Telemedicine for reach, education, access, and treatment: Structural analysis of the pilot data

Abstract

Background: Tele-health Centre at AIIMS Bhopal was established in January 2012 with the help of Information Technology Group and Department of Community and Family Medicine. High bandwidth connectivity was ensured through National Knowledge Network and Bharat Sanchar Nigam Limited that is the current provider of '104' telephone service free to the patient. Materials and Methods: Pilot data of 1000 calls of first phase simple telephonic voice-based service are reported using 3 internet protocol phones. A second phase model has been conceived, its cost analyzed and presented here. This led to designing of a scalable 3-tier system. Results: Ninety eight percent calls belonged to 12 clinical domains which include seasonal illnesses (29%), chronic and noncommunicable diseases (15.8%), depression and psychological problems (15%), sexual advises (11%), worried mother (7.5%), women health and sexual symptoms (7%), family planning related advise (5.0%), oro-dental (4.0%), acute illnesses (1.5%), child growth and vaccination (1.2%), critical illnesses (0.8%), and others (2.2%). The total cost of the tele-health center was calculated to be around ` 1.2 crores. Cost analysis showed that the cost for consultation provided to AIIMS Bhopal was ` 34 for 5 min and free to the caller. Conclusion: We identified 12 clinical domains for tele-consultation. The proposed 3 tier tele-health center shall curtail crowd of out-patients resulting in cost savings. Fiber to home enabling video conferencing, image transmission, assisted consultation, e-prescription, SMS, apps-based services and onsite camera-based emergency and disaster management will greatly enlarge its scope. Crank call elimination and cost reduction can be achieved by converting it to pay by caller service.