For any government, ensuring that all citizens have access to quality healthcare is afundamental responsibility and an essential economic function. Healthcare must be accessible, affordable, and responsive, both to the constantly changing medical and clinical needs of patients as well as to the broader demographic, social, and cultural shifts that typify the modern world.

The health status of a country is the complex interplay of a variety of factors like economic growth, per capita income, literacy, education, age at marriage, birth rates, nutrition, access to safe drinking water and healthcare infrastructure. In countries like India rural healthcare IT infrastructure needs to be upgraded and modernised to enable faster, safer and more efficient delivery.

IT implementation apart, innovative models of public private partnership and capacity building through technologies like Telemedicine are needed to address the challenges of ‘access’ to affordable and quality healthcare in rural areas.

Why Telemedicine?
Telemedicine employs collaborative technologies to facilitate a virtual doctor-patient encounter. These solutions combine voice, video, medical data, and collaboration tools, to facilitate a patient to see a doctor, without having to travel long distances. They enable patients, providers, and allied health workers to come together on a common platform and collaborate in real time.

Such solutions give doctors tremendous flexibility to divide their time between virtual and physical consultations. They allow patients to be seen quickly without delay, improving the efficiency and effectiveness of healthcare and clinical outcomes. Telemedicine solutions are designed to work on a lower bandwidth, enabling healthcare providers to serve patients in remote locations, where last mile connectivity is a lingering problem. They are flexible, and do not need expensive infrastructure or dedicated space. They can be set up pretty much anywhere, as long as there is the minimum bandwidth.

Patients can present themselves at any location be it a medical kiosk in a remote village, retail centre, corporate office, or their own home. The solutions can also be set up in a Mobile Health Unit e.g. a bus or ambulance, which would allow healthcare services to be provided to remote locations, circumventing the issue of delay in getting together specialists, nurses, and physicians to these locations.

The Mobile Health Unit, equipped with essential drugs, biomedical devices, laboratory equipment, and disposables, can go from place to place, providing healthcare services to the underserved communities and rural citizens. These units can be quickly mobilised to areas which require urgent healthcare services in the event of calamities like floods, earthquakes, epidemic outbreaks, etc. This allows the central pool of doctors and specialists to be located at a hospital and provide consultation on demand to remote locations.

Telemedicine solutions allow doctors to capture, store, and retrieve patient details such as demographics, patient history, allergies, clinical findings, vitals and medications. Readings from the medical devices are made available to the clinician to facilitate a quicker and more accurate diagnosis. The physician or the specialist can also write prescriptions digitally. The user friendly interface and the flexibility to integrate these solutions with existing Hospital Information System and Electronic Medical Records, make them easy to use, deploy, manage and economical to run and maintain.

A solution like Cisco HealthPresence Extended Reach for example, is a desktop-based telemedicine solution, based on Cisco’s Unified Communications technology and can run on low bandwidth internet (512 kbps). It has medical device connectivity to allow sharing of vital medical data with physician providers and specialists in real time.

Telemedicine-as-a-Service:
Telemedicine services can also be offered by various Telecom Service Providers, who can bundle the service along with bandwidth. Healthcare providers can use the telemedicine solution as a managed service by paying a monthly subscription fee or on a per consultation basis.

Telecom Service Providers can market this service to a wide cross section of hospitals who can offer affordable Telehealth services to citizens. Hospitals can also offer this as a value added service to their patients, and charge them on a subscription basis. This provides an added advantage because healthcare providers need not make upfront investment in the technology infrastructure.

Implementation challenges
Nearly seventy percent of India’s population lives in rural areas and disparities in the access to basic healthcare exist between the various income groups, communities, states and even the districts within a state. Factors like low paying capacity of the rural population, inadequate medical facilities, and difficulty in retaining doctors in rural areas, compounded by the cost of implementing technology infrastructure act as deterrents for implementation of IT enabled rural health care services. Bandwidth availability is another challenge. Lack of adequately trained IT personnel can become an issue while implementing an IT project.

Implementing an IT solution is a challenge also because in general the healthcare stakeholders are resistant to changes in their well-established work practices. There is a tendency to resist change because they are seen as contributing to a higher workload, or because the stakeholders are forced to learn new skills. Good ‘Change Management’ efforts on the part of the solution vendor are critical to make IT initiatives a success.

Ray of hope
While rural India is still grappling with lack of basic healthcare, telecommunication infrastructure in the country has seen remarkable progress. Access to broadband internet connectivity in rural areas is steadily increasing and the adoption and penetration of internet has shown tremendous growth. The advances in medical science and Information and Communication Technology (ICT) offer wide opportunities for improved health care. The Internet is playing a pivotal role in providing a cost-effective healthcare to a widely dispersed population.

Sustained efforts from both the Government and private sector help create uniformity in healthcare availability. To capitalize on technology investments now and in the future, rural hospitals need an integrated IT network that helps diverse entities to collaborate and communicate effectively.

Over the last few years, the government, NGOs and a few private companies have tried to crack the technology barrier and provide affordable and specialized health care via Telemedicine. For example, Cisco and Apollo hospitals have conducted a number of pilots in rural areas in Karnataka and Tamil Nadu to provide easy access to healthcare.

Similarly, Cisco has collaborated closely with the Government of Karnataka in a public- private partnership to provide telemedicine in Raichur district which was affected by floods in 2009. A Cisco HealthPresence solution has been deployed there helps 30,000 villagers to get access to doctors across several specializations and includes pediatricians, gynecologists and cardiologists. In addition to saving time and costs the project has garnered positive feedback from its beneficiaries.

Such and other efforts can go a long way in ensuring that the health status of the country improves significantly.