Telemedicine helps close distances as well as the gaps between the demand and supply of health services in all corners of the globe. We take a closer look at the concept.

A 16-year-old boy in the Democratic Republic of Congo lost his left arm. When Dr David Nott, a volunteer with the charity, Medecins Sans Frontieres, found him in a hospital in the town of Rutshuru in October 2008, he realised that the boy wouldn’t make it unless prompt action was taken.

The wound had become badly infected and gangrenous. The only way the boy could be saved was by amputating his shoulder, or more specifically, removing his collar bone and shoulder blade. Although Dr Nott lacked the expertise to perform this complex operation, he knew of a colleague in the UK who could guide him.

Telemedicine in its simplest form

Dr Nott text messaged his colleague asking for instructions. Almost immediately, he received a message detailing the entire procedure step-by-step. Still, he took a day to mull over whether he should go ahead—it was a bold step to take as he would be working in a very basic operating theatre with just one pint of blood for transfusion, sans the support of an intensive care unit for post-operative care. Eventually, he took the plunge, as the boy’s life depended on it. Fortunately, the surgery was successful and when the international media reported this news in December 2008, the boy was well on the way to making a miraculous recovery.

This case represents the simplest form of telemedicine. As Abhimanyu Gupta, director, Actis Technologies opines, “Telemedicine is the delivery of medical care at a distance. A broad term, {quotes}telemedicine may be as simple as two health professionals discussing a case over the telephone, or as complex as using satellite technology and video-conferencing equipment to conduct consultation sessions (in real time) between medical specialists in two or more geographically dispersed locations.{/quotes}”

Tailormade for India

Cut across to India’s remote hinterland and telemedicine is just as relevant as it is in Congo. Although about 70 per cent of India’s one billion plus population lives in rural India, 70 per cent of its medical community has opted to dwell in cities where both the work environment and the general living conditions are better. As a result, not only are medical facilities concentrated in urban areas, but these are also scarce. There is only one hospital bed available for every 1,333 Indians, and one doctor for 15,500 people. Only 9 per cent of our one billion people are covered under health schemes.

Added to this is the difficulty and cost involved in rural folk travelling to cities for medical care, the consequent over-crowding of health amenities in cities, and you have all the makings of chaos and discontent in the healthcare sector!

Telemedicine could save the day. Healthcare providers are increasingly becoming aware of telemedicine as a means to deliver healthcare across India’s vast geographical spread, thus eliminating the costs, hassles and time lag in people receiving healthcare.

The backbone of effective telemedicine

But the delivery of health services, remotely, is subject to a major proviso--not all technologies are conducive to sustain uninterrupted telemedicine services of a high quality.

Explaining this further, Gupta elucidates, “There is a wide array of conferencing products available (see box) from leading global brands. Most of these are at the cutting edge and can be easily customised to suit one’s need/budget. But, essentially, video-conferencing products that are based on standard definition technology prove to be limiting in the field, since these are associated with glitches such as inconsistent video and audio quality, narrow viewing angles, and the lack of readability of shared documents.”

According to Gupta, the way forward is for hospitals to adopt high definition video conferencing systems that assure a smoother video and audio quality, and enable wider display possibilities as well as a higher resolution that is essential to accurately share medical records.

If you think of the boy in Congo, Dr Nott would not have had to rely solely on text messages to perform the complex operation had telemedicine facilities been available at the hospital in Rutshuru. He could then have been guided in real time by his colleague, perhaps making for better post-surgery results or a back-up opinion and guidance in case he faced a complication during surgery.

In fact, {quotes}high definition telemedicine systems offering high visual acuity are essential to the success of guided medical care and critical in the case of remotely assisted life-saving surgeries.{/quotes}

On the other hand, in these times of economic recession, telemedicine also emerges as a means to optimise the use of scarce medical resources. Rather than have doctors sit idle, hospitals geared to cater to a higher patient load can offer consultations to distant patients, albeit for a lower cost. Of course, success and profits lie in the numbers of patients served.

Making technology accessible

While high definition video conferencing technology is taking current telemedicine systems to the next level, there are certain constraints. Shivasankar Krishnamurthi, country manager, LifeSize (India) observes: “Alongside offering high quality video, an ideal telemedicine solution should be cost-effective and simple to use so as to ensure its wide deployment.”

Krishnamurthi seeks to emphasise the fact that a single telemedicine system consists of an interface between hardware, software and a communication channel to spatially bridge two geographical locations. The doctor and patient, or doctor and assisted doctor, must feel as though they are face-to-face. But for telemedicine to make significant inroads across India, it must be deployed on a large scale. One or two systems will not make a difference to the millions of people living in India’s rural areas. Hospitals must be able to establish a network covering many remote rural hospitals and health centres. And that can be an expensive proposition.

Krishnamurthi cites the availability, quality and cost of bandwidth as another challenge in deploying this technology. In India, bandwidth infrastructure is still an expensive resource. Yet without adequate bandwidth, doctors cannot reach out to distant villages to offer remote diagnostic and medical consultancy services. In this context, he shares the need for a high definition telemedicine system to be capable of delivering high quality audio and video across all available bandwidths, and especially at low bandwidths.

Until that happens, telemedicine will be unable to deliver health services to the masses, notwithstanding its immense potential.