“Even a crude form of ‘tele’ touch may be possible a few years from now. Images of the interior of any part of the body can be viewed in real time.”
It may never ever be possible to spend Rs 30,000 crore annually to put up, every year, 750 hospitals of 250 beds each, to achieve the minimum WHO (the World Health Organisation) standards. Yet, using ICT (information and communication technology), we can provide healthcare to suburban and rural India, assures Prof K. Ganapathy, Head of the Division of Stereotactic Radiosurgery in Apollo Hospitals Chennai, and President of the Apollo Telemedicine Networking Foundation.
“We can leapfrog, not piggyback or follow, the West,” he adds. “The Indian brain is differently wired. The so-called illiterates are tech-savvy and take to computers like a duck to water. Telehealth is the only method of extending our reach and providing healthcare to every nook and corner of India,” declared the enthusiastic doctor, during a recent interaction with eWorld.
Prof Ganapathy, an eminent neurosurgeon, and formerly Secretary and President of the Neurological Society of India, and Secretary General of the Asian Australasian Society of Neurological Surgery, is a pioneer in introducing telehealth in South Asia. A co-founder (Joint Secretary & Treasurer) of the Telemedicine Society of India, and a member of the National Task Force on Telemedicine and the Planning Commission working group on Telemedicine, he has a number of presentations and publications to his credit ( www.kganapathy.com). Dr Ganapathy, who has a Ph.D in neurosurgery, is an adjunct professor at the Anna University Chennai and IIT Madras.
Excerpts from the interview.
What is telemedicine?
Telemedicine (TM) can be defined as a method by which a patient can be examined, investigated, monitored and treated, with the patient and the doctor physically located in different places. In other words, TM makes distance meaningless and geography history!
And, why telemedicine?
India is a paradox. 750 million people living in suburban and rural India have no direct access to secondary and tertiary medical care. Even primary healthcare in rural India leaves much to be desired. The distribution of the limited number of specialists is lopsided. Chennai with 8 million people has 90 neurosurgeons while North-Eastern India with 250 million people has about 85.
At the same time, ICT is growing exponentially. The teledensity of India is a staggering 28 per cent. The right slogan for today is roti, kapda, makaan and bandwidth!
In what spheres of healthcare or for what categories of patients do you see telemedicine as very apt?
Strictly speaking, there is no sphere of health or category of patients to whom telemedicine is not apt. It can be used to provide tele-consultations at home, in apartments, and in offices.
Pre-hospital management can be initiated in ambulances. Doctors’ clinics, small nursing homes, medium-sized hospitals, and large hospitals — all these can have customised, tailor-made telemedicine solutions relevant to their particular needs.
During the last about eight years, in the 45,000 teleconsults carried out at Apollo Hospitals Chennai, most specialties have been covered. These include cardiology, neurology, psychiatry, sexual medicine and rheumatology.
If proper infrastructure is available at both ends and the logistics well-planned, 24/7 services for emergencies can be carried out in any specialty.
ECGs (electrocardiograms), echocardiograms, images of X-rays, ultrasound, CT (computed tomography) scans, and so on can be transmitted. Heart sounds can be heard thousands of miles away. Detailed examination can be carried out.
Even a crude form of “tele” touch may be possible a few years from now. Images of the interior of any part of the body can be viewed in real time. It just involves connecting the appropriate endoscope to a PC (personal computer) with Internet connection. Today, we are talking about “Doctor, anyone, anytime, anywhere”. As soon as 3G-wireless becomes available even wireless telemedicine could be a reality in India.
Is there resistance to telemedicine — from patients and doctors?
When the concept was discussed in 1999, there was laughter and derision all around. Today the intensity of the laughter has come down! The disbelievers are slowly being converted. However, there continue to be sceptics who are cynical of hi-tech methods.
There will always be a group of people who want to spend effort, time and money to see a doctor face to face rather than interact with him on a high-resolution, giant plasma screen at a fraction of the cost.
Enthusiasm both among doctors and patients is varied. After all, Socrates, Plato and Aristotle were never recognised by their contemporaries. In the next decade, telehealth will be an integral part of the healthcare delivery system.
We are now in a state of transition. All transitions offer great opportunities to reduce and remove resistance. The people have to be convinced that telehealth is in their interest. Once we reach a critical mass, the acceptance will be much more.
While critical cases need urgent and direct medical attention, can telemedicine serve as the first touch-point for healthcare in the rest of the cases? And thus can it ensure that high-end care as in super-specialty hospitals is used optimally?
Theoretically, a telemedicine system can be evolved to provide instantaneous attention to critical cases. However, transmission of voice, text, images and video clippings is not the solution. A brilliant telediagnosis by an experienced teleconsultant has to be followed up. The investigations suggested must be done at the remote end. The e-prescription has to be dispensed at the remote end.
Telemedicine, however, can offer a triage, which could ensure that a significant percentage of patients are treated at the smaller hospital without unnecessary referral to a tertiary hospital in a far-away metro.
Do we have any studies on the economics of telemedicine, highlighting the cost advantages? Can you tell us broadly about ongoing research in telemedicine?
