Monday, Jul 29, 2002
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By Aniket Alam
The APVVP has fixed low, and even free, user charges on various facilities to be provided and superspeciality hospitals of Hyderabad have been allocated different hospitals to link up with.
Dr. Anji Reddy feels that telemedicine is the perfect vehicle for a successful implementation of the private-public partnership in extending health services to the districts.
Apollo (Karimnagar) and CARE (Mahaboobnagar) already have telemedicine links with district hospitals. Nizam's Institute of Medical Sciences is on course to link up at least one district hospital before the end of August. CDR Hospitals too has plans to link up two districts.
It is through the development of software and the spread of communication infrastructure that telemedicine has actually become a public health possibility from being merely a technology demonstrator. Images transmitted over ordinary formats have too many distortions for medical use and there were problems of slow network speeds. Most importantly, integration of images, graphics, texts and voice in real time has often proved an obstacle to spread of this technology.
K. Subbarao, Director, NIMS says that the medico-legal aspects of telemedicine have still not been properly worked out. "Who owns the images and accepts responsibility for diagnosis made on the basis of these images,'' he asks. Till recently almost all the images transferred were not on the DICOM (Digital Imaging and Communication in Medicine) format which is the only internationally recognised format for medical image transfer. Moreover, most of the machines in use, like CT Scans, Echo colour Doppler and ECG, were analog based and thus not DICOM compatible.
Apart from that there were problems with bandwidth -- either it was too slow and unreliable or expensive and impractical. As recently as November last year the CARE link with Mahaboobnagar had to depend on the VSAT satellite link which cost upward of Rs. 27 lakhs to install and about Rs. 1 lakh to maintain every month.
The Mahaboobnagar telemedicine link is now working on a BSNL leased line of 2 mbps on its optical fibre cables network and costs about Rs. 25,000 per month.
Says V. Giridharan, Managing Director, Karishma Software Ltd, the software solution provider for the CARE - Mahaboobnagar link, "We can set up a completely functional telemedicine link, with integration of all high end diagnostic machines, video conferencing and online medical records availability, between any two centres in less than one week.'' The cost of the computer equipment and software too has come down to less than Rs. 7 lakh per centre.
The software links the high end diagnostic machines at the remote centre with the super speciality centre through real time transfer of images along with a parallel video conference between doctors at these two centres. It is this clarity of images and the possibility of interactive communication between doctors engaged in diagnosis that has set the benchmark in telemedicine.
The possibilities provided by this software solution has emboldened CARE to extend telemedicine links as far as Orissa and even Assam.
The Government of India has plans to spread telemedicine all over the country. R.R. Shah, Secretary, Union Ministry of Information Technology, told The Hindu that the Government was even considering the possibility of a dedicated "Health Satellite'' to provide enough bandwidth for this project. Andhra Pradesh can feel proud at having been in the forefront of this technology driven initiative, whether it was Apollo's technology demonstrator at Aragonda or the Hyderabad based Karishma Software's DICOM based solutions which even got a pat from our President a few weeks ago.
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