A few minutes later, thousands of miles away, doctors at a hospital in Philadelphia prepare the boy for surgery after receiving an urgent email from Kalyanpur diagnosing a subdural haemorrhage in the child's brain.
It is the middle of the night in the United States, but it is daytime in Bangalore and Kalyanpur and his team of 35 radiologists are reading hundreds of scans sent by hospitals across the United States during the night shift.
"ERs in the U.S. find it difficult to staff at night. There is a radiologist shortage in the U.S. as well," Kalyanpur told Reuters.
Bangalore, the outsourcing capital of the world, is becoming a global centre for telemedicine thanks to a pool of Western educated doctors, extensive outsourcing infrastructure, lower costs and a convenient time zone to diagnose medical conditions during the U.S. night.
Teleradiologists in India read x-rays, CT scans, MRIs and other medical images of patients in the United States, Singapore and a host of other countries around the world.
It is ideal for hospitals facing ballooning costs and a shortage of radiologists. And it is not just teleradiology; experts say just about every area of medicine that does not require direct patient interaction could be outsourced in the future.
This could include scans of pathology samples, ECGs, EEGs and other diagnostic systems used to determine a preliminary diagnosis.
"Telemedicine is on the rise," said Avinash Vashistha, the CEO of Tholon Inc, a private equity advisory firm, who has written a book about outsourcing.
"Once it acquires critical mass in 2 to 3 years, we expect the thrust to come from insurance companies as they recognise the cost benefits and lower premiums for the plans that have components of telemedicine."
There are some concerns, though, that it might lead to dangerous misdiagnosis and even those in the industry admit that regulation has not caught up with technology when it comes to medical malpractice, ethics and legal liability.
Liability, privacy and malpractice issues pose challenges as this new industry expands without a supporting international regulatory framework as well as an ethical code of conduct. "In the end the challenge really is when you are doing something for the U.S. and something happens, who is liable for it?," said Vashistha.
Kalyanpur's clinic can make as much as $1,500 per scan, about 35 percent less than the price charged in the United States. With an average of 1,000 scans read a day, that adds up to hefty revenues.
Kalyanpur and his wife, Dr. Sunita Maheshwari founded Teleradiology Solutions from a home office in Bangalore six years ago. Both are U.S. board certified physicians and are graduates from Yale University.
Today, they have a 118-member team in a swank, five-story setup where they provide radiology services for over 70 hospitals in the U.S., 10 hospitals in Singapore, a few in the former Soviet republic of Georgia as well as hospitals and medical clinics in cities and villages across India.
The maximum time at Teleradiology Solutions for a radiologist to read an x-ray and provide analysis is 45 minutes. Diagnosis are provided within 10 minutes for urgent cases such as acute strokes.
Ironically, India faces an acute shortage of radiologists even as teleradiology clinics sprout up in Bangalore. The biggest players are Kalyanpur's firm and his main competitor Wipro Ltd, a leading software services exporter.
"We are currently focused on consolidating this service line and building our expertise in this as this practice requires strict adherence to quality and norms," said Achaiah Palekanda of the clinical processing services of Wipro Technologies. The firm has five permanent radiologists and several who work part time.
Kalyanpur feels teleradiology is just the beginning.
"Telecardiology, telepathology, teledermatology, telephathology and robotic telesurgery," he said, naming a few.
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Quelle/Source: TVNZ, 19.10.2008
