Telemedicine utilization focusing on telemedicine speciality centre under ISRO in Bangalore medical college - A descriptive study.

Introduction

India being a huge country of are 32 lakh sq. km, and population over 1.2 billion. India has a huge urban rural divide of 68% living in rural. It also has inaccessible hilly regions, islands, desert, coasts, tribal areas. 75% of the qualified doctor’s practice in urban areas, which covers only 28% of country’s population. To provide the basic minimum healthcare for India’s population technology plays a pivotal role. Then what is the scope of technology? India has a huge number of highly trained IT Human resource professionals. We do have indigenous satellite Communication technology in place. Also, various pilot projects with successful outcomes are evidenced. Thus, is the scope of telemedicine in India. The primary aim is to reach the unreached through information management of the patients, giving low cost benefits, delivering service to large population. Telemedicine encompasses the major innovative contribution towards health. The effective utilisation of the technology forms the basis of daily living in modern era. So it is when it comes to health sector. A day is not far when diagnosis is not just a mere clinical diagnosis, but in terms of genetic diagnosis and molecular diagnosis. So much advancing is technology and its innovations. It is the use of electronic information to communicate technologies to provide and support health care when distance separates the participants. Telemedicine addresses when distance is the critical factor for imparting delivery of health services.¹

Be that asynchronous-where the narrative use of technology is provider to provider for second consultation or be that synchronous-where the patient interacts directly with the consultant, telemedicine has made a definitive contribution towards progress of India in terms of health. It is a way forward in delivering interactive or store and forward or remote patient monitoring. It can be point to point where there is a patient at one end or multipoint to multipoint. The mode of transmission of data is through advanced ISND or internet. The data relaying from the telemedicine consultation centre to the telemedicine speciality centre in through Interface between hardware, software and a communication channel.

Telemedicine significantly reduces the time and costs of patient transportation, provides easy access to remote unreached areas, in disaster management when there is just a on field health care provider and specialist second opinion and complex interpretations consultation is required.² Tele mentored procedures—surgery using hand robots are developed aiding the human kind. It can bring expertise to the medical practice once established through Continuing medical education and clinical research. It acts as a tool for public awareness.³ It aids in Disease surveillance and program tracking through geographical assessment of risk factor identification, epidemics identification, interventional planning, assessment of interventional strategies and their effectiveness. It aids in health education and Interactive health communication and disease prevention, by relaying information to those living in remote areas, supporting primary, secondary and tertiary modes of intervention through health promotion and disease prevention policies, and adopting healthy life-styles. The patients are benefitted by Access to specialized health care services to under-served rural, semi-urban and remote areas, early diagnosis and treatment, access to expertise of Medical Specialists,with reduced visits and travel expenses, thus reducing the health care expenditure. There can be maximum utilisation of limited resources, making geography meaningless. International ground rounds are hence made easy. In this regard, in India telemedicine evolved when in 2001 ISRO started a pilot project. Telemedicine system was installed in the School of Tropical Medicine (STM), Kolkata & two district hospitals. First telemedicine network between three institutions AIIMS-New Delhi, PGI-Chandigarh & SGPGIMS-Lucknow was started.⁴

Hence this study was conducted with the objectives of studying the utilization of telemedicine services andto explore the centre characteristics of Telemedicine Speciality Centre (TSC) at Bangalore Medical College and Research Institute.

Materials and Methods

This study is a descriptive study about the centre characteristics of Telemedicine Speciality Centre started by ISRO at BMCRI. This study was conducted for a duration of 3 months from June 15th to September 15th. Data was collected of the time period of September 2017 to August 2018. Data was collected using Centre's manual Telemedicine log book and ISRO project documents, training modules for centre specifications like room size, etc. Data was analysed by entering in MS excel sheet and analyzed using descriptive statistics and inferential statistics using SPSS software (version 20.0). Results expressed in terms of percentages, tables and graphs.

Results

1) Centre characteristics

The center characteristics as defined by ISRO has to be met is terms of room size, temperature, acoustics flooring and illumination. And as mentioned in the table 1, our center met these prerequisites.

2) Network characteristics

The bandwidth was 06-16 mbps for video conferencing. Now the network provider is Karnataka State Wide Area Network⁵ through ISDN. The centre uses SoftwareVitalware 3.0 version. As illustrated in table 2, the centre used computers, multimedia devices like camera, scanners and power backups. Also connectivity hardware like routers, modems and video conferencing devices were used for teleconsultations.

3) Utilization characteristics

As depicted in the figure 1 the number of teleconsultations were total of 1285 in from September 2017 to August 2019. Of these 23.7% were of store forward type while the 980 were of video conferencing sessions. The number of store and forward mode of referencing remained steady for the whole year but the number of teleconsultations steadily increased. Also, as depicted in figure 2, the number of teleconsultations were more in the field of dermatology when compared to other fields of urology, medicine etc. Of the total consultations 981 were of dermatology and rest others in the field of ophthalmology, pathology, ENT, pathology, radiology, physiotherapy

This clearly is in favour of the dire need of telemedicine in speciality branches like dermatology, emphasizing the need of urban rural gap of dermatologists and also explaining with regard to department characteristics. That is, it can be diagnosed using audio-visual aids.

Discussion

Study conducted by Ganapathy K et al., showed more than 56000 teleconsultations, making Apollo telemedicine a success story. Similarly, study conducted Ganapathy K et al., showed more than 34000 patients of Lahaul and Spiti (ht of 14000 ft in Himalayas) have been reached so far for teleconsultations.

Conclusion

We found that the Centre characteristics were in accordance to ISRO guidelines. Also with respect to network characteristics the TSC was equipped with necessary requirements. With respect to utilization characteristics, video conferencing was used more when compared to store and forward teleconsultations. Maximum teleconsultations are in the field of dermatology emphasizing the need and explaining with regard to department characteristics.

Recommendations

Beyond all its challenges to be faced, technology can still surpass and reach the unreached with no doubts. It is a new vehicle for the delivery of health care. It makes the national health care services more accessible, available and equitable. It may turn out to be the cheapest as well as the fastest way to bridge rural-urban health divide. There is a lot of positive attitude towards the usage of telemedicine. It is definitely cost effective in terms of travel, cost to the patients, making it accessible and affordable. There is high penetration reaching the unreached. It imparts better education. There would be definitely improvement in quality of study as it would be more practical and evidence based. Usage of telemedicine directly and indirectly would lead to economic growth and need based rapid development of technology. Tele mentoring of Primary care doctors should be emphasized toimprove speciality care in rural and make health care affordable and accessible. Emphasize on Teleconsultations in the field of departments like dermatology and psychiatry where audio visual aids can be used. Rapid development of mobile broadband is a great promise for improving e-health.