿ Professional education
Ÿ Continuing medical education
Ÿ Administrative services
Main Location
Ÿ Regional/tertiary care hospital
Ÿ Consultation
Ÿ Screening and diagnosis
Ÿ Monitoring
Ÿ procedure guidance
Ÿ Patient education & follow-up
Ÿ Professional education
Ÿ Continuing medical education
Ÿ Administrative services
Telehealth Report - 2011
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Telemedicine in India
Medical
Science
Communication
Technology
Biomedical
Engineering
Information
Technology
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The Telemedicine system comprises of customized hardware and software at the “Patient” site and the
“Specialist doctor” site, with diagnostic equipment like ECG, X-ray, Pathology, Microscope/Camera, etc.
provided at the patient end. They are connected through a Very Small Aperture Terminal (VSAT), WIFI,
and Broadband, controlled by a Network Hub Station. Through a Telemedicine system that consists of a
simple computer with communication systems, the medical images and other information pertaining
to the patients can be sent to the specialist doctors, either in advance or on a real time basis through the
satellite link in the form of Digital Data Packets. These packets are received at the specialist centre, the
images and other information are reconstructed so that the specialist doctor can study the data,
perform diagnosis, interact with the patient and suggest the appropriate treatment during a Video
Conference with the patient end. Telemedicine facility thus enables the specialist doctor and the
patient, separated by a distance, to interact visually and talk to each other.
Major components of Telemedicine include :
Ÿ Telemedicine workstation
Ÿ Document and radiographic film digitizer
Ÿ Ultrasound device, ECG, MRI, Scanner, X-Ray
Ÿ Processing unit and keyboard
Ÿ Audio Module – speakers, headphones, volume and base control
Ÿ Camera - lens, image sensor, pixels, resolution, illumination range, video output signal,
power zoom
Ÿ Microphone
Ÿ Monitor – resolution, speakers, signal type, dot pitch
Ÿ Central power switch, power requirements
Ÿ Communication platform allowing compatibility with networks (WAN) – SW-56, ATM, ISDN,
satellites, and networks (LAN) - Ethernet
Ÿ Connector panel – LAN, WAN, phone network, audio and video input and output ports,
radiographic film digitizer, CD-ROM, etc.
Ÿ Telemedicine peripheral devices – Otoscope, Dermatoscope, Stethoscope, Ophthalmoscope, etc.
Ÿ Telecommunication network architecture
Ÿ Plain Old Telephone System (POTS) - Analog telephone lines
Ÿ Dial-up digital telephone lines - Integrated Service Digital Networks (ISDN) and Switched-56
(SW-56)
Ÿ Asynchronous Transfer Mode (ATM)
Ÿ Satellite – Geo-synchronous and Low Earth Orbit (LEO)
Ÿ Microwave
Ÿ Coaxial Cable, Fibre Optics
Ÿ Asymmetric Digital Subscriber Line (ADSL)
Ÿ Various Digital Subscriber Line (xDSL)
Ÿ Internet or Modem
Ÿ Virtual Private Networks
Ÿ Hospital and Regional Health Networks
Ÿ Software Architecture
Ÿ Human intervention
Ÿ Physicians – General practitioners, specialists and medical students, etc.
Ÿ Nurses – Registered Nurses (RN), Licensed Practical Nurses (LPN) and nursing students
Ÿ Allied Health Professionals – occupational therapists, physiotherapists, etc.
Ÿ Health Administrators, Educators and Researchers
Ÿ Technicians
Ÿ Patients and their families, informal care givers
Ÿ Telehealth project Managers and site coordinators.
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Telemedicine in India
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mHealth
mHealth, also known as Mobile health, leverages mobile devices and ICT to deliver health services and
information exchange which can increase access, affordability, and quality of healthcare significantly.
Telemedicine in India
Today’s Technology Tomorrow’s Technology
Hardware
Ÿ Features suitable for basic
mHealth services available on
mobile phones
Ÿ Mobiles can access web,
download pictures, etc.
