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| REVIEW ARTICLE |
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| Year : 2016 | Volume
: 4
| Issue : 1 | Page : 3-8 |
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Telemedicine and telehealth - The Indian scenario
A Singh1, A Roy2, P Goyal3
1 Assistant Professor, Department of Community Medicine, SHKM Govt. Medical College, Mewat, Haryana, India
2 Deputy Director Health, Directorate of Health Services, Port Blair, Andaman & Nicobar, India
3 Associate Professor, Department of Community Medicine, ESIC Medical College, Faridabad, Haryana, India
| Date of Web Publication | 29-Aug-2018 |
Correspondence Address:
A Singh
Assistant Professor, Department of Community Medicine, SHKM Govt. Medical College, Mewat, Haryana
India
 Source of Support: None, Conflict of Interest: None  | 3 |
DOI: 10.4103/2347-6486.240041
The health care industry is currently undergoing a massive and irreversible transformation and change. Time is approaching when telemedicine/e-health initially shall be visibly practiced in majority of the Indian hospitals as a separate department before eventually fusing into respective medical specialties in spite its slow growth in India. This review appraises current scenario of telemedicine and telehealth in India. Official documents belonging to the Health ministry and finally related literature were examined. Telemedicine can enhance basic/specialty healthcare for India’s population which is predominantly rural. Indian Medical Personals, by large are not computer savvy’s, virtually lack awareness and exposure with regard to the application of information and communication technology in Medicine. These are foremost bottlenecks to the growth of Telemedicine in India. The present study outlines telemedicine strong and weak points. Undoubtedly, the advantages outweigh its disadvantages, but just like any other innovations, it has some drawbacks.
Keywords: Telemedicine, Telehealth, Advantages, Drawbacks, Benefits, Bottlenecks, India
How to cite this article:
Singh A, Roy A, Goyal P. Telemedicine and telehealth - The Indian scenario. J Integr Health Sci 2016;4:3-8 |
| Introduction | |  |
Telemedicine is the use of telecommunication and information technologies in order to provide clinical health care at a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities. It is also used to save lives in critical care and emergency situations.[1],[2]
Although there were distant precursors to telemedicine, it is essentially a product of 20th century telecommunication and information technologies. These technologies permit communications between patient and medical staff with both convenience and fidelity, as well as the transmission of medical, imaging and health informatics data from one site to another.[3] Early forms of telemedicine achieved with telephone and radio have been supplemented with videotelephony, advanced diagnostic methods supported by distributed client/server applications, and additionally with telemedical devices to support inhome care.[4] Government of India is committed to provide best telecommunication and information technologies to its citizens.[5],[6],[7]
This review appraises current scenario of telemedicine and telehealth in India. Official documents belonging to the Health ministry and finally related literature were examined.
Regarding disambiguation in the term, other expressions similar to telemedicine are the terms “telehealth” and “eHealth”, which are frequently used to denote broader definitions of remote healthcare not always involving active clinical treatments. Telehealth and eHealth are at times incorrectly interchanged with telemedicine. Like the terms “medicine” and “health care”, telemedicine often refers only to the provision of clinical services while the term telehealth can refer to clinical and non-clinical services involving medical education, administration, and research.[8]
Telemedicine is the use of electronic communication and information technologies to provide or support clinical care at a distance. Tele-health, a broader concept, is the use of electronic information and telecommunications technologies to support longdistance health care, patient and professional health-related education, public health and health administration”.[9],[10]
A key concept in the definition is distance between the participants, a factor that makes this technology especially useful in rural settings. These systems represent one method of linking urban concentrations of physicians with widely dispersed groups of rural patients and their caregivers. Technological advances and price reductions both in computing and communications equipment and in transmission charges have made the use of these tools more feasible.[11]
Indian scenario
In India, Telemedicine is catching up though slowly, a couple of private Telemedicine service providers/clinics (for second opinion with their counterparts in the developed countries) have come up in large cities of India in recent past.[12] Web based Telemedicine solutions are gaining popularity owing to internet’s low cost and almost universal availability. The Ministry of Communications and Information Technology, Government of India, has classified “Telemedicine” as one of the thrust areas for development in the country.[13]
In today’s world, despite several advances made in the Medical field, the benefits are still available to the privileged few residing mainly in the urban areas. 75% of the qualified Doctors and Specialists practice in urban centres. Whereas, the vast majority of India’s population lives in rural areas. Telemedicine can enhance basic/specialty healthcare for India’s population which is predominantly rural.[14],[15]
Telemedicine may turn out to be the cheapest, as well as the fastest, way to bridge the rural–urban health divide. Taking into account India’s huge strides in the field of information and communication technology, telemedicine could help to bring specialized healthcare to the remotest corners of the country.[12],[16]
The efficacy of telemedicine has already been shown through the network established by the Indian Space Research Organization (ISRO), which has connected 22 super-specialty hospitals with 78 rural and remote hospitals across the country through its geostationary satellites. This network has enabled thousands of patients in remote places such as Jammu and Kashmir, Andaman and Nicobar Islands, the Lakshadweep Islands, and tribal areas of the central and northeastern regions of India to gain access to consultations with experts in super-specialty medical institutions.[17] ISRO has also provided connectivity for mobile telemedicine units in villages, particularly in the areas of community health and ophthalmology.[18]
Types of telemedicine
Telemedicine can be broken into three main categories: store-and-forward, remote monitoring and (real-time) interactive services.[19]
Store-and-forward telemedicine involves acquiring medical data (like medical images, biosignals etc.) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline. It does not require the presence of both parties at the same time. Dermatology (cf: teledermatology), radiology, and pathology are common specialties that are conducive to asynchronous telemedicine. A properly structured medical record preferably in electronic form should be a component of this transfer. A key difference between traditional in-person patient meetings and telemedicine encounters is the omission of an actual physical examination and history. The ‘store-and-forward’ process requires the clinician to rely on history report and audio/video information in lieu of a physical examination.
