A newborn infant in an ICU in Bangalore is found to have an irregular heart rhythm. The neonatologist is unsure of how to treat this condition and requests a pediatric cardiology consultation. A sonographer from our institution visits the hospital, performs an echocardiogram at the bedside and uploads it to our teleechocardiography server. The baby’s ECG is also uploaded to the telecardiology server. Minutes later our pediatric cardiologist who is off-site reviews the images of both the ECG and the echo and has a telephonic consultation with the neonatologist wherein she recommends specific investigations and a clear course of management, and provides reassurance that can be in turn communicated to the anxious parents. The neonatologist signs off saying “thank you so much, that was extremely helpful”. The baby now has a plan.
This is a very simple and basic example of what telecardiology today has the potential to achieve even in an urban metro setting. Bangalore is a city of 11.5 million people, with a small handful of about 25 pediatric cardiologists to tackle complex medical issues that go beyond the scope of the training of pediatricians, neonatologists and adult cardiologists. And as every Bangalorean is only too painfully aware, the traffic and infrastructural challenges mean that getting from one location to another within the city is akin to intercity travel in terms of time taken. In this environment, having the capability to deliver subspecialized diagnostic and consultative expertise from off-site by leveraging information technology is of tremendous value, primarily by reducing the time taken to reach a diagnosis and secondarily by allowing physician time to be utilized much more effectively. This can either achieve the goal of ensuring prompt treatment for a life threatening condition or the equally important goal of parental reassurance in the setting of a minor, easily treatable condition.
What I believe this also highlights is that telemedicine to be successful, needs to be focused on delivering specific value in a specific environment of need, ie it works best with a ground up approach. Large scale projects, while certainly greater in potential impact also are at greater risk of spectacular failure. Even a large scale project therefore to be successful needs to be broken down into modules of efficient delivery.
Our experience in teleradiology has certainly been gained in a ground up manner. And at the other end of the spectrum, our experience in primary care telemedicine, namely in providing the most basic of primary consultations to a large rural population via 22 PHCs in Madhya Pradesh and Karnataka, has also given us valuable insight into how telemedicine can be most effectively deployed. A recent (http://www.rxdx.in/event/telemedicine-society-of-india-conference-karnataka-chapter/) and an upcoming (http://telemedicon2016.com/) conference both hosted in part by our team,
gives us opportunity to share such experience and work towards highlighting the value that telemedicine provides in this complex world we inhabit.
The gist of the learning to me personally is that in telemedicine, as in most things in life, focus is everything.