Ÿ Internet speeds limit the
number of applications which
can be used
Ÿ Most laptops, handhelds, PDAs
easily access wireless networks
where available
Ÿ Cell phones and mobile
computers become less discrete
Ÿ Larger displays and Solar
chargers for mobiles
Software and applications
Ÿ Widely available for laptop and
handhelds
Ÿ Availability of handsets with
open architecture.
Ÿ Open source software
accelerate application
development and reduce cost
Network access
Ÿ Cellular usage common in urban
areas compared to rural areas
Ÿ Broadband, internet access is
limited in several geographies
and also costly
Ÿ Network transparency
Ÿ Wireless networks create almost
universal Internet access
Standards
Ÿ Policies and standards required
for Broadband
Ÿ Allowance of greater range of
services, provider
Ÿ Partnerships
Services
Ÿ Education/awareness programs
Ÿ Medication monitoring
Ÿ Data collection services
Ÿ Disease tracking
Ÿ Remote monitoring
Ÿ More sophisticated
diagnoses/consultations, e.g.,
Teleradiology, teleopthamology.
Ÿ More effective use of healthcare
workers
Ÿ More ‘personal’ mHealth
services
Ÿ Services for travel-restricted
Chart 9: Mobile technology evolution
Technology
advancement
WIMAX availability for
Pcs
Open source systems
Greater bandwidth
IP access for standards and
decisions over licensesI
Better services offerings
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It involves the use and capitalization of a mobile phone’s core utility of voice and short messaging
service (SMS), as well as more complex functionalities and applications including general packet radio
service (GPRS), third and fourth generation mobile telecommunications (3G and 4G systems), global
positioning system (GPS) and Bluetooth technology.
As 3G swings in India with over 900 million mobile phone connections and Android phones become
increasingly available, the opportunity for high value mobile enabled services is tremendous. Two
industries that have already tapped into the ubiquity of mobile phones in a big way are entertainment
and financial services, with applications ranging from music downloads to banking that are attracting
swaths of users and investments. But mHealth has only scratched the surface in India largely because
there is a lack of awareness among patients and doctors about what mHealth is and what benefit it can
provide.
23
Table 2: mHealth – A win-win for all
Ÿ Improved treatment, education, and illness
prevention
Ÿ Improved operational efficiencies, improved
quality, and effectiveness of healthcare
Ÿ More effective delivery of healthcare
services
Ÿ Improved operational efficiencies
Ÿ Organizational mission closely ties to
program success
Ÿ Expansion or scale of program
Ÿ Revenue from hardware sales
Ÿ Strategic market positioning for short and
long term brand and business development
Ÿ Revenue from training or supporting
contracts
Ÿ Opportunities for placement in network
expansion projects
Ÿ Revenue from service fees through increased
subscribers
Ÿ Revenue from handset device sales
Ÿ Expanded mobile subscriber base for
increased revenue from other services
Ÿ Revenue from application license fees
Ÿ Revenue from application customization fees
Ÿ Revenue from training contracts, hardware
support system
Ÿ Opportunity to become a standard in
mHealth
Ÿ Potential for add-on sales as program scales
Patient: Recipient of healthcare service
Caregiver: Delivering healthcare services like
physicians, nurses, midwives, healthcare
workers
Project management: The entity responsible for
direct management of the project including
business and programmatic, like a government
agency or independent organization
Equipment provider: Generally the
manufacturer of any hardware relative to the
services including customer devices or network
devices. May also provide training, support to
operator or health care practitioner.
