Telecommunication
has made a miraculous advancement in every aspect of development in terms of
trade, commerce, education, transportation, entertainment, finance, marketing,
science, research & technology etc. but has failed to bring about any major
improvement in the field of health services in the country. And when a person
from a fairly well-to-do family is still stuck in an uncertainty about his plan
of action during his illness, how can we guarantee a sound health to the rural
and backward and not so well-to-do strata of the society that builds the
majority of the country.
Every
healthcare initiative by the government of the country bears in mind the key
motives namely accessibility, quality, affordability and equality of healthcare
in all respects. But unfortunately one or the other motive always remains
unmet. The greater chunk of the population dwelling in the backward rural areas
and the slum areas are still struggling to gain access to a quality healthcare.
Leap
for Mankind to cover the gaps
Given
that there are still huge and unmet demands for healthcare in the rural
backwoods, making it available as well as affordable to the needy and
attractive for the providers at the same time is a challenge. In such a
scenario, we ought to think beyond the boundaries of a conventional brick and
mortar hospitals and “Telemedicine” is a great strategy to channelize and
strengthen the existing human resources in healthcare delivery.
Health
care in India gets limited due to the affordability and time factor most of the
time. Thus, Telemedicine has a major role to play. It‟s a method of remote
diagnosis, monitoring and treatment of the patients via videoconferencing or
Internet. It may be as simple as two health professionals discussing medical
problems of a patient and seeking advice over a simple telephone to as complex
as transmission of electronic medical records of clinical information,
diagnostic tests such as E.C.G., radiological images etc. and carrying out real
time interactive medical video conference with the help of IT based hardware
and software, video-conference using broadband telecommunication media provided
by satellite and terrestrial network.
Telemedicine
and mHealth- Untapped potential
Being
started just a decade ago, Telemedicine is at a fairly inchoate stage presently,
but undoubtedly with its emerging trend, has the potential to address medical
needs of the masses and taking a doctor to people having no doctor before. The
large scale application of this innovation will however be possible by
effective government intervention.
Presently,
some of the major players in telemedicine in India include Narayana Hrudayalaya
(earliest and largest program with ISRO), Apollo Telemedicine Enterprises, Asia
Heart Foundation, Escorts Heart Institute and Aravind Eye Care. Though, there
are no clear numbers regarding the size of the telemedicine market in India but
it has been estimated that it is around US $7.5 million which is estimated to
grow at a compound annual growth rate of 20% in the next five years which would
make it around US $ 18.7 million by 2017(M. Rao, Technopak Advisors,
2012).Also, if it is believed that it calls for a huge investment then it‟s a
myth. The basic system requires hardware, software and a telecommunication
link. The costs are well within the reach of the hospitals and can easily be
recovered by charging nominal amount from the patients which would be much less
than the physical travelling.
Indians
attach multiple cultural beliefs especially to medical care hence, difficult to
convince them about the credibility of such technology .Getting personally
examined by the doctor will always be preferred by the people of hinterlands
than adopting any technology of such kind. Moreover, the medical facility and
staff available in the vicinity may not be well tuned with the hi-tech
equipments. A major limitation seems to be the poor bandwidth in the remote
areas and the problems of power supply. Thus, these technologies will make no
sense if the required facilities are not intact. In such situation, it is
inevitable for the government to make sure that connectivity is established
(e.g. via ISRO) to all the districts and village level hospitals and required
facilities (power supply) is provided round the clock. Low cost, easy to
install and use technologies capable of operating at not so good bandwidth
should be encouraged. Educating and updating the masses about the benefits of
these technologies and at the same time training the manpower in the vicinity
to handle the technology is inevitable. The newer technologies – telemedicine
boxes and software rather than just a video conferencing link and its „tools.
e.g. digital stethoscopes and otoscopes, oxygen saturation probes (to assess
the oxygen level in the patient), blood pressure monitors etc. have made the
telemedicine consultation more scientific and data based.
A
brief mention about the scope of mHealth (mobile health) in healthcare
delivery. Mobiles have been able to penetrate more deeply into the masses than
the internet with more than 800 million mobile users. Presently, entertainment
and financial services have only been able to reach out to the public via
mobiles.
Though
mhealth has been successful in other countries, it has just managed to scratch
the surface in India largely due to the lack of awareness among the public and
the doctors about its benefits. One such initiative “mHealth ventures in India”
was started in 2010 with the first product “mera doctor” i.e. “call-a-doctor”
service, a medical call centre involving licensed doctors and medical protocols
for consultation on phone 24/7 at a nominal charge per consultation.
But
frankly, in my view, mHealth should be largely directed towards education and
awareness generation, training for healthcare workers, tracking an epidemic
outbreak and remote monitoring than diagnostic and treatment support. It is my
personal opinion that it would be more helpful in an acute emergency, to
provide some life sustaining tips until medical help arrives in person or in
very common diseases/epidemics where just prescribing the medicine sis
sufficient. As, diagnosis made just on the basis of symptoms (call a doctor) without
considering the clinical signs might not be helpful in complicated cases where
one can always be referred for further consultations. This too remains a
nascent field yet to be developed which will answer many of such queries in the
near future.
Thus,
today India needs an effective collaboration of these innovations in a well
planned manner to reach out to the needs of unprivileged masses in order to
ensure that everyone gets the equal opportunity to attain a sound health
status. Moreover, all these initiatives will help in establishing internet
enabled health centres and usage of point-of-care devices will enhance the
quality of services and bring health services within coverage of ALL.
Dr.
Anindita Banerjee
MHA-Hospital
Administration
2012-2014
Batch
TISS,
Mumbai
