Telemedicine can make healthcare available, accesible and affordable. This presentation addresses some of the myths around Telemedicne in India and discusses why Tele-followup as an achievable paradigm.

1. MYTHS
&
STUDIES
Dr RK Pathni
rpathni@gmail.com

2. The uses of Telemedicine
are limited
only by
our imagination.
*Pathni RK. Telemedicine in emergency medical care. Indo-US Emergency Medicine
Summit. 2005

6. http://www.informationweek.com/mobile/10-medical-robots-that-could-change-healthcare/d/d-id/1107696?
Whereas the world is moving …

7.  < 1Dr / 1700
population
 28 mn babies born
every year
 Only ~40 Paed
Cardiologists in the
entire country
 India is the Diabetes
capital of the world –
more renal / cardio
problems
 Indians are 3 times more
vulnerable to heart attack
than Europeans
<80 Cardiologists / year
<60 Nephrologists /year
Where are the specialist to treat this huge
case load?

9. “Healthcare should be
available
affordable
accessible
&
acceptable”

10. “The two monsters of rural communities
are time and distance. Spending money to
conquer either is simply making an
investment in our children.”
-Dr. John Hall

11.  Telemedicine helped in saving about 81% of
treatment costs for patients (ISRO).
 Upto 90% financial and man work-hours savings*
 Level of satisfaction withTele-follow-up ranged
from very good to excellent.*
* Mishra A, Pradeep PV, Kapoor L, Basnet R, Satpathy C, Mishra SK. Tele follow-up of thyroidectomy
and parathyroidectomy patients: preliminary experience.

13. • We need PHC, not fancyTM
Need
• Indian public is traditional
Acceptability
• Indian doctors are traditional
Acceptability
• We can’t do such hi-tech things
Ability
• What we have is no good
Availability

14.  95% doctors use telephone, e-mail, letters frequently.
 Faculty in higher age group were found to be more likely
to have used telemedicine (p<0.05)
 Most users expressed apprehensions regarding physical
examinations through TM.
 Surgical disciplines were found to be more likely to use
telemedicine.
* Pathni RK, Satpathy S, Chaubey PC, Kailash S. Patterns of Practice Of TM at AIIMS. JAHA.

15.  Acceptable
 Very beneficial
 Usage increased during the study period with 96%
users wishing to continue the service
* Bali S, Singh AJ. Mobile phone consultation for community healthcare in rural north India. J
Telemed Telecare 2007; 13: 421-24

16.  “The necessary infrastructure in the form of satellite or
broadband connectivity is already in place in the
country.
 Telemedicine in India is generally seen as
technologically on a par with the developed
countries.
 Internationally, the Indian Telemedicine pilot projects are
also largely being viewed as successful.”
Solberg KE. Telemedicine set to grow in India over the next 5 years. Lancet. 2008 Jan; 371:17-18

17. *Pathni RK, Satpathy S, Kailash S. Need for tele-follow-up. J Telemed & Telecare. 2009

19. AIIMS OPD : 25 lakh patients p.a.
14 lakh were old cases
OLD CASES AS PERCENTAGE OF OPD WORKLOAD
(SPECIALITY-WISE)
0% 50% 100%
Medicine
Haematology
Gastroenterology
Paediatrics
Dermatology
Psychiatry & NDDTC
General Surgery
Urology
Anaesthesia (Pain clinic)
Paediatric Surgery
Orthopaedics
ENT
Obstetrics & Gynaecology
Dental Surgery
Cardiology & CTVS
Neurology & Neurosurgery
Oncology & Oncosurgery
Ophthalmology
Old New
Pathni RK, Satpathy S, Kailash S. Need for tele-follow-up. J Telemed & Telecare. 2009

20. *Pathni RK, Satpathy S, Kailash S. Need for tele-follow-up. J Telemed & Telecare. 2009
Tele-Follow-up*
Essential
encounter

22.  Infrastructure costs
 Equipment – Capital costs, Imports, Maintenance
 Building, staff, training,
 Connectivity costs
 Acceptability ofTelemedicine
 Patient – No touch, no confidence (GP can provide that)
 Doctor – No trg
 Logistics of bringing Consultant –Patient-Connectivity
together at the same time

23.  Standards, Guidelines
 Legal Issues – Licensing, Liability
 Ethics – Confidentiality, consent, doctor-patient
relationship
 Virtually no exposure to the applications of medical
ICT in curriculum of medical colleges.
 Lack of health infrastructure and services

25.  MCIT – Development ofTelemedicineTechnology
 NRHM
 11th 5yr Plan (2007-12) – Rs 200 cr
 NeGP Rs22,600cr
 NationalTelemedicine Grid
 Development of Standards
 EMR - Guidelines

26.  Buy – Install - Operate
 Buy “Know-how”
 “Plug-in” (Apollo-RWW)
 Rent
 MobileTM
 Telemedicine-in-a-suitcase
 Railways
 TM Homes
 mHealth
 Teladoc
 Recharge Coupons

27.  Tele – ANYTHING
 Tele-presence
 Tele-surgery
 Tele-Diagnostics
 Tele- ICU
 Tele-Homecare
 Tele Home- Dialysis

28.  Tele-obstetrics*
 78% of the patients avoided referral
 All major anomalies and diagnoses confirmed
 Tele – ultrasonography
*Prenatal Telemedicine. Andrea Di Lieto, et al. www.intechopen.com

30.  Tele- Robotic Surgery
1992 - experimental demonstrations
1997 – Lapcholecystectomy
1998 - Beating heart surgeries
 Tele Hypnosis

31. The uses of Telemedicine
are limited
only by
our imagination.
*Pathni RK. Telemedicine in emergency medical care. Indo-US Emergency Medicine Summit. 2005

33. rpathni@gmail.com
9560-432-345
THANKS