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Table of Contents    
CORRESPONDENCE
Year : 2017  |  Volume : 65  |  Issue : 1  |  Page : 232-233

Concern and utilization of smart phone based telemedical health-care in allied neurological speciality: Real health–care model of future India


Department of Neurosurgery, Neurosciences Centre, AIIMS, New Delhi, India

Date of Web Publication12-Jan-2017

Correspondence Address:
Guru Dutta Satyarthee
Department of Neurosurgery, Room No. 714, Neurosciences Centre, AIIMS, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.198169

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How to cite this article:
Satyarthee GD. Concern and utilization of smart phone based telemedical health-care in allied neurological speciality: Real health–care model of future India. Neurol India 2017;65:232-3

How to cite this URL:
Satyarthee GD. Concern and utilization of smart phone based telemedical health-care in allied neurological speciality: Real health–care model of future India. Neurol India [serial online] 2017 [cited 2017 Feb 21];65:232-3. Available from: http://www.neurologyindia.com/text.asp?2017/65/1/232/198169


We read with interest the article “Telestroke in resource-poor developing country model.”[1] Sharma et al., reported thrombolysis treatment delivered to a total of 26 patients under the telestroke projects located at different district hospitals in the state of Himachal Pradesh using hub and spoke model.[1] The authors concluded that the smartphone based telestroke services may prove to be a much cheaper alternative to video conferencing based telestroke services, as it is comparatively more portable with relatively lesser technical glitches. However, the authors reported that two patients developed intracranial bleed following thrombolysis treatment for ischemic stroke, and fortunately both were nonfatal and managed conservatively. As super-speciality care requires a dedicated team comprised of radiologists, anaesthetists, specialist nurses, trained paramedical staff and rehabilitation facility besides the specialist concerned, including departmental physician and surgeons, setting up such a vast and dedicated facility entails a huge manpower and monetary investment. A simple but effective solution is the hub and spoke model, as vividly illustrated by the authors for ischemic stroke management by thrombolysis treatment.[1] The typical functioning of the hub and spoke model consists of a central, single hospital, e.g., the speciality department of a medical college or a tertiary health care centre (where high-techechnology infrastructure is available) forming the 'hub;' and, other lesser equipped hospitals with lesser facility forming the 'spokes.' These 'spokes' hospitals are utilized to provide maximum health care facilities as they have the backup of the 'hub' hospital. This hub and spoke model can ensure availability of health care that would otherwise not be feasible. It eliminates expensive travel, reduces the need to move the patient for vast distances, and also helps in educating the health care providers.[2],[3],[4] The model is, therefore, a win-win situation not only for patients but for physicians as well.[1],[2],[3]

India in the 21st century has witnessed the greatest and unanticipated transformation in the domain of communication modalities. This has manifested in a widespread usage of mobile communication devices and smartphone applications, which were primarily being used for entertainment. These applications have pervaded every aspect of life including health care and e-marketing, education and banking. The introduction of the applications has brought the world from the 'screen to the palm.' It is the welcome entry of this technology into the healthcare sector in India in the form of hub and spoke model that enables dissemination of services in areas, where the government cannot provide specialist treatment to the poor and resource-deprived population. At present, the total number of telephone subscribers including wireless and wire-line is 1058.6 million, and in addition, 149.8 million broadband subscribers are present in India with an overall tele-density of 83.36.[2]

In USA, transmission of electrocardiograms and electroencephalograms on ordinary telephone lines, as well as medical advice services for sailors based upon Morse code and voice radio has been carried out since the 1920s. In 1950, telepsychiatry consultation was held in USA, between a state mental hospital and the Nebraska Psychiatric Institute using a microwave link. National Aeronautics and Space Administration and the US Public Health Services developed a joint telemedicine programme to serve the Papago Indian Reservation in Arizona. Also, a two-way closed-circuit television system was also established to facilitate both the transmission of medical images such as radiographs as well as to carry out consultations between doctors.[3]

However, there are many concerns of mobile phone based telemedical health care. Firstly, the finding and training of an experienced team of dedicated and trained physicians, surgeons and trained paramedic staff with team spirit, striving with the common aim of providing prompt treatment is necessary for the success of this endeavour. This task is easier stated than done. Secondly, communication connectivity is dependent on the service provider. Increasing episodes of call drop or connectivity issues may cause a problem in the delivery of emergent health care. Thirdly, in case of any treatment mishap, there is a significant risk of medical litigation, as primary care is provide at 'spoke' hospitals, which are not well equipped to provide critical care issues in an emergency situation.[4] Two cases developed brain haemorrhage.[1] Although these were minor and managed well, in general, the spoke centre has to be made capable of dealing with emergency complications arising out of the treatment rendered.[1] Fourthly, the potentially poor quality of transmitted records, such as patient progress reports or images, and decreased access to relevant clinical information are quality assurance risks that can lead to a significant treatment quality compromise. Virtual medical treatment also reduces the human interaction between medical professionals and patients, which may lead to an increased chance of error. Nevertheless, the current technique is really a major advancement in the field of management of neurological disorders with the potential to optimize health care across all strata of the society, thus helping to bridge the economic as well as rural and urban divide, helping in breaking down geographical barriers in the country, and also in providing training to medical personnel across the country.[5] The mobile phone based telemedical health care represents an economically viable option. It is the result of the Indian communication revolution and should also be integrated into the national rural and urban health mission programmes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Sharma S, Padma MV, Hardwar A, Sharma A, Sanal N, Thakur S. Telestroke in resource-poor developing country model. Neurol India 2016;64:934-40.  Back to cited text no. 1
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2.
Telecom regulatory authority of India. www.trai.gov.in/WriteReadData/WhatsNew/..../Press_Release_34_25may_2016.pd.  Back to cited text no. 2
    
3.
Geidam MA, Prasad R, Bello IA. Child and maternal health care using telemedicine: A case study of Yobe State, Nigeria. International Journal of Computer Engineering and Applications, 2014;7.  Back to cited text no. 3
    
4.
Nakajima I, Sastrokusumo U, Mishra SK, Komiya, R, Malik AZ, Tanuma, T. The asia pacific telecommunity's telemedicine activities. IEEE Xplore.com website, 2006; 17-19: 280-2.  Back to cited text no. 4
    
5.
Angaran, DM. Telemedicine and telepharmacy: Current status and future implications. Am J Health-System Pharmacy 1999; 56:1405-26.  Back to cited text no. 5
    




 

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