About SATHI

S.A.T.H.I. (Society for Administration of Telemedicine and Health Care Informatics) – a non profit organization – is a group consisting of like minded highly trained and skilled Medical, Information Technology, Social Sciences as well as Tele Communication Professionals who think that Telemedicine can go a long way in providing affordable and quality healthcare to each and every person of our country. All of us are actively working to bring these thoughts to fruition. The society was registered in June, 2004

We serve as a Resource organization for

· Developing Software

· Training of personnel

· Field Testing

· Project management

· Disaster Relief

· Standardization

SATHI is actively involved in the promotion of responsible and proper usage of Information Technology in the Healthcare field whereby we believe that it can help the respective Healthcare workers and Medical Professionals in providing better care to the entire population without the constraints of Time and Distance. Our members have been actively helping the Ministry of Health and Family welfare as well as the Ministry of Rural Development in India as advisers and consultants towards its vision towards promoting Telehealth.

The Product

The concept was first floated in 2005 when we presented a paper in the Amritsar meeting of Indian Association for Medical Informatics ( www.iami.org.in ). Most of the text of the abstract is being repeated here.

Telemedicine is a wonderful technology with the potential of provision of Healthcare cutting across geographical and economic barriers. While analysing the Telemedicine networking is being hindered by the following problems:

  • The general apathy of Doctors towards Information Technology.
  • Non-availability of user friendly applications.
  • The current running applications are unique and uncoordinated and as a result they do not talk to each other.
  • Hugh cost of current applications
  • High amount of complexity in most existing applications means they require specialized persons to run the same
  • Most systems require availability of high end communication options like ISDN or satellite links which are either not available or expensive to run and maintain.
All systems are top heavy, while the simpler, generally more required,

The emphasis is on transferring High end patient data like MRIs, Angiograms etc. - While transfer of such data is also required, MRIs and Angiograms and CT scans are only done in places which have this equipment. Such places, it can be rest assured after investing crores for such expensive equipment can surely invest a few thousand for a trained Radiologist for an opinion on it. So in all likely hood they will not require telemedicine based help. There are ready made apps available with such equipment and the proprietary restrictions of DICOM etc with these ensure that they would be out of reach of a day to day practitioner who requires such help lower end components of the diagnostic tree are ignored.

This product was conceived to overcome some of these barriers, especially costs leading to a cycle of low usage followed by even higher cost of implementation.

IT Application usage
A low cost solution, we believe is very much possible, especially as the essential components of a consultation – i.e. a simple textual conversion of History and examination is all that is required for low end clinics. Most lab investigations done in some clinics – like Haemoglobin etc are also data or text.

70% of health care providers in our country are private practitioners. A large burden of healthcare is borne by them. Telemedicine has yet to reach these persons due to the problems explained above. As a result a vicious circle of insufficient number of users leading to high costs for the manufacturer sets in leading to disappointment with telemedicine as a tool in general is setting in. The telecommunication networks – also require a certain minimum number of users to keep the costs of maintaining the network which is also not happening. BSNL as a result, is not opening enough avenues for ISDN connectivity is even mooting the idea of discontinuing it altogether. The advent of Broadband, Wimax and other faster networking modes that, we can go beyond these simple requirements ECG and X Rays – assuming such equipment exists