Service provider: The mobile telephony
operator
Application Solutions provider: The entity
providing mHealth application, either as a
standalone software application or an integrated
application
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Telemedicine in India
Table 3: Overview of mHealth use case findings across the Healthcare Continuum
ŸAccessibility of patient data; reduction in
procedures and tests; fewer medical errors
ŸImproved patient access to physicians;
increased billable hours
ŸLower administrative costs; faster service
ŸImproved supply chain efficiency/accuracy;
increased productivity; lower risk of
compliance breaches
ŸAccurate and timely feedback to patients;
ease of coordinating remote providers;
streamlined consultations
ŸRegular patient monitoring; increased
productivity; reduced travel time
ŸReal-time updates of patient data; ability to
offer “untethered” care outside of traditional
settings
ŸEase of locating specialists and services in
network; lower costs with drug cost-comparison
shopping; increased consumer
usage of plan benefits; better management of
medical expense accounts
ŸIncreased accuracy and lower costs;
compliance-certified apps meet regulatory
requirements
ŸCommunity-based retail stores use mobility to
improve ACO care coordination
ŸReal-time access to data to advise doctors and
patients on drug therapies and associated
risks
ŸEnables pharmacists to interact with patients
“in the aisles” with access to real-time patient
data
ŸMore efficient and accurate order processing;
improved compliance in sample distribution;
digital signature capture
ŸAbility to identify and catalog worldwide
epidemiologic trends
ŸInteractive apps to identify appropriate care
providers
ŸAccurate and timely feedback of health data;
rapid throughput of test results to providers
ŸImproved care/lower costs through home
healthcare
ŸGreater emphasis on patient-centered care;
reduced isolation of convalescing patients
ŸIncreased knowledge of cost/benefit trade-offs
ŸElectronic Health Records,
Health Information Exchange
ŸTelehealth/remote care
ŸPatient self-registration using
tablets
ŸBar code scanning
ŸElectronic Health Records,
Health Information Exchange
ŸTelehealth/remote care
ŸPeripheral devices integrated
into mHealth solutions
ŸConsumer self-help apps
ŸMobile apps replace paper-based
forms; bar code
scanning
ŸDrug reference and drug
interaction apps
ŸMobile access to back-office
ŸMobile CRM apps for
“detail” sales representatives
ŸElectronic Health Records,
Health Information Exchange
ŸSymptom checker
ŸApps with integrated
peripheral devices
ŸTelehealth/remote care
ŸSocial engagement-based
solutions
Hospitals
Doctors, Nurses
Insurance
Companies
Suppliers
Pharmacies
Drug and Medical
Supply CRM
Federal Agencies
Consumers
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A February 2011 report authored by Pyramid Research found that more than 200 million mobile health
applications are used by doctors and patients today, and more than 600 million medical apps will be
available by 2012. (Source: Pyramid Research)
According to a February 2011 study by Aptilon, 79 percent of physicians prefer the iPad, compared with
12 percent of doctors who prefer a Windows-based tablet and nine percent who prefer an Android
device.
An InfoWorld article published in May 2011 cites a study by RNCOS. The study estimates healthcare IT
spending in the United States is expected to reach $40 billion in 2011. Of that, the mobile health market
is estimated to be 5.3 percent of total healthcare IT spending.
Projections indicate that over one third of all smartphone holders worldwide or 1.4 billion people
globally, will be using mHealth solutions within the next five years, according to research2guidance.
Through informal polling, Epocrates estimates up to 70 percent of medical schools are having a mobile
device requirement or recommendation for medical students. The average physician can re-purpose
130 administrative hours each year by using a mHealth solution.
According to Galvin Consulting, August 2011, many healthcare professionals are looking to new
mobility technologies as a way to solve some of the industry’s most pressing problems. These thought
leaders believe society is on the cusp of dynamic change in the way healthcare is both provided and
consumed. Mobility in the general workforce is expected to increase at an unprecedented rate in the
coming years, both in the United States and other countries, including India.
In developing countries such as India, mHealth shows special promise in specific mHealth applications,
including:
Ÿ Widespread care through telemedicine and “virtual hospitals”.
Ÿ Improved medical data processing as a result of direct data input into mobile devices.
Ÿ Improved patient care as physicians interact directly within local communities.
Ÿ Early warnings of shifting health trends, including emerging and infectious diseases, as large
amounts of data from mobile devices are collected and analyzed.
