Telemedicine in India
(Vol. 1 as in 2002)
[Government of India's Initiative]

Sanjay P. Sood

sood@spsood.com

Vast area with varied geography (from deserts to frozen mountain ranges), with maximum temp. touching 50 degree Celsius and in some northern regions mercury stays settled at below -20 degree Celsius round the year, population (1.029 billion) [1], high infant mortality rate (63.19 per 1000 births) [1], high population per physician (1916) [2], majority of the population (72.2%) [2] living in isolated villages, total life expectancy is 63.14 years as against China's 69.76 years [3] (keeping in mind that India spends 5.2% of its GDP on health as against China's 2.7% [4]) - the figures reflect India as a developing country. At the same time the factors support and justify the need for Telemedicine in the country. India can be classified as one of the countries with a potential to reap from almost all the applications of telemedicine.

The Ministry of Communications and Information Technology, Government of India, has classified "Telemedicine" as one of the thrust areas for development in the country. In sync with the policy, the Government initiated a project called "Development of Telemedicine Technology". Teams at SAS Nagar and Pune have been working for this pilot project. Efforts are towards linking three tertiary level hospitals of North India namely :

1. All India Institute of Medical Sciences at New Delhi.

2. Post Graduate Institute of Medical Education and Research (Nehru Hospital) at Chandigarh.

3. Sanjay Gandhi Post Graduate Institute of Medical Sciences at Lucknow, Uttar Pradesh.

The proposed Telemedicine setup between these medical institutes would primarily be in the three specialties of Radiology, Cardiology and Pathology. Doctors (working in Radiology, Cardiology and Pathology) in any of these three hospitals would be in a position to (Tele)consult an expert in the other hospital using the technology under development. The cities of New Delhi (capital of the Country), Chandigarh (capital of the states of Punjab and Haryana) and Lucknow (capital of the state of Uttar Pradesh) are among very few Indian cities which enjoy benefits of the State-of-the-art communication technologies like ISDN, leased lines etc. The project is currently in the terminal stages of the development. It would enable the exchange of clinical information among the three hospitals via ISDN lines. Technology for the transfer of data over POTS has also been developed and is currently in the lab testing phase. The three hospitals being linked in the pilot project are referral hospitals and the technology from these referral hospitals would flow down to the secondary and eventually to the primary healthcare delivery level.

At SAS Nagar, we have named the development as "Sanjeevani" - an integrated Telemedicine application software. The foremost requirement of any application of IT in Medicine, in a developing country, is that the application should be user friendly, mainly because the medical fraternity is not technology savvy. Besides being user friendly, Sanjeevani supports a comprehensive patient medical record, DICOM image format, video conferencing, standard TWAIN interfaces for webcams, digital cameras and scanners and offers tools for image enhancement as well.

For Teleradiology - Sanjeevani supports capturing of images in common formats including DICOM from scanners with transparency adapters and specialized medical film scanners.

For Telepathology - Sanjeevani supports the transmission of the following pathological reports: Urine, Stool, Haematology and Biochemistry in alphanumeric/textual form in addition to the images in popular formats from video microscopy systems.

In the case of Telecardiology - Sanjeevani can capture, display and store 12-lead ECG besides transfer of heart sounds and Lung Function Test reports.

Sanjeevani is a Telemedicine system based on Store and Forward concept and video conferencing over 384 kbps ISDN lines. The peripherals like medical film scanner, video microscopy system, ECG machine, electronic stethoscope, spirometer being integrated with the application had to be imported due to their unavailability in the Indian market. In India, Telemedicine is catching up though slowly, a couple of private Telemedicine service providers/clinics (for second opinion with their counterparts in the developed countries) have come up in large cities of India in recent past. Web based Telemedicine solutions are gaining popularity owing to internet's low cost and almost universal availability [5]. Internet is proving to be a very popular networking technology universally.

Some of the bottlenecks w.r.t. the growth of Telemedicine in India are :

1. Lack of health infrastructure and services.

2. Shortage of computer savvy healthcare personnel.

3. Out flow of doctors There are about 60,000 and 35,000 Indian doctors in United States of America and United Kingdom respectively. [6]

4. Lack of training facilities with regard to the application of information and communication technology in medicine. Terms like HIS, RIS, PACS etc are unheard of by the medical/healthcare community.

5. Virtually no exposure to the applications of ICT in curriculum of medical colleges.

6. Inadequate communication services to facilitate telemedicine in most of the cities but the situation is rapidly improving.

Public hospitals lack in the latest technology and infrastructure due to the financial considerations involved in catering to more than what they are meant for. Private or corporate hospitals are coming up and promise world class services. Names like Apollo, Escorts and Batra are the popular corporate hospitals and each of them is in one way or the other involved in Telemedicine. International names like Fortis have reached India. Besides the Central Government the State Governments have also started showing interest in this suite of technologies of high social relevance.

Time is approaching when telemedicine/e-health initially shall be visibly practised in majority of the Indian hospitals as a separate department before eventually fusing into respective medical specialties.

References :

1. The World Factbook 2001, CIA Publication, Office of Public Affairs.

2. Asia And The Pacific In Figures 2000, Statistics Division, United Nations Economic and Social Commission for Asia and the Pacific (ESCAP)

3. United Nations World Population Prospects, 1998 Revision, Vol III, Analytical Report.

4. WHO World Health Report 2000 "Health Systems : Improving performance"

5. Sanjay P. Sood & J.S. Bhatia, Internet as the backbone for Telemedicine : How far/close are we? Presented at All India Seminar, Challenges ahead with Information Technology, organized by IE & SLIET, Longowal, 19 - 20 January, 2002.

6. International Trade in Health Services A Development Perspective, UNCTAD-WHO Joint Publication, Geneva, 1998.

Some more information can be found at the following sites: