India Insight

Telemedicine in India might be just what the doctor ordered

June 4, 2014

Between surgeries and hospital rounds one recent day, Dr. Rajiv Parakh made a dash into his Gurgaon office for an appointment he couldn’t miss: a consultation with a patient who lives hundreds of kilometres away.

Seated before his laptop in this city on the outskirts of India’s capital, the surgeon listened as a patient in Bangladesh’s capital Dhaka described his swollen legs. For the next 20 minutes, Parakh examined the patient via Web camera, made a diagnosis and prescribed treatment.

The bespectacled Parakh, a practising doctor for nearly 30 years, spoke in Hindi during the session, enunciating his words for clarity.

Medanta, the multi-specialty hospital where he works, started its free telemedicine service about a year ago as an outreach service for patients who cannot visit the hospital.

“In-person consultation is obviously the gold standard,” Parakh told India Insight. “But if we have a doctor at the patient’s end, especially somebody who he trusts and who he knows, we can be reasonably comfortable about prescribing treatment.”

Medanta is one of several e-health providers that say they want to change how healthcare is delivered in India, and address the industry’s two biggest problems: accessibility and lack of manpower.

India has 0.7 physicians per 1,000 people — BRIC peers Russia (5), Brazil (1.5) and China (1.5) have better ratios — and most Indians travel about 20 kilometres to reach a hospital, according to a 2012 report by accounting firm PricewaterhouseCoopers (PwC).

teleHaving direct interaction with a specialist is nearly impossible for many patients since most specialist doctors live in cities, while 70 percent of India’s population lives in rural areas.

Even in cities, health workers say hectic lifestyles and longer commutes make it tough to visit the doctor.

But with nearly 900 million mobile phone connections and over 200 million internet users, experts say wireless technology can be harnessed to decentralise India’s healthcare industry, which is expected to touch $250 billion by 2020.

“Whatever you would have done in a physical hospital in the outpatient department can be achieved by sitting at home in front of a technologically enabled device like a tablet, a PC or a mobile phone,” said Debraj Shome, co-founder of MediAngels, which has specialist doctors from 15 countries on its rolls.

Health portal MediAngels has specialists from the United States and Italy available for Web chats or video calls. iClinic has telemedicine centres in smaller towns that connect patients to specialists in India’s cities. Mediphone, a countrywide medical phone service, costs 35 rupees (60 cents) per consultation.

Amit Dhiman, 33, suffered from nasal polyps and tried Medanta’s telemedicine service for a second opinion without taking a day off from work.

“We are in a corporate world, we get very less time, so I found that this medium is very useful for me because I can interact with the doctor directly without being in a queue,” said Dhiman, a data analyst with an IT services and consulting firm in Noida, southeast of Delhi.

Debasis Sarkar in Siliguri, West Bengal, used the service after meeting several doctors for the treatment of his wife, a singer who developed an “inconsistent fracture” in her voice.

“After the first consultation with the doctor through this telemedicine, I could have a brief idea about the [medical] procedure which is going to take place, so I could plan my trip [to New Delhi for treatment], I could plan my finance and prepare my family,” said Sarkar, speaking by phone from Siliguri.

Several state governments such as Maharashtra and Andhra Pradesh have launched free medical helplines. There also are private companies, such as Mediphone. Started in 2011, the paid service has more than 1,000 phone calls each day seeking medical advice, with 33 percent of the calls coming from Bihar, one of India’s most underdeveloped states.

“[In Bihar] somebody was collapsing and our operators gave [the caller] advice on how to do CPR and saved a life,” said Maninder Singh Grewal, managing director at HealthFore, the healthcare solutions firm that launched Mediphone along with mobile phone carrier Airtel.

iClinic, a start-up that started operations in October, has telemedicine centres in eight towns where patients can consult around 70 city-based specialists via video conferencing. This month, it also launched a 24/7 health portal.

“We have proved the concept works. We need to now stabilize the revenue and we need to start expanding in all parts of India because today there are 12,000 towns in India which have got 3G and broadband,” said Sanjoy Mukerji, managing director at iClinic.

Newer and smarter health devices are also helping the industry’s growth. Heart and blood pressure monitors can now wirelessly transmit the patient’s data to mobile phones or a central online database accessed by telemedicine centres.

“Almost all the big manufacturers are looking at developing devices with mobile functionality,” said Ankur Bharti, a consultant at PwC India. “Telemedicine centres have started picking up in the last one year because of these devices.”

Hospital operators such as Apollo and Fortis are also stepping into telemedicine, lured by lower costs and a pan-India reach.

“Hospitals have kind of understood how remote healthcare can give them better ROI [return on investment]. The telemedicine centre that cost you 125,000 rupees ($2,120) can give you 25 percent margins by the end of the year,” said Ruchi Dass, Founder & CEO at HealthCursor Consulting Group.

Despite the benefits of telemedicine, some users don’t see neighbourhood physicians and hospitals shutting up shop any time soon.

“There is no alternative to seeing a doctor face-to-face, at least not now,” said Sarkar.

(Editing by Robert MacMillan and Tony Tharakan; follow David on Twitter at @davidlms25, Robert @bobbymacReports and Tony @TonyTharakan. This article is website-exclusive and cannot be reproduced without permission)

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