Dial Rx for telemedicine
Living in remote villages or smaller towns can mean being cut off from good medical facilities. One could make an occasional trip to city hospitals for a planned surgery or a one-time diagnosis, but consultation on a regular basis is unfeasible.
Not any more. Welcome to telemedicine, a medical concept that's gaining ground in India as hospitals get linked with patients far away. Like Nabam Aetum, 60, throat cancer patient in Naharlagun, Arunachal Pradesh. Aetum is due for a consultation via telemedicine with his doctors at the Tata Memorial Hospital (tmh), Mumbai, where he had his throat operation three years ago. Senior radio-oncologist R L Balavat and senior surgeon K A Pathak will study Aetum's latest reports and recommend a future course of action. The session will be conducted at the local general hospital, where his doctor, Mari Basar, is waiting with him. Soon, Balavat and Pathak link up from the tmh telemedicine centre. In the next 15 minutes, they study Aetum's latest test reports and affirm that he has made good progress. They suggest some medicines and wish him good luck!
With hospitals across India getting connected, more people are linking up to the convenience of telemedicine. The network is also growing to include hospitals in neighbouring countries. Kolkata-based Asia Heart Foundation (ahf) launched its integrated tele-cardiology and tele-health project in 2001 with hub centres in Narayana Hrudalaya (nh), Bangalore and Rabindranath Tagore International Institute of Cardiac Sciences (rtiics), Kolkata. It has now set up telemedicine centres in Pakistan and Malaysia as well.
How does it work? The brainchild of Indian Space Research Organisation (isro), telemedicine uses satellite to link up rural centres with city hospitals. A typical session needs a computer, a web camera, an advanced scanner, a 21-inch colour television and connectivity through Very Small Aperture Terminal Satellite (vsat). Patients far away can share medical data/test results through free video conferencing at the nearest health centre.
isro, which funded the project, has now established 100 telemedicine nodes across the country. 22 of these are located in super speciality hospitals like nh, tmh and Apollo Hospital , and 78 in remote rural areas, including in the Andaman and Nicobar Islands. isro provides vsat , diagnostic equipment and satellite bandwidth to the hospital, and setting up one such centre costs over Rs eight lakh. Says S Krishnamurthy, isro, "We provide a telemedicine network only if the hospital provides free medical consultation and conducts regular follow-ups. If a private hospital wants to set up such a centre, then it has to provide treatment at government hospital rates. We want to take the telemedicine network first to every district of the country and then down to every taluka .'
Remote no more Already used in other branches of medicine, telemedicine is a new step in cancer treatment. The connectivity is a blessing for the seriously ill in rural areas who can neither access highly trained doctors nor speciality treatment options. Earlier, such patients would have had to travel across states to access treatment at tmh and nh. Says Rekha Batura, officer in-charge, telemedicine project, tmh, "One fifth of our patients are Mumbai locals. About one third come from other western states of the country. But a huge chunk of cancer patients come from the northeast, contributing 50,600 patients out of an annual total of 220,000. We estimate that through telemedicine, almost 25-30 per cent of our patients will avail of latest cancer treatment close to their homes.'
Isolated areas with a shortage of specialists need telemedicine consultation the most. The nh network connects with 39 secondary centres through vsat, extending from remote Tinsukia in Assam to Yadgir in north Karnataka. 20-35 per cent of patients may still have to travel to nh for treatment, but 60-65 per cent can be treated locally. Together, nh and rtiics have treated 16,000 patients with the help of telemedicine.
An economical option
Telemedicine, besides being free, also cuts costs like outstation travel and stay. Typically, diagnostic work and treatment for cancer could take up to four weeks, and patients are often accompanied by a relative. Telemedicine could save a minimum of Rs 25,000 per patient visit. Of the 63 patients tmh treated via telemedicine, only three were advised to come to Mumbai.
Doctors want it too
Telemedicine also strengthens treatment options available in rural centres. Doctors in far-flung outposts lack regular training and exposure to latest medical research. An important advantage of telemedicine, therefore, is judicious consultation. Local doctors can now discuss their cases with specialists and send their patients to town only if surgery is required. As Basar says, "We often need timely consultation, which we get from senior doctors at tmh. Since there is a rise in cancer incidence in the northeast, many patients from nondescript villages of Arunachal Pradesh, who do not have the resources to travel to Mumbai, come to us. In these situations, telemedicine is the saviour. Our patients are very happy with this service.' Like Aetum, who has already had his operation and needs only regular follow-ups and expert consultation from time to time. Telemedicine fulfils this need right in his hometown. Yet, as Basar says, "We never get to know the latest advances in medicine. There should be more e-conferences involving doctors from far off centres. If we could also see surgeries being performed, it would really help us.'
Expanding the scope
Telemedicine is trying to push the envelope and do more. Soon, services boosting timely data interpretation, like telepathology (sending pathological slides through the server) and teleradiology (interpreting ct scan and mri reports), may be possible. tmh has a three-phase plan. In Phase I, from September 2003 to December 2004, 14 centres were connected via telemedicine. Phase II will link four regional cancer centres between January and December 2005. Telepathology services will also be available at eight hospitals, seven of them in the northeast. During the last phase, from January to December 2006, the other centres across the country will also get linked
Telemedicine is clearly growing. Karnataka's telemedicine project was launched in 2002, with isro, nh and the state government as partners. 20 telemedicine centres for coronary care were set up in 12 districts and the doctors trained. In the second phase, 17 centres are coming up, with the state spending Rs 15-20 lakh per centre.
isro is also poised to widen the nation's network. "We have reduced hardware-transmission costs by 20 per cent in less than three years. It's a good opportunity to reach space-based applications to the community and extend it to mobile vans, dedicated terminals, high-tech service deliveries and telemedicine-trained doctors,' said Madhavan Nair, chairperson, isro recently at Intelemedindia 2005, in Bangalore. The picture for outstation patients can only get brighter.