‘Telemedicine is a thrust area in India’s race to become a developed nation’

Neurosurgeon and director Telemedicine Apollo Hospitals, Chennai, Dr K Ganapathy, in conversation with Rita Dutta about impact of telemedicine and its potential to revolutionise healthcare delivery in India

What’s the impact that telemedicine had so far on the Indian healthcare scenario?

The Indian healthcare industry is obviously one of the biggest industries in the world, every sixth individual on this planet being its consumer. To expect a fledgling different method of healthcare delivery (ie telemedicine) to have a significant effective impact on the healthcare scenario so soon, is to turn a Nelson’s eye to the stark realities.

However, there are oasis in a desert. In the last five years, thanks to the relentless work done by several groups of committed champions of telemedicine spearheaded by the Apollo Hospitals, a beginning has been made. The Indian Space Research Organisation (ISRO), SGPGI Lucknow, SRMC Chennai, AIMS Kochi, Narayana Hirudalaya have all contributed to this. Today, there are probably about 120 telemedicine centers in the country.

The first international conference on telemedicine organised by ISRO on behalf of the Govt of India will take place at Bangalore in March 2005. As the chairman of the scientific committee, I am pleased with the response and the excellent programme we have been able to put together. We expect the impact to be much more after this meeting.

Telemedicine was dubbed to revolutionise healthcare delivery. Has it lived up to the promise?

Telemedicine, as we know it today, has not really come of age even in advanced countries where it has been introduced less than two decades ago. It takes time to create a revolution. The exponential growth in ICT, the plummeting costs and the increasing awareness of telemedicine leaves no doubt in my mind that telemedicine will certainly revolutionise healthcare delivery in India sooner rather than later.

Telemedicine has certainly revolutionised delivery of healthcare in several countries in Europe where its need is crucial. President Abdul Kalam in his Republic Day address used the word “telemedicine” five times. Obviously, telemedicine is a major thrust area in India’s race to become a developed nation.

What factors have led to the growth of telemedicine?

The exponential growth in ICT and the plummeting costs making it cost effective have been major factors. The role played by the ISRO in not only providing VSAT’s but also telemedicine hardware and software have also contributed.

The enthusiasm displayed by the pioneers - Apollo Hospitals, Narayana Hridulaya, AIMS Kochi, SGPGI Lucknow, SRMC Chennai who have championed the cause steadfastly has resulted in increased acceptance. Attempts by the Ministry of Information Technology, Govt of India to standardise digital communication in telemedicine have also been helpful.

However, the growth has not yet reached the critical mass necessary for a take off. For this, it is essential that awareness permeates throughout society. Real growth will take place only when society realises that today distance is meaningless and that telemedicine can bridge the gap between the haves and the have-nots at least in so far as access to healthcare is concerned.

What are the adverse effects of this technological innovation? Will telemedicine open access to the knowledge-base or will it be abused? If it will be abused, what are the ways to curb the abuse?

Progress is always a two-edged weapon. The free access to what was once highly specialised medical information may perhaps change the way medicine will be practised.

Earlier on only the doctor possessed the knowledge to make the right diagnosis and select the appropriate therapy Today, the patient is part of the decision making process. Tomorrow it may be the doctor who is also part of the decision making process!

Quack dispensers of health information may start using ICT. In our anxiety to start telemedicine centers in rural and suburban India, it is essential that we ensure that basic minimum standards are met.

Methods of curbing abuse include special licensing procedures for starting telemedicine centers. Factual knowledge available through ICT cannot replace the wisdom of the grey-haired doctor. The public must be educated that all information on the net is not necessarily correct.

How do we address the fear of people who say that telemedicine has depersonalised relationship between the doctor and the patient?

This is all a state of the mind. One also has to accept the fact that if it was a choice between having one’s illness cured through a remote teleconsultation versus having your hand held by an extremely sympathetic but ignorant doctor, most would prefer the former.

The ideal scenario is where the urban elitist super specialist virtually wipes a tear of his rural patient. Many countries have started addressing these issues by starting courses on ethics and humanism in conjunction with the use of hi tech gizmos. Indian doctors all over the world excel because of their innate ability to combine professionalism with compassion.

Pastoral, as well as technical skills, art as well as science is required. This has to be taught in medical school now so that when telemedicine is common place this will not be forgotten. What are the various issues/challenges in implementing telemedicine?

Firstly, acceptance of this modality by society, patients, family physicians, specialists, administrators and the government. Secondly, designing cost-effective appropriate technology connectivity, hardware and software. Thirdly, standardising, certifying, authenticating and registering telemedicine units so that minimum safe standards are uniformly adopted.

Fourthly, running short-term courses to train the trainers and the users. Fiftly, drafting and passing a telehealth act for India. Sixthly, payment to teleconsultant to make the scheme attractive and viable. Seventhly, getting grants, subsidies and waivers to introduce this suburban and rural areas. Eightly, getting Indian telemedicine units recognised by other countries so that we can provide overseas teleconsults for revenue generation which can be used to subsudise rural telemedicine. Lastly, introducing telemedicine in the medical/ IT curriculum.

What is the current fate of the legislation related to telemedicine?

Very few countries in the world have clear legislation related to telemedicine. The detailed information is however readily available on the net. Though we are a long way from passing legislation on telemedicine related issues a beginning has been made. ’Guidelines & Standards for Practice of Telemedicine’ in India has already been recommended by the Ministry of technology Govt of India. The Medical Council of India has also constituted committees to look into this and other legal aspects of telehealth.

We have to understand that worldwide legislation can never ever keep up with changing technology. It is an erroneous perception that growth of telemedicine will be hampered because legislation on this is not available. Let us not put the cart before the horse. Rome was not built in a day. Necessity is the mother of invention. Once telemedicine is more widespread , more attention will be paid to legislation issues.