Medical Treatment Over Distance Not So Far Off

New Delhi: | Updated: Dec 23 2002, 05:30am hrs
For far too long, the remote areas of the country have been untouched by the revolutions in medical science. As doctors are unwilling to shift to the interiors, the rural masses were forced to traverse hundreds of kilometres to the nearest town centre for the simplest of ailments. While super speciality hospitals on anything from cardiology to infertility have mushroomed in the metros, the rural scenario has more or less remained the same over the years. But, all that is set to change with the advent of telemedicine, and a huge population in the hinterland will, in the not-too-distant future, have access to treatment enabled by technology.

Telemedicine can be described as treatment over distance. With the current technologies, it is now possible to connect rural areas via VSAT (very small satellite aperture terminal) and link them to super-speciality hospitals in urban centres.

Telemedicine also plays a significant role in disaster management. When Gujarat was devastated by an earthquake in the year 2000, many paramedics rushed there, armed with satellite kits and immediately set up camp in the affected areas. Many lives were saved due to this initiative.

Telemedicine covers a wide range of activities. In the past, it primarily meant tele-radiology, transferring of high resolution medical images, X-ray pictures, ultrasound, CT, MRI pictures, live transmission of ECGs and echocardiograms. But, today, even a detailed clinical examination can be conducted remotely, with the specialist located in super speciality centre in the town interacting with a general practitioner in any of the numerous villages.

And the structure is not that complicated either. All that one needs is high-end computer and a dedicated channel for the interaction to take place. The system can also be linked to other medical equipment like ECG machines, et al, and can thus transfer data in real time.

An important aspect in the system is the software. Many professionals complain that private software companies charge a hefty price for the software and can thus be afforded by only private institutions. But the Centre for Development of Advanced Computing (C-DAC) is developing a software for the telemedicine initiative, named Mercury, which is expected to work out cheaper.

State governments across the length and breadth of the country have grappled with medical practitioners trying to coax and cajole them into taking posting in rural areas, even going to the extent of making it compulsory. Even the distribution of specialists in the cities is lopsided.

With infrastructure in place, patients in rural areas can avoid travelling to hospitals in cities and can avail of treatment right there in the village. This will ensure considerable monetary savings. Also, it will prevent all the hassles related to travelling and accommodation. Currently, with modern software/hardware at either end, 90 per cent of the normal interaction can be accomplished through telemedicine.

The satellite communications system provides a cost effective means for distribution of video and data. Where ISDN video-conferencing is effective for small groups, the proper application of satellite communications is for point to multi-point distribution. Current technology allows Internet data to be carried on video sub-channels, giving more applied capabilities.

According to industry estimates, IT expenditure in healthcare is pegged at $1.2 billion. There are over 10,000 known diseases and around 3,000 drugs. And, 75 per cent of the role of IT entails capturing and managing of data.

Is the current telecom infrastructure sufficient for telemedicine It is, the telephone lines provide a data exchange rate of 64 kbps, while ISDN provides 128 kbps. Live conferencing needs 384 kbps. The Ku band and C band connectivity provided by ISRO is sufficient for the data transmission, says AIIMS (All India Institute of Medical Sciences) deputy director and head of Computer facility Dr R S Tyagi. ISRO will also be launching a small satellite in January 2003 for communication processes in telemedicine.

The other important aspect of telemedicine is Computerised Medical Records (CMR). It enables doctors to collect, store, and manipulate large quantities of data with relative ease and in a miniaturised form. Clinical and administrative information about patients and medical care can be compactly stored, even on smart cards. Doctors can now exchange massive data about patients with specialists, hospitals, and insurers. They can now compare tests performed on a patient over many years. Mistakes can be minimised, since allergies are immediately identified and medical history is transparent. CMR is also extremely helpful in cutting administrative costs. As Dr Tyagi says, it will help in the evolution of the single-window clearance for the patients.

Kolkata-based Rabindra Hospital, as well as the Apollo and Escort network have successfully deployed telemedicine procedures. Says a researcher from the armed forces working on the telemedicine application: Many telemedicine systems are evolving and though some of them are good, most of them are far from realising their full potential until several fundamental barriers are overcome.

He adds that for development of next generation of telemedicine applications, some of the issues which need to be addressed are security, privacy, and integrity of medical information stored in computers and during communication over public networks.

Issues such as inter-operability and open architecture system to enable the creation of plug-and-play component-based solutions are also significant in this context. Ironically, the industry standard protocolCORBA (Common Object Request Broker Architecture)is being used only by a handful vendors.

Nevertheless, telemedicine is set to revolutionise the Indian healthcare industry. Even classification of hospitals on the basis of their specialisation is in the offing.

There will be public healthcare centres (PHCs), state healthcare centres (SHCs) and the super speciality hospitals (SSHs). Telemedicine will also help in evolution of the chain referral system, whereby patients will be referred to hospitals depending on their ailment. Telemedicine seems like a panacea for all the healthcare ills in India, but the government needs to get its act together and ensure that a secure and standard infrastructure is in place.