Remote monitoring also known as self-monitoring or testing, enables medical professionals to monitor a patient remotely using various technological devices. This method is primarily used for managing chronic diseases or specific conditions, such as heart disease, diabetes mellitus, or asthma. These services can provide comparable health outcomes to traditional in-person patient encounters, supply greater satisfaction to patients, and may be cost-effective.
Interactive telemedicine services provide real-time interactions between patient and provider, to include phone conversations, online communication, and home visits. Many activities such as history review, physical examination, psychiatric evaluations and ophthalmology assessments can be conducted comparably to those done in traditional face-to-face visits. In addition, “clinician interactive” telemedicine services may be less costly than in-person clinical visit.[20]
Benefits and uses
Telemedicine can be extremely beneficial for people living in isolated communities and remote regions and is currently being applied in virtually all medical domains. Patients who live in such areas can be seen by a doctor or specialist, who can provide an accurate and complete examination, while the patient may not have to travel or wait the normal distances or times like those from conventional hospital or GP visits. Recent developments in mobile collaboration technology with the use of hand-held mobile devices allow healthcare professionals in multiple locations the ability to view, discuss, and assess patient issues as if they were in the same room.[21]
Telemedicine can be used as a teaching tool, by which experienced medical staff can observe, show, and instruct medical staff in another location, more effective or faster examination techniques. It improved access to healthcare for patients in remote locations.[22]
Telemedicine has been shown to reduce the cost of healthcare and increase efficiency through better management of chronic diseases, shared health professional staffing, reduced travel times, and fewer or shorter hospital stays. Several studies have documented increased patient satisfaction of telemedicine over the past fifteen years.[23],[24]
Tele-monitoring is a medical practice that involves remotely monitoring patients who are not at the same location as the health care provider. In general, a patient will have a number of monitoring devices at home, and the results of these devices will be transmitted via telephone to the health care provider. Telemonitoring is a convenient way for patients to avoid travel and to perform some of the more basic work of healthcare for themselves.[25]
In addition to objective technological monitoring, most telemonitoring programs include subjective questioning regarding the patient’s health and comfort. This questioning can take place automatically over the phone, or telemonitoring software can help keep the patient in touch with the health care provider. The provider can then make decisions about the patient’s treatment based on a combination of subjective and objective information similar to what would be revealed during an on-site appointment.
Some of the more common things that telemonitoring devices keep track of include blood pressure, heart rate, weight, blood glucose, and hemoglobin. Telemonitoring is capable of providing information about any vital signs, as long as the patient has the necessary monitoring equipment at his or her location. Depending on the severity of the patient’s condition, the provider may check these statistics on a daily or weekly basis to determine the best course of treatment. The first Ayurvedic telemedicine center was established in India in 2007 by Partap Chauhan, an Indian Ayurvedic doctor and the Director of Jiva Ayurveda. Teledoc used Nokia phones running Javascript to link mobile ayurvedic field techs with doctors in the Jiva Institute clinic; at its peak, Teledoc reached about 1,000 villagers per month in Haryana province, primarily treating chronic diseases such as diabetes.[26],[27]
Indian Medical Personals, by large are not computer savvy’s, virtually lack awareness and exposure with regard to the application of information and communication technology in Medicine. These are foremost bottlenecks to the growth of Telemedicine in India. Time is approaching when telemedicine/e-health initially shall be visibly practiced in majority of the Indian hospitals as a separate department before eventually fusing into respective medical specialties. Benefits and Bottlenecks for the growth of Telemedicine in India are summarised below. [Table 1]. | Table 1: Summary of benefits and Bottlenecks for the growth of Telemedicine in India
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| Conclusions | | |
This review outlines strong and weak points of current scenerio of telemedicine in India. Undoubtedly, the advantages outweigh its disadvantages, but just like any other innovations, it has some drawbacks. In order to overcome these challenges judicious use of currently available money, man power and material is needed in resource constrained setting like India. More and effective public-private partnerships, governmental support could improve telemedicine services in the country.
| References | | |
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[Table 1]
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