Telemedicine for Rural India – Health is not everything but everything else is nothing without health. One of the first pieces of literature known to humans, Rig Veda also says “In the beginning, there was a desire which was the first seed of mind”. In a nation with 1.3 billion people, out of them 700 million in rural areas, ensuring better healthcare access to everyone has been quite a task for the governing bodies.
The lack of proper healthcare infrastructure, doctors, pharmacists, and equipment has only added to those issues. How do we solve it? We hear every day about technology revolutionizing nearly everything, can it be used to offer affordable and efficient healthcare services to every Indian? No matter if he lives in New Delhi or a remote corner of Chhattisgarh. The world seems to have identified the right answer in terms of choosing the right technology, and Telemedicine it is!
What is Telemedicine?
The first spark of the idea came in with Dr. Hugo Gernsback in 1925, as it was illustrated on the cover page of ‘Science & Invention Magazine’. His original conception was of a spindly robot finger and radio technology to examine the patient from afar and show a video feed of the patient to the doctor. He named it “teledactyl” and over the next few decades, the world formalized the name ‘telemedicine’ which typically summarizes “the remote diagnosis and treatment of patients by means of telecommunications technology”.
The National Aeronautics and Space Administration (NASA) played an important part in kicking off the first commercial wave of telemedicine. Their first set of efforts in telemedicine started as early as the 1960s when humans began flying in space. Physiological parameters were transmitted from both the spacecraft and the space suits during missions.
In the modern world, telemedicine is rather more comprehensive. It is not just about getting a video feed of a remote patient. In the current generation, it’s about apps (mobile/desktop applications) that are installed on smartphones/tablets/desktops/ kiosks and offer multi-dimensional support in terms of organizing remote connectivity between doctor and patient using a video feed. Connected Blood Pressure Meter to Glucose Meter capable of immediately transferring the data to the apps and making it available for review in real-time.
Whereas all the primitive telemedicine infrastructure used simple technology protocols like Bluetooth and WiFi, to cater to the future, in terms of scale and accessibility, IoT (Internet of things) is the key.
The Internet of things (IoT) “is the internet working of physical devices, vehicles (also referred to as “connected devices” and “smart devices”, buildings, and other items embedded with electronics, software, sensors, actuators, and network connectivity which enable these objects to collect and exchange data.” Before getting to know how telemedicine could revolutionize rural healthcare, we need to understand two terms, namely preventive and reactive healthcare.
Preventive Healthcare: Preventive healthcare is all about keeping a strong check on changes happening to your body, which requires one to undergo health check-ups and routines at regular intervals and practice a lifestyle as per the outcomes of the trivial changes observed before it gets transformed into a disease or a serious health problem.
Reactive Healthcare: Reactive healthcare is more like responding to a situation. You’ve been diagnosed with a disease and are proceeding with corrective action or in the process of getting it diagnosed through advanced methods. For ages, Indians have not been known for keeping up with preventive healthcare standards. Although our roots are very strong in terms of trying to maintain a healthy lifestyle, nutritious food and all, seeing a doctor before a non-trivial change is observed in the body, more falls in for our tendencies to only react to the situations.
But in the last decade, it gradually started changing and we paid focus to preventive healthcare as well. Top corporates to govt. agencies made a big push for Yoga, marathons, and walkathons motivating people to know more about their body and keep it under a strong check, not just by controlling diet, but also observing the physical/chemical changes being followed. Just in time, the first wave of telemedicine did strike India as well when private sector healthcare providers started offering homecare services to elderly or to the ones in need of regular health monitoring.
As of today, there are several companies/ start-ups offering different forms of telemedicine platforms/assistance:
- Remote Consulting, which enables you to connect to a doctor when you need to through a smartphone/web app.
- Remote Monitoring, enable doctors to regularly keep a regular check on the body of a remote patient using connected devices, and get real-time access to his medical data/parameters.
