Technology to help take healthcare to rural areas

by Darinia Khongwir    Apr 02, 2013

Kiosk with patient

Healthcare in India is still a rare commodity in India with over a large percentage of the population unable to access it because of geographic encumbrances. The doctor to patient ratio in the country is still an abysmal 1:2,900 and India is ranked 135th out of 170 countries in the world that has access to healthcare.

Technology can play a big role in trying to bridge that gap so more and more people in rural and semi-urban areas can access a medical practitioner where none is available. Medical enterprises like eHealth Access is taking technology via Internet and mobile to help patients and doctors communicate with each other and deliver actionable insights.

Key platforms

eHealth Access helps doctors, irrespective of where they are based, reach out to patients via video-consultation. The consultation takes places in a kiosk that has ECG machine and stethoscope and manned by a trained paramedic. The doctor attending the patient can stream in real-time the ECG and listen to patient’s pulse rate via videoconferencing, using just a computer and a 3G datacard.

“A doctor just needs a computer and a phone. And in a village of say 5,000 residents at the kiosk, they can immediately access over 500 doctors – and all kinds of specialists. Residents just need a kiosk of 5X5 square feet and a 3G connection datacard and the village immediately becomes a doctor-enabled village. So, this is one way of making the Universal Health Program a reality,” said Ram Prabhu, Technology Director, eHealth Access.

The process also keeps personal health records – which keeps each and every medical history of the customer – his or her previous history and current medication so doctors will have a holistic view of what the patient needs. And the doctor will be able to give a proper diagnostic based on the current history of the customer.

“Neither the patient nor the doctor have to move anywhere. Both can sit in the comfort of his/her own home and consult. We have 540 specialists working with us. So, if there is a skin issue, if the skin specialist is in Bhopal, the patient does not have to go to Bhopal. He can sit in the kiosk and consult with the doctor,” said Prabhu.

Patients who are more net-savvy can also access doctors via the eHealth Access portal. Patients can log on to the portal and ask questions or email doctors directly on the site to get an appointment. It even allows patients to upload scanned reports or lab results to get a second opinion.

The third option is mobile phone. With more and more people having access to a mobile phone, patients in urban and semi-urban areas can get a consultation over the phone. “So, we have leveraged the ubiquity of the mobile phone to help patients gain access to a doctor via dial-a-doctor initiative. By using a mobile phone, customers in pan India will be able to talk to a doctor 24/7. Doctors can view your reports on the site of sent via the kiosk to access medical history and make a diagnosis. The prescription is sent via a SMS where patients can fill out at any pharmacy,” said Prabhu.

It is often argued that with Internet penetration being so low in India, the feasibility of the project is still in doubt. However, Prabhu allayed such fears saying that a pilot was conducted in Andra Pradesh and one more Gujarat a week ago. The patients were able to access doctors using a datacard.

“We took a case study of North East India where the doctor-patient is patient is abominable. We ran the pilot in Arunachal Pradesh, Nagaland, Manipur and Tripura, we were not able to find a doctor-patient ratio at all. But when we look at the Internet penetration, it was found that we were find Internet and telephone penetration all over North East India. All the service providers were available there. So why are we not able to leverage the technology available there and set up a kiosk? That will make the most of India healthy. That is what prompted us to leverage 2G and 3G datacards to reach out to doctors and use the present day models to be deployed anywhere in India,” said Prabhu.

Infrastructure

eHealth Access will install the kiosk, support and operate it. The kiosk is a manned process where a paramedic is trained and supported and executed by eHealth Access through a NGO or government agency. Ehealth Access is responsible for the daily execution of the kiosk, keeping records, getting the information to the doctors and getting the doctors available.

The company is working with local government agencies to create job opportunities for local youth of the area. “So, we are not only looking after their medical needs but also provide a job opportunity for them. So we create a curriculum for them to undergo training. After which we will certify them as a paramedic and they can man the kiosk every day. The key benefit of this is the local person is fluent in the local dialect and hence communication will not be a hindrance in getting world-class medical care,’’ said Prabhu.

Currently, the services are available at Rs 499-Rs 999 per patient per annum. The kiosk costs about Rs 3.5 lakh and running it with a paramedic in place could cost Rs 4.5 lakh per annum Corporate houses and urban customers pay for the services individually. But in rural areas, the government and NGO sponsor the patient. Some of the kiosks that are running are sponsored by the government or NGOs and the people benefit from it.

Access to pharmacy

Access to a pharmacy is also a key concern for many.  eHealth Access is addressing this problem by aiding the paramedic manning the kiosk to set up a pharmacy next to it.

“We are ambitioning for the future that pharmacies that are in local areas, will be our agents so they can attach the kiosk and deploy it in that place. This could work either ways. If there is a pharmacy with no doctors, the chemist can attach the kiosk to it and deploy it. If there is a kiosk, it will make good business sense to set up a pharmacy next to it. So entrepreneurship will be groomed from the people we are coaching. Over time wherever a kiosk is deployed, the paramedics can also turn entrepreneurs and start their own diagnostic centre and pharmacy close to it,” said Prabhu.  

eHealth Access has already started operations in Vishakhapatnam, Gujarat and Kerala and one Ahmedabad that was started with an NGO that is tied to a Gurudwara and another in New Delhi also with an NGO as a pilot. It is in the process of identifying areas in Andhra Pradesh.

“In the North East India, we are looking at two models—one is the brick-and-mortar model where we will set up a physical kiosk. The other is the mobile unit—where a kiosk is set up inside a Maruti Van that will go from village to village. That will be a bit of a challenge. But we are already working with network providers to provide us with a direct link via V-SAT,” said Prabhu.