|Year : 2011 | Volume
| Issue : 4 | Page : 286-288
Telemedicine: A technology in waiting
Arun Kumar Sharma
Professor-in-Charge, Telemedicine Unit, University College of Medical Sciences, University of Delhi, New Delhi - 110095, India
|Date of Web Publication||30-Jan-2012|
Arun Kumar Sharma
Professor-in-Charge, Telemedicine Unit, University College of Medical Sciences, University of Delhi, New Delhi - 110095
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sharma AK. Telemedicine: A technology in waiting. Indian J Public Health 2011;55:286-8
According to the 2001 census, 72% of India's population lives in rural areas.  The metropolitan cities of Mumbai, Delhi, Chennai, Hyderabad and Bangalore have modern state-of-the-art healthcare delivery systems in place which are not only utilized by the local residents, but have also given boost to medical tourism in the country. Even government run health facilities are well equipped in large cities.
According to a report of World Bank and Public Health Foundation of India, the distribution of health workers is heavily skewed in favor of urban areas, with 60% of health workers having an urban residence.  The density of various categories of health workers in India is given below [Table 1].
|Table 1: Rural and urban distribution of health workers' population in India|
Click here to view
It highlights the acute shortage of trained manpower in rural areas of India, thus severely compromising with the delivery of healthcare. Further, the density is even lower in poor states like Bihar, Uttar Pradesh and Rajasthan, compared to Goa and Kerala. 70% of the health workers, both in rural and urban areas, are employed in the private sector.  Only 6% of the rural doctors are females (2 female doctors/10,000 females),  thus making it difficult for women to seek healthcare in majority of rural societies where consulting a male doctor for gynecological/obstetric problems is a serious taboo, particularly in the states of Rajasthan, Uttar Pradesh and Madhya Pradesh. There is a 66% shortfall of specialist doctors (surgeon, gynecologist, physician, pediatrician) at the Community Health Center level.  The process of increasing the density of doctors in rural areas is long drawn. It will mean increasing the number of seats in medical colleges, motivating young doctors to work in rural areas and providing infrastructure conducive for work in those places. This path may take not less than a decade to achieve the WHO benchmark doctor population ratio in rural areas. This acute shortage of healthcare professionals reflects in the indicators of health for rural areas [Table 2].
In rural areas, the healthcare infrastructure is very rudimentary and the large rural population is deprived of standard healthcare services. The two most significant indicators of health, namely infant mortality rate (62 per 1000 live births) and maternal mortality ratio (301/100,000 live births), of rural India are among the highest in the developing world. India has the largest number of child deaths in Asia (2.3 million), followed by China and Pakistan.  [Table 2] shows a comparison of certain key health indicators for rural and urban areas.
The mechanisms by which these deficits translate into poor health indicators are as follows:
The biggest impact on health indicators are the following:
- Lack of diagnostic expertise for complicated illnesses and emergency health conditions
- Lack of specialist services for remedial action in medical and surgical emergencies
- Maternal deaths at the time of delivery due to lack of emergency obstetric care
- Infant deaths due to non-availability of pediatrician's advice in a timely manner
- Difficulty in moving the patient from a primary healthcare facility to a tertiary healthcare facility for emergency care due to non-availability of transport, long distances and poor road conditions
In summary, it may be said that by providing diagnostic facility, expert advice and timely intervention, health of rural population can be improved.
- Inability to provide emergency obstetric care, leading to fetal death, early neonatal death, infant death and maternal death.
- Delay in diagnosis of cancer and other fatal illnesses, thereby delaying start of treatment, leading to early mortality and high morbidity with cancers.
- Increase in burden of diseases such as diabetes mellitus, cardiovascular diseases and nervous system disorders which are chronic, debilitating conditions. This happens due to non-availability of services of specialists and experts and diagnostic support services.
| The Solution|| |
One of the resources available at our disposal is telemedicine, which is a technology- based facility that can meet the demands of diagnostic facilities, expert medical advice and preparedness of hospitals to provide treatment for patients being brought from remote areas on the way and immediately upon arrival.
Telemedicine is essentially an application of information and communication technologies for the exchange of valid information between the care provider and the receiver for diagnosis, treatment and prevention of diseases and injuries. The technology is also useful in continuing medical education and training of doctors and paramedical staff located in remote locations. The technology is a combination of hardware and software that enables transmission of audio-visual signals across two points, using the internet network. A device as simple as a desktop computer with a webcam and a microphone at both ends is sufficient for basic telemedicine services. More advanced versions use high-resolution camera with zoom and axial rotation facility and sensitive microphones which can transmit heart sounds and breathing sounds. Several peripheral equipments like electronic stethoscope, microscope, and computed tomography (CT) scan can also be connected in order to transmit the data live from one end to the other. The most advanced version of telemedicine has achieved the wondrous feat of surgical procedures being performed by robots in on OT being controlled by the concerned surgeon seated in a different country across the oceans.
At the first go, telemedicine appears to be a panacea for all the woes of healthcare delivery in rural areas which suffer from lack of manpower, equipments, facilities and all else that are required for health services. In my opinion, the single most important bottleneck is that of dedicated manpower. We are all aware of reluctance of doctors to work in remote, rural areas, and so is true for paramedical staff as well, who look westward for greener pastures. If we can provide specialist services, high level of connectivity and opportunities for professional growth during working in rural areas, I am sure some more committed doctors and paramedical staff will venture out to rural areas as well. Availability of quality healthcare in small centers will also help in decongesting large tertiary care hospitals. It will also save valuable time and money spent in transportation of patients to urban centers, and will make the patients believe in the availability of quality care in their small village/town. Further access to healthcare can be improved by mounting the telemedicine system on a mobile van and making it ferry to different villages with a regular periodicity, so that primary healthcare is made available at the doorstep in the truest sense of the word.
With gradual advancement in technology, the cost of equipments has also come down. A basic telemedicine facility may not cost more than 6 lakh and an advanced facility can be created within 20 lakh.
The biggest constraint in application of telemedicine in rural areas is availability of the telemedicine system and high-speed connectivity; but with constantly expanding network and mobile telephony, it is possible to provide adequate bandwidth even in remote areas. The alternative is to use satellite-based internet connectivity for places where wired connection will take longer time to reach.
The National Knowledge Commission of the Government of India has already embarked on a mission to provide high-speed internet connectivity to 1500 academic institutions in the country through National Knowledge Network (NKN).  This network will also be extended to district and block level subsequently. Availability of high-speed internet and connection to all medical institutes in the country will provide the appropriate infrastructure to create opportunities for continuing medical education of doctors and other staff posted at primary and secondary care institutions in remote and rural areas, thus motivating them to stay put at those institutions. They will also be able to actively participate in conferences and workshops conducted in academic institutions from time to time as the NKN will provide live webcast of such events with seamless transmission.
The utility of telemedicine as a system is now amply demonstrated. Even in India, large private sector hospitals like Apollo Hospitals, Aravind Eye Hospitals, Narayan Hrudayalaya, etc. are using this technology in a big way to help people access their service settings in distant locations. Evidence has been created conclusively that telemedicine can go a long way in improving health care in terms of access, affordability, quality and content.
| References|| |
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[Table 1], [Table 2]