- Health Kiosks/PHCs (Primary Health Care Centre), a small setup with or without the physical presence of a doctor could only be run by a para-medics. Could perform basic tasks like getting to know the basic health parameters of a person like blood pressure, blood glucose, and related things and facilitate a video consultation session with a doctor on demand.
Telemedicine for Strengthening the Rural Healthcare
Imagine a Primary Healthcare Centre which requires equipment and minimal staff installed at a remote location in a rural area. Locals could reach out at ease whenever in need. PHC could address basic pathology requirements meanwhile connecting to a qualified doctor over a video chat session who could use a digital stethoscope (IoT enabled) and get immediate access to blood pressure and other critical parameters for the first diagnosis.
A primitive solution like this could make a difference in the lives of people who have got to travel several kilometers from rural and far-flung inaccessible areas to the nearest town or suburbs to get access to even primary healthcare services. Although referrals/advance diagnosis could require more than this, it is just sufficient to build an effective first response system.
rural areas, set up under the national e-governance plan and run by village entrepreneurs. This will not only benefit 28 percent population with virtually no access to doctors but also will meet the needs of almost 70 percent of people residing in rural India with patchy access to quality medical practice.
It stationed 120 telemedicine officers at village councils with the hospital in Patna, Bihar’s capital city, as the nodal center. A similar start-up DoctorKePaas is organizing PHCs’ in remote corners of Andhra Pradesh taking in 200 patients a day and offering health packages (health scan and online consultation) at a cost as low as 100 INR per patient. In August 2015, the government of India launched a telemedicine initiative in collaboration with Apollo Hospitals under which, people can consult doctors through video links.
As part of the service named ‘Sehat’, people in rural areas can consult doctors online and also order generic drugs. The Common Service Centres (CSCs) have been delivering teleconsultation services with support from Apollo and Medanta in some areas and now with this initiative, the teleconsultation services are being extended to 60,000 CSCs across the country.
In July 2016, the Union Ministry of Health and Family Welfare signed a Memorandum of National Telemedicine Network (NTM) Providing services to remote areas by upgrading existing government healthcare facilities like MC, DH, PHC, SDH, and CHC in states. In the current FY,7 states have been provided financial assistance for providing Telemedicine. services.
Understanding (MoU) with ISRO to expand its telemedicine network to remote places. These telemedicine nodes would be consisting of VSAT System, diagnostic equipment like ECG Machines, X-Ray Scanner, and a paramedic staff who will recognize the vital stats before connecting the patient with the doctor over an online consultation.
In similar efforts, state governments have also been partnering in PPP (Public-Private-Partnership) model to set up telemedicine nodes. For example, in Himachal Pradesh, the government partnered with Apollo Group and have been running such nodes successfully in the remote district of Lahaul and Spiti. Benefits of Rural Tourism
Telemedicine Challenges
There would be fewer challenges in the implementation and effectiveness of telemedicine in rural areas, but one of the most critical challenges is to do it in time. Given that the largest segment of our population still lives in rural areas, it is important to do it and also, at an exceptional pace. And the govt. initiatives alone, to build up the required infrastructure would just not be sufficient.
The Silver Lining
The official Telecom Subscription data released by TRAI shows that Rural India has close to 500 million wireless telephone subscribers and is growing at a rate of 1.05% per month. Most of the international mobility forums also reported that India possesses one of the world’s largest Smartphone Internet user base. It proves that the cell/data network has reached the farthest corners of our nation.
If not the complicated VSAT/connectivity infra then a small PHC/telemedicine node could be tuned to run at a 2G/3G bandwidth-enabled smartphone internet connection. There are companies known, to be using such simple methodologies for setting up rural PHCSs’ in India and abroad. Increasing penetration of smartphone networks would add to simplify this further.
In a parallel effort, there is enough innovation happening in the IoT ecosystem, where the devices are being developed to consume low power and offer higher efficiency of connectivity to the provider network directly. This would help ensure seamless connectivity of PHCS’ to the nodal centers offering smoother functioning.