Biggest Opportunity for Healthcare in Rural and Small Town India – Tele-medicine In India and especially in a small-town rural health perspective, tele-medicine can add much larger value as compared to any other country

While no one will argue that the country's physical infrastructure is of poor quality, the data network in India is certainly among the world's best. This means that by using fast and affordable video connectivity doctors can treat patients anywhere in India. Certainly, some such patients may need to travel to a doctor to be treated, yet nearly 70per cent of the cases brought before a doctor can be diagnosed and subsequently treated simply by examining a patient during a video conference. This means that patients living in a remote corner of the country that is poorly connected with the rest of the world can nonetheless be treated by the best doctors in the world.

No one will deny that India is a vast country, both in the area and in the size of its population. Also, it's plainly obvious to anyone who lives in India that the country's physical infrastructure is simply inadequate to allow an easy commute to large urban centres from isolated towns and villages. However Indian doctors are counted globally as among the best and allowing such exception, doctors to treat Indians live in smaller towns, cities, and villages will lead to much higher quality healthcare across India.

What is Happening in Tele-medicine Currently?

It will be quite ignorant to say that there is nothing happening in Tele-medicine in the country. Biggest steps have been taken by the government itself through programs such as:

• Accredited Social Health Activists (ASHAs) who are part of the Government of India's (GoI) National Rural Health Mission (NRHM) are using basic telehealth programs for pregnant women and child

• NEHA and Digital India are using e-health means and programs in their campaigns

• Ministry of Health & Family Welfare has undertaken various initiatives using Information & Communication Technologies (ICT) for improving efficiency & effectiveness of the public healthcare system

Hospitals Using Tele-Medicine to Consult Their Patients

• The Apollo hospitals were one of the first to set-up a tele-medicine facility in a rural village called Aragonda 16 km from Chittoor (population 5000, Aragonda project) in Andhra Pradesh

• All India Institute of Medical Sciences (AIIMS), New Delhi

• Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS)Lucknow

• Post Graduate Institute of Medical Education and Research (PGIMER)Chandigarh

• A Coronary Care Unit inaugurated in Siliguri District Hospital, Siliguri, West Bengal

• Bankura Sammilani Hospital, Bankura, West Bengal inaugurated on 21 July 2001

• The latest to join in is Medanta Medicity hospital who launched their Medanta E Clinics website for teleconsultation

If the Government is Promoting and Big Hospitals are Interested in Pursuing Tele-Medicine, Then What is the Challenge?

A tele-medicine delivery is a 3-stakeholder process:

1. Stakeholder 1: The hospitals or doctors sitting (generally) in a big city and offering their services to patients via tele-medicine to rural patients

2. Stakeholder 2: The technology provider or tele-medicine facilitator who provides the platform and technology to connect doctors in big cities to patients in small cities

3. Stakeholder 3: The patients/a small clinic/primary care centre based in rural areas who wish to receive tele-medicine services from big hospitals/doctors sitting in big cities

Then who is the best fit to be facilitators

It must be private players, technology start-ups, private inventors and investors. It is a huge business opportunity and the private sector must take charge so that hospitals can focus on what they do best – Care for Health.

There are private players who work in the tele-medicine domain, but they are mainly focused on creating devices that enable tele-medicine. Few companies who are prominent in this space includes Neurosynaptic, Cardiotrack, etc.

In the past few years, few companies have taken up the challenge of creating a network of tele-medicine facilities across rural India. Private players are working towards this direction but there are miles to go before this becomes the national phenomenon as it deserves to be.

Can the tele-medicine quality be compared to that of a face to face connect?

Many of the historical tele-medicine debates have touched upon the effectiveness and quality of a tele-medicine consultation.

Now, most people would argue that a Facebook conversation doesn't require a technical skill-set but a healthcare conversation between doctor and patient require a much higher amount of sophistication. A few technologies that are available in India today for enabling a teleconsultation.

However today, things have changed massively. In today's tele-medicine consult between a rural patient and a doctor sitting in Delhi. The doctor can:

• See and talk with the patient in real time

• Take "Real Time" vitals such as

  12 channel ECG

  Pulse oximeter

  Height and weight

  Blood Pressure

  Glucose level for Diabetes and other chronic patients

  ENT camera

  Fetal Doppler for pregnant women

  Thermometer to measure temperature

  An optical reader for eye patients

  Spirometer

  And an electronic stethoscope where the doctor can hear the real-time auscultation voice of a patient heartbeat sitting thousands of miles away

  Many kinds of blood tests, etc

• The patient doesn't need to keep track of their prescription, the tele-medicine software does it for them

The Business of Tele-Medicine

Currently, in India, tele-medicine revenue comes majorly from the companies who make these devices for tele-medicine. Only a handful of private companies are facilitating tele-medicine in rural and small cities.

However, the opportunity is huge, to say the least. An average of 30-35per cent of admissions in big city hospitals come from small cities and villages from nearby areas. This is a huge number. It effectively means that each year millions of Indians travel to far of cities from home for better healthcare requirements.

Conclusion

In India and especially in a small-town rural health perspective, tele-medicine can add much larger value as compared to any other country. African countries have patients but not technology players and even good doctors, developed countries by virtue of being developed have little need, developing countries in SE Asia and LATAM are best positioned to use tele-medicine to their rural health advantage.