Ÿ Improved disaster response efforts for earthquakes, floods and other disasters as first responders
use mobile devices to identify areas most in need of assistance.
Over and above these benefits are improved accuracy throughout the healthcare system and earlier
detection of medical issues that help to prevent expensive and serious complications later.
Current state of Telemedicine in India
Telemedicine practice was first initiated in Lucknow and Chennai in 1997. In Kerala, first unit of
Telemedicine was formed at the Medical College, Thiruvananthapuram in 2003. Recognizing the
common interest of health and community welfare, Telemedicine was promoted for the availability of
quality medical services to the needy, irrespective of socio economic and geographic disparities like
rural, remote, and inaccessible places.
During the National Conference on Telemedicine held in Lucknow in April 2001, the participants
resolved to form a scientific society dedicated to Telemedicine at national level and carry out an annual
scientific event pending a formal registration. Thus the Telemedicine Society of India (TSI) was born and
all the participants signed a resolution to this effect and were made the founding members. It has been
a long journey for the TSI. Although the efforts had started from 1996, yet it took time to reach this
position. Having survived infancy, it is now coming of age. In all developing countries, there is an acute
shortage of resources in the health care sector. In emerging economies like India, there has been an
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Telemedicine in India
28. exponential and an unprecedented increase in the availability of Information and Communication
Technology. ICT has provided a unique opportunity of bridging the urban rural health divide. For
Telehealth to take off, it had to be embraced by all the stakeholders; the Government, private sector,
public sector, entrepreneurs, etc.
The first TSI meeting was held in Lucknow in 2001. Its focus was on rural medicine. Initial support from
ISRO played a very vital role in the growth of Telemedicine in India. The official TSI meet took place in
Bangalore in 2005 when the smooth life of TSI began. Then the annual successive meets took place in
Delhi (2006), Chennai (2007), Chandigarh (2008), Pune (2009), Bhubaneshwar (2010), and Mumbai
(2011). The first TSI chapter was started in 2010 in Bhubaneswar. Over a period of time, TSI has
extended their services to Indian army. They set up Telemedicine units initially in the southern
command and subsequently in the central command. Training programs were organized exclusively for
officers. They have also pioneered in partnerships with Uganda, Mauritius, Nigeria, the Netherlands,
etc. As of now, TSI has provided teleconsultations in various specialties to 29 countries in Africa, and
also initiated teleconferences with many countries including Japan, US, Saudi Arabia and Hong Kong.
India is beginning to make strides in the areas of Telemedicine and eHealth. Most of the Telemedicine
activities are in project mode, supported by the ISRO and the Department of Information Technology
and being implemented through state governments. A few corporate hospitals have developed their
own Telemedicine networks, prominent among them being the Apollo Telemedicine Networking
Foundation, which commenced Telemedicine operations as early as January 2000. Around 500
Telemedicine nodes are in place across the country.
Telemedicine has a market size of USD 70 – 110 million in India. It is expected to grow at very high CAGR
of approximately 35% over the next five years to reach USD 314 – 493 million by 2016. The full potential
of the Telemedicine market could be realized with appropriate stakeholder vision and better adoption.
Key growth drivers are:
Ÿ Low cost and wide reach over satellite or fiber optic bandwidth
Ÿ Lack of disease management framework
Ÿ Lack of healthcare facilities in far-off regions
Ÿ Reduced technology cost and availability of qualified technical personnel
Ÿ Shortage of qualified medical professionals
Ÿ Increased government focus on healthcare for all
Ÿ Urban-rural divide causing disparity in medical facilities
Ÿ Dedicated satellite for health communications from ISRO
Ÿ Growth of Information and Communications Technology as a sector
Ÿ National Telemedicine grid to connect practitioners and institutions
Ÿ PPP model for development of healthcare infrastructure
The key growth driver for Telemedicine is India is its technologically advanced ICT sector which is self-sufficient
in meeting its needs of hardware, software, connectivity and services. Therefore, ICT
technologies have the potential of making healthcare affordable for India, especially in rural India. This
success can be further reinforced if these ICT technologies are integrated into existing health-care
delivery systems. In the last decade, there has been active investment for development of Telemedicine
in India, but considering the demographic spread, this investment is not sufficient for such a large
country. The scale of Telemedicine services in India has been limited so far to medical transcription,
health awareness through portals, Telemedicine and hospital management system and customer
service using the internet. While globally and particularly in Africa, advanced technologies such as 3G
services are used efficiently for providing healthcare solutions to remote villages, the use of
communication devices such as mobile phones or conferencing solutions for Telemedicine in India has
been limited.
