Indian government’s spending on health is a mere 1% of the total GDP1. According to the Union Ministry of Health and Family Welfare Department, there is an acute shortage of physicians, nurses and lab staff especially in rural India. In the vision of “Health for All” to be realized, telemedicine could prove to be a game changer by bridging the supply of doctors with demand of patients through telecommunication and broadband. An example of telemedicine is when a patient phones a dedicated helpline number and is attended to by a registered nurse or a doctor. The medical practitioner listens to the symptoms and can prescribe over the counter drugs or write lab tests that need to be done or refer the patient to the nearest hospital. Similarly, consultation can be done via video conferencing. Reports, scans etc can all be looked at.
Telemedicine obviously has the biggest impact in rural areas considering that the mobiles cover 83% of Indians2. When employed telemedicine can reduce infant and maternal mortality by 90% by sending text reminders about immunization, helping diagnose pregnancy complications and providing timely intervention to contain diarrhoea, pneumonia in new born infants This is an area where the government has invested money while the private sector implements it via point of care stations e.g. Narayana Hrudayalaya’s tele cardiology is supported by the Karnataka Government and ISRO3. Such public private partnerships have been forged in Tripura, Bihar and Uttar Pradesh. Sanjay Sharma, the Executive Director at APTA Healthcare Advisers, points out the work by World Health Partners, one of the private players that has been particularly successful in Uttar Pradesh. They have trained people traditionally engaged in healthcare to be Sky care providers, set up rural kiosks and established an ecosystem of entrepreneur-run Sky Health centers. The care providers perform first line diagnosis and refer the needy to health centers. Doctors in Delhi are wired to these health centres. The consultation charge ranges from Rs. 10 to 50 making it affordable.
Other key players include Apollo hospitals, Fortis, AIIMS, Aravind eye care, Sankara Nethralaya and Narayana Hrudayalaya. Narayana Hrudayalaya has treated over 30,000 cardiac patients making it World’s largest tele-cardiology programme4 .
However, not all is rosy as it seems. For telemedicine to be widely implemented, it has to be profitable to both vendors and patients. Bandwidth costs, training and maintaining personnel at the point of care centre increase costs while confidence of the patient is low when the doctor untrained in tele-health attends to them. “Lack of focus on training the technical staff and lack of domain knowledge with the policy makers on the subject has been a big hindrance in evolution of telemedicine” adds Rajendra Gupta, Member of Advisory Group at Ministry of Health & Family Welfare. Sanjay points out that unless tele-health teaching modules are incorporated during medical Studies, it would be hard to get doctors accustomed to practicing tele-health since the majority of senior doctors do not do so.
However there are reasons to be optimistic considering the promising results achieved in maternal and infant mortality and eye care segments. Aravind eye care looked at over 2.5 lakh cases last year alone through telemedicine and has brought down the cost of consultation from Rs. 350 to Rs. 147 while Shankar Nethralaya looked at 2 lakh cases between 2008-2010.
So how does the future of telemedicine look like? Technavio’s Global Telemedicine Market 2010-2014 report forecasts the growth of global telemedicine market at 19% Compounded Annual Growth rate. Yet another report (Telemedicine Market in Brazil, Russia, India, China) estimates a market size of $418.4 million by the year 2014 in BRIC countries. This means the monetary opportunity is large enough for both existing and new players. Simple top of the head calculations also point to the immense market potential. If one considers the 1 billion population and assumes 50% need to consult a specialist doctor once a year, that gives 500 million. Now even if 1% of these consultations were to occur via telemedicine that would be a whooping 5 million cases.
Telemedicine can also be useful in addressing gaps in Psychiatry where, the doctor to patient ratio is an appalling 1: 1,00,000 or in management of chronic diseases like diabetes where daily or regular intervention can help make lifestyle changes and manage the disease better or expand in new areas such as tele-dermatology and tele-surgery. Development of mobile both, phones and portable devices monitoring vital clinical signs will spur tele-monitoring to reduce emergency situations by supporting timely clinician intervention.
Perhaps what we will see in the future is telemedicine working as,
- an enabler and a feeder system to the existing hospital network
- mitigating the number of emergencies by providing rapid diagnosis, point of care solutions and continuous monitoring
- catalyzing disruptive innovations in medical devices, monitoring, mobile technology
- a reason around which an ecosystem comprising of health kiosks, pharmacies and lab services will be built.
I like to thank Rajendra Gupta and Sanjay Sharma for their valuable inputs.