Several evaluation and impact analysis studies have been carried out globally. Most of them have reconfirmed that there is a tremendous reduction in expenses for outstation patients.
Research in telemedicine is now taking place on all fronts. Intelligent clothes, smart homes, wireless telemedicine, telesurgery, attempts at standardisation at a global level are just a few of the areas being studied.
How much does an initial investment in telemedicine entail, at both ends of the healthcare chain? Will telemedicine centres become, one day, as ubiquitous as telephone booths?
The cost of a Nano is 1 per cent of the cost of a high-end Mercedes Benz though both are cars. Similarly, the cost of setting up a telemedicine unit can be as low as Rs 60,000 at each end, or go up to several lakhs depending on what is required. It is our dream, vision and hope that in the next 10 years telehealth kiosks will indeed be as commonplace as the erstwhile telephone booths.
What skills are needed for telemedicine personnel at the customer end? Do we have courses in colleges that focus on this branch?
The advantages of a modern telemedicine unit are that the unit is almost operator-independent. Any Standard XII student can be trained in a few days to run a unit at the entry level. We are trying our best to introduce telehealth in the curriculum of engineering and medical colleges but have a long way to go.
Apollo Telemedicine Foundation, in conjunction with Anna University, has a two-week telehealth technology course for science graduates.
Is there scope for insurance products that are woven around telemedicine?
Yes. Teleconsultation is likely to be included in packages offered to policyholders.
Where across the globe is telemedicine widely in vogue? What best practices can India adopt from successful implementations?
Telemedicine is widely in vogue in Europe, particularly in countries with scant population. Canada and the US are other countries deploying telemedicine. Malaysia was one of the first countries to pass a Telehealth Act.
The National Task Force constituted by the Ministry of Health, Government of India (of which I was a member) has recommended best practices, taking into account the measures used in other countries.
With a wider availability of Internet, is there a possibility of healthcare attention being made available right at the desktop of, say, an employee?
We are already working on solutions that will enable a consultant to give teleconsultation from the PC in his room rather than physically come to a dedicated telemedicine room. The technology is available to provide healthcare attention right at the desktop of, say, an employee. When this will become a reality is difficult to predict.
On the technological advancements, in the form of gadgets, that make telemedicine effective.
Technology has never been, and will never be, a stumbling block to progress in telemedicine. Today we have very high-resolution display monitors, superb videoconferencing cameras, broadband hi-speed Internet for fast transmission. Terabytes of data can be transferred at lightning speed. 4G wireless technology and mobile phones, which can be opened up into big screens, will be a reality. Chips in intelligent clothes will be sending a host of data to a telemedicine unit even without the owner being aware of the same.
Smart intelligent homes will monitor the elderly, 24/7. Heart sounds and lung sounds can be transmitted across continents and can be heard without stethoscopes. A crude form of haptic sensation will even make tele touch possible.
We should, however, remember that a fool with a tool is still a fool, and ultimately therefore it is the individual, not the technology, that can make or break the system.
How did you get interested in telemedicine?
In 1997, I gave an ‘Institute lecture’ at IIT-Kanpur where my son was studying. The take-home message of my talk (on Neurosurgical advances) was that eventually to be a postgraduate in neurosurgery one would have to graduate from IIT!
At 10 p.m., when the Q&A session was at last over, a Prof Srivathsan, HoD, Electrical Engineering (currently Director IIITM, Thiruvananthapuram), insisted I accompany him to his department immediately. He then related how ISDN lines, just evolving at that time, could be used to examine a patient. The discussion went on till 4 a.m. We met again at 8 a.m, spent the next few hours doing a literature search, and put up a proposal for a research grant with Dr Srivathsan and me as investigators.
The word telemedicine did not exist in my lexicon at that time. Retrospectively, we were obviously too far ahead of the times. We did not get the grant.
I then made a proposal to Dr Prathap Reddy, Chairman of Apollo Hospitals. In 1999, he asked me if I was still interested in telemedicine. The rest, as they say, is history. Res ipsa loquitur! There has been no looking back. Hopefully telemedicine will soon reach the critical mass essential for a successful take-off.
What keeps the telemedicine hopes ticking in you?
It is not the destination that counts but the journey. The scores of talks in India, outside India, the dozens of meetings with officials, non-officials, the disbelievers, the cynics and the sceptics have only been a shot in the arm. I have always believed in the adage that you have to keep running even to stay where you are.
The organisation of an international conference in telemedicine in November 2007 gave us an opportunity to put Chennai and India in the world map of telemedicine. The ISRO, Department of Science and Technology, Department of Information Technology, Apollo Hospitals, SRMU and Sankara Nethralaya were the co sponsors. Starting the Telemedicine Society of India has been another satisfying attainment.
A dwarf standing on the shoulders of a giant sees farther than the giant himself. It has been my good fortune to work with visionaries of healthcare like Dr Prathap Reddy who has provided the much-needed support and encouragement to make telehealth a reality in India and overseas.
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Autor(en)/Author(s): D. Murali & N.S. Vageesh
Quelle/Source: The Hindu Business Line, 31.03.2008