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“In the next 3-5 years, I can well foresee a fight between Tablets & Smart-
Phones, a fight between Windows, Apple & Android rather than a fight
between a user and non-user of mHealth.”
Rajendra Pratap Gupta,
Leading Healthcare Policy Expert
“mHealth is more relevant in India than conventional eHealth, as access
to PCs, laptops and broadband is far less than access to mobile phones.
India has just 12 million broadband connections, 24 million internet
subscribers and 85 million PCs as compared to 881 million mobile
phones.”
Prof. K. Ganapathy,
President of Telemedicine Society of India and President of Apollo Telemedicine Foundation
Utilizing wireless to access the internet is steadily increasing and telecom operators in India see this
as a growth segment. One would not like to call mHealth a killer application, but considering that
health is a truly universal requirement, this would perhaps be an apt description. The ubiquitous all-pervading
universally available mobile phone can now be used as a tool, and an enabler to deliver
healthcare. There are unlimited opportunities and strategies for using the mobile in implementing
mHealth in hospitals, insurance companies, Pharma companies, etc. With thousands of health
applications, the mobile phone can soon become a hand held hospital.
According to Dr. P S Ramkumar, Director of Applied Cognition Systems, “Practical mHealth will take time,
although the concept is easy to sell due to large scale user familiarity with mobile phones. Although
mobile communication has equipped the country with approximately 881 million phones, a recent
survey has found that, of 30 Tele-Health projects only two had intersect with mobile phones while 60%
used free satellite connections provided by government initiatives. The RTBI group of IITM in
collaboration with LIRNEasia, Sri Lanka, National Centre for Biological Sciences, Bangalore and
Department of Health and Family Welfare, Tamil Nadu, have demonstrated adoption of ordinary text
based cell phones by rural health workers showing improvement in disease surveillance and response
time. Apollo Telemedicine network foundation has demonstrated Telemedicine application on mobile
platforms on 3G networks in collaboration with Ericsson’s Gram-Jyothi program demonstrating Tele-presentation
of radiology images, ECG, etc.
“It is not possible for
everyone to own a
computer or to use a
computer for health,
but smart phones
comes in handy, and
so, for sure, all
aspects of healthcare
will finally converge
to mHealth”
Rajendra Pratap Gupta,
Leading Healthcare Policy Expert
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Telemedicine in India
Growth of Health Apps by Platform over six month period
Platform
Total Apps as
of 2/2010
New Apps
launched:
/2010 –
9/2010
Total Apps as
of 9/2010 Growth
Apple
AppStore
Health Apps
4,276 2,860 7,136 66.6%
Google
Android
Health Apps
505 791 1,296 156.6%
Blackberry
App World
Health Apps
140 198 338 141.4%
30. However, the system lacks legal clarity on the question of who is accountable for delayed data,
inaccurate transmission and privacy/security loss of the data”
A truly different way of patient empowerment, mHealth can bridge the urban rural health divide. With
50 mobile phones being sold every second, with an urban teledensity of 113% and a rural teledensity of
49%, India should certainly be poised to incorporate mHealth into the very fabric of its healthcare
delivery system.
