Healthcare ecosystem in India is still evolving. Considering the diverse landscape in India, various technologies have been considered for increasing access and improving the care outcomes. In this context Telemedicine continues to be a relevant discussion and one that many feel will ultimately solve our issues with care specially in the rural parts of the country. But has Medicine delivered on its potential? Or does more need to be done to harness the benefits of this technology. To get the answers for these questions we spoke to Dr Harsha Rajaram, Vice President, Telemedicine, Columbia Asia Hospitals Pvt. Ltd. Below are some snippets from the discussion.
Healthcare India: Last mile connectivity is one of the issues that constantly comes up while talking about Telemedicine in India. What’s your perspective on this and what can be done to improve the situation?
Dr Harsha Rajaram: In India, connectivity is still an issue. Challenges are three folds ‘penetration’, ‘reliability & speed’ and ‘affordability’.
While currently, the penetration is about 60% in Urban India, it is only 17% in rural India. The good news is, it is improving and growing at 22-25% in rural India. The ambitious ‘Digi Gaon/ digital village program’ focusing to connect 150,000 villages will hasten reduction in this gap; one of the focus of this project is connect Primary health centres to lead hospitals for provision of Telemedicine services. The other leverage is the ever-growing penetration of affordable smart mobile devices, which is the primary source of internet in rural India today, proving 92% of internet usage.
The fluctuating network and speed are the other concerns for having a seamless Telemedicine services. India currently, ranks 89th globally in connection speeds with an average speed of 6.5Mbps. The situation is changing rapidly; over the last one year we have improved speed by a whopping 87%. Moreover, in a short span the mobile network has moved from no ‘Gs’ to ‘4Gs’.
Making connectivity, the affordable key to adoption. We need to look at providing subsidise or free broadband access for Telemedicine services. This concession, if provided, will be miniscule compared to the big gains provided by Telemedicine in lowering the overall cost of healthcare.
Healthcare India: That”s interesting to hear but what are the other challenges that you see that are impeding successful Telemedicine programs in India?
Dr Harsha Rajaram: It is surprising, when across the globe digital transaction is part of everyday life, Telemedicine is yet to catch up as a mainstream tool. The main challenge is “Recognising Telemedicine” as a tool for healthcare delivery. The lack of framework for Telemedicine practise, reimbursement mechanism, ambiguity in legal and jurisdiction for Telemedicine practise has impeded Telemedicine being part of mainstream healthcare delivery. Clarity in these areas will automatically evolve a viable business model for providers to adopt the technology.
Technology is no more a challenge, since this space is only improving multi folds; lack of conducive policies is the barrier.
Healthcare India: Change Management is often considered a key issue in the implementation of Telemedicine Programs, how are doctors reacting to Telemedicine initiatives and what do you feel are the key success factors here?
Dr Harsha Rajaram: Change management is key to success of technology adoption. Change is driven by awareness, building user-friendly technology and backed by a good training program. More importantly, an incentive for adoption will hasten the implementation. In the western world, the incentive to keep patient away from the hospital to decrease the cost of care and recognising Telemedicine for reimbursement has fuelled the adoption.
Lack of clarity in policy framework and reimbursement for services has deterred the doctors from adopting Telemedicine at the anticipated pace.
Healthcare India: Please let us know a few examples of successful Telemedicine programs in India
Dr Harsha Rajaram: There have been many Telemedicine programs across the country for the last three decades. Few successful among them have been government driven projects like Onconet Kerala and ISRO/ NEC projects in northeastern states of India.
In private space, many corporate hospital chains have successfully adopted Telemedicine for engaging with its patient base.
Columbia Asia Hospitals has implemented Telemedicine as part of its e-health initiative to use technology to extend reach of its medical experts and optimize the medical resources. Columbia Asia successfully participated in technical demonstration for provision of remote ICU support – Tele-ICU to district hospital at Tumkur for over six months, in collaboration with Government of Karnataka and GE. Columbia Asia also provides regular e-OPD and follow-up services to patients both nationally like Maharajganj (U.P.) and internationally like in Kenya.
Healthcare India: If a rural hospital wants to implement a Telemedicine program what should be the key steps taken by them?
Dr Harsha Rajaram: The key is recognising passionate computer literate medical personnel, who can liaison effectively between the patient and the remote doctor. In addition, a good bandwidth and simple Telemedicine solution would be adequate to start tele consult. Based on the profile of the patient in the area, further enhancement of technology and devices can be incorporated. It is also important the regular tele-consult is supplemented with a physical visit by the remote doctor at least once, this goes a long way in establishing trust and confidence on the Telemedicine system.
Ensuring internet connectivity at the rural set-up
- Computer and basic equipment training of the staff
- A visit by the doctor at the unit to ensure trust among the staff and people. This is important, as the doctor works with the paramedical staff including nurses. So establishing confidence among the team with a physical presence will ensure undisruptive work, over a period of time. This is vital to ensure good communication between the doctor and the team, as for most of the time the doctor will be virtually available.
Also, there needs to be a third-party validation of the practising doctor for Telemedicine services. Apart from the infrastructure model, a financial model is necessary that accounts for all the stakeholders involved in Telemedicine.
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