Key stakeholders driving Telemedicine
Tele medicine as a concept has multiple areas of application which are not only based on advantages
key to the medical field but also help in the business end by accessing more people and reducing costs
for all parties involved. This has led the various possible stakeholders in India to actively implement and
promote Telemedicine. A key part of Telemedicine, m-Health or mobile driven health services is
receiving the most amount of attention. This is fuelled by India’s unique mobile service cost structure
combined with the huge disparate population and low cost of mobile handsets. The major stake
holders in the progress of Telemedicine can be broadly classified under three categories :
1. Government and Government Bodies
This includes organizations that facilitate growth of Telemedicine through policy initiatives, and
financial backing. It consists of organizations such as the Ministry of Health and Family Affairs, the
Department of Information Technology, Ministry of Communication and IT and the various state
governments. In India, various departments have been proactive in launching initiatives and partnering
with various other organizations to promote Telemedicine.
Ÿ Ministry of Health and Family Welfare (MoHFW), Government of India
There is a very structured and planned approach toward Telemedicine in India. This is evident from the
setup of the National Task Force on Telemedicine under the chairmanship of Secretary, Union Ministry
of Health and Family Welfare, incorporating members from various concerned ministries of the union
government e.g. Health, Communication & Information Technology and Space; technical agencies e.g.
Indian Space Research Organization, Indian Council of Medical Research, Medical Council of India,
Centre for Development of Advanced Computing; academic medical institutions and corporate
hospitals practicing Telemedicine actively.
Ÿ State Governments
A large number of state governments have shown positive support for the development and inclusion
of telemedical facilities in their state. In Odisha and Uttarakhand, the secondary-level hospitals have
now been linked to SGPGIMS at Lucknow for specialty consultation with the support of the
governments. ISRO together with the government of Chhattisgarh has established a state-wide
network linking the state government medical colleges at Raipur and Bilaspur and other premier
hospitals across the country. Similarly, the Rajasthan state government has established a Telemedicine
network between six state medical colleges and 32 district hospitals and six mobile vans with ISRO’s aid.
The Karnataka State Telemedicine Network Project, run by an autonomous trust formed by the state
government, has set up 30 nodes in collaboration with ISRO. The Punjab go vernment has also
launched a Telemedicine project, with state-of-the-art facilities at the Government Medical College
and Hospital to link the five polyclinics set up in the state. Many state governments, along with the
department of IT, have started establishing Telemedicine networks with state specialty hospitals
connected with different district and smaller health centres. Some of them are the governments of
Tripura, West Bengal, Himachal Pradesh, Punjab, Tamil Nadu and Kerala.
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Ÿ Ministry of External Affairs Projects
The progress in Telemedicine is not restricted within domestic networking and resource pooling. The
ministry of External affairs has initiated a SAARC Telemedicine Network project that connects one or
two hospitals in each of the SAARC countries with three to four super-specialty hospitals in India. The
super specialty hospitals in India include AIIMS, SGPGIMS, PGIMER at Chandigarh and the CARE
Hospital at Hyderabad.
2.Technology Providers
By collaborating with state governments the Department of Information Technology (DIT) and
Ministry of Communication and IT (MCIT), has established a Telemedicine network of more than
100 nodes all over India. The medical network includes:
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ŸWest Bengal for diagnosis and monitoring of tropical diseases.
Ÿ Kerala and Tamil Nadu Oncology Network for facilitating cancer care.
Ÿ North-eastern and Himachal Pradesh hilly states for specialty health care access.
Another initiative of the ministry, the Pan-African eNetwork Project, along with Telecommunications
Consultants India Ltd. (TCIL) is that of setting up a VSAT-based Telemedicine and tele-education
infrastructure for African countries in 53 nations of the African Union.
Ÿ Various technology providers
This group includes the various companies such as Ericsson, Texas Instruments, CISCO Systems, C-DAC,
Sony which provide specialized hardware and software solutions aimed at innovative telemedical
services. The category also includes the various stakeholders which provide the sustaining
infrastructure and connectivity support. In India some of the players so far have been ISRO, Aircel, Airtel
and IBM. The contribution of these stake holders has been in terms of forging relationships that prove
to be socio-economically beneficial to the country. With innovation in services and improved
efficiencies in communication and support tech, these groups of stakeholders hold the key to the long
term growth and commitment to Telemedicine in India.
Ÿ Indian Space Research Organization (ISRO)
ISRO’s pilot Telemedicine project was launched in 2001 with the aim of introducing the Telemedicine
facility to the grassroots level population as a part of “proof of concept technology demonstration”
program. The Telemedicine facility connects the remote District hospitals/health Centres with super
specialty hospitals in cities, through the INSAT Satellites for providing expert consultation to the needy
and underserved population.
Telemedicine facilities are established at many remote rural district hospitals in many states and union
territories of the country including Jammu & Kashmir, Andaman & Nicobar Islands, Lakshadweep
Islands, and North Eastern States, etc. State level Telemedicine networks are established in Karnataka,
Kerala, Rajasthan, Maharashtra, Odisha and Chhattisgarh. Many interior districts in Odisha, Madhya
Pradesh, Andhra Pradesh, Punjab, West Bengal and Gujarat have the Telemedicine facility.
Presently, ISRO’s Telemedicine Network has enabled 382 Hospitals with the Telemedicine facility. 306
among them are remote/rural/district hospital/health centres and 16 are mobile Telemedicine units,
connected to 60 Super Specialty Hospitals located in the major cities. The mobile vans are extensively
used for tele-ophthalmology, diabetic screening, mammography, childcare and community health. The
Mobile Teleopthalmology facilities provide services to the rural population in ophthalmology care
including village level eye camps and vision screening for cataract /glaucoma / diabetic retinopathy.
About 150 thousand patients are getting the benefits of Telemedicine every year.
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Ÿ The Centre for Development of Advanced Computing (C-DAC)
C-DAC has been working in the area of Health Informatics since early 90s. It has developed several
solutions till date in this area. Notably CDAC developed and deployed the first indigenously developed
total hospital information system (HIS) software in collaboration with the Sanjay Gandhi Post Graduate
Institute of Medical Sciences (SGPGIMS) at Lucknow in 1998.
Currently, there are more than 16 hardware and software Telemedicine activities undertaken by C-DAC.
3. Hospitals and Bio-medical Institutions
The core part of Telemedicine, be it e-health, mHealth or medical research is the medicine. This is
driven by the innovation and standards set by the medical fraternity. Innovation in terms of pioneering
mobility in medical instrument, spreading awareness of the benefits, reliability and correct use of tele
medical techniques are just a few critical roles taken on by organisations under this stake holder
category. In India, hospitals and institutes across varied locations and sizes of operation are continuing
to be a part of many initiatives. The most notable contributions have been seen from the Apollo Group
and SPGIMS. Other significant participants and premier medical institutions include All-India Institute
of Medical Sciences (AIIMS), New Delhi (Jammu & Kashmir, Haryana, Odisha, North East states
network), PGIMER12, Chandigarh (Punjab and Himachal state network),Sri Ramachandra Medical
College and Research Institute (Andaman & Nicobar Islands), Tata Memorial Hospital and Sir Ganga
Ram Hospital, New Delhi, The Amrita Institute of Medical Sciences (AIMS), The Asia Heart Foundation,
Fortis Hospital, Narayana Hrudayalaya, and Escorts Heart Institute and Research Centre .
Ÿ The Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS)
SGPGIMS, since its inception, has been actively involved in promoting Telemedicine. It has helped in
networking 14 national and international partner nodes and in carrying out tele-education and tele-healthcare
activities. It is also actively involved in various research and development activities in
collaboration with its technical partners. The institute is also credited with establishing the School of
Telemedicine and Biomedical Informatics to train workers in this upcoming field.
Ÿ Apollo Hospitals
Amongst the latest initiatives, Apollo hospitals is planning to open 1,000 Telemedicine centres in the
next three years (2011-14, 1000 days) and is also actively involved in various other eHealth activities,
having done over 69,000 tele consultations till date. Apollo Hospitals along with Aircel, has also
launched the first Telehealthcare delivery on the mobile for consumers in India. In the past, Ericsson
and Apollo had collaborated for a three-month Gramjyoti project, aimed at exploring benefits that can
be met for rural India with the advent of internet connectivity and bridging the digital divide. Gramjyoti
covered around 18 villages and 15 towns.
In September 2010, Apollo Hospitals joined hands with pan-India telecom operator Aircel, to launch
the first telehealthcare delivery on the mobile for consumers in India. With a subscriber base of more
than 45 million, Aircel is India’s fifth largest service provider, making it an ideal partner for Apollo to
launch a mobile healthcare initiative, initially via two dynamic products – Tele Medicine and Tele Triage.
Role of Telemedicine Society of India in promoting Telemedicine
TSI promotes and encourages development, advancement and research in the science of Telemedicine
and its associated fields. It has constantly played a major role in boosting the application of
Telemedicine technology in clinical care, education and research in the health sector. TSI fosters
networking and collaboration among interest groups in Telemedicine technology and professionals
from different streams of science, health care providers, policy makers, NGOs and industry.
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It promotes training of students, health professional, research fellows and technicians, in various
aspects of Telemedicine. TSI coordinates with academic institutions and Medical Council of India,
AICTE, DOECC and regulating agencies in developing curriculum for Telemedicine training courses and
incorporates appropriate modules in the Medical, Dental and Paramedical training programs. TSI has
been arranging regular scientific meetings, symposia, seminars and workshops for Telemedicine. It is
heading the development of appropriate clinical and industry policies and standards. TSI spreads
knowledge in Telemedicine field by publishing brochures, periodicals, journals and has also created an
exclusive web site for the society and regularly updates it with Telemedicine news. TSI works in close
collaboration with scientific organizations and the industry in development and implementation of
innovative products & services related to Telehealth. TSI also organizes trade exhibitions during annual
meetings of the society.
Public Private Partnership (PPP)
An example of a Telemedicine public-private partnership is the collaboration of Narayana Hrudayalaya
with the government and ISRO at Chamarajanagar District Hospital (Govt. owned), which is 185 km
away from the super specialty cardiac care hospital situated in Bangalore, Karnataka. The network
helps provide remote cardiac care to the local population of Chamarajanagar. According to Dr. Devi
Prasad Shetty, Chairman, Narayana Hrudayalaya, the unit has treated about 52,000 patients since its
inception in 2002.
An impact study by an independent evaluating agency on 1,000 patients at the district hospital has
reported that the patients who availed Telemedicine consultations spent only 19% of the cost they
would have spent if there was a need for them to travel to the nearest city for similar treatment.
The Tripura Vision Centre Project is a novel and innovative project in delivering preventive and primary
eye care services to remote and underserved areas of Tripura, in North East India. Established in April
2007, the project was designed by IL&FS-ETS, a social infrastructure initiative, in collaboration with
Aravind Eye care system, for the State Department of Health. Services are rendered through 40 vision
care systems (VC), staffed with trained paramedical ophthalmic assistants. Situated in the premises of
Community Information Centre (CICs), the VC can leverage the Tripura State Wide Area Network
(TSWAN) and existing infrastructure to connect to the base hospital, IndiraGandhi Memorial (IGM)
Hospital, situated in the state capital of Agartala. Here, outpatient department ophthalmologists
provide remote consultations through video conferencing and application modules. Preliminary
treatment options like prescriptions and spectacles are provided online. Only those requiring special
care like surgeries or complicated interventions are required to visit the hospital, thus keeping a check
on the logistics and expenditure.
Since its inception, the project has now expanded to 35 centres, having screened 71,000 patients till
August 2010, among whom approximately 5,000 were referred to the base hospital. It has been
estimated that each VC screens around 100 patients per month, thereby having a large impact on the
healthcare delivery. The project was recognized by the Government of India and received the National
e-Governance Award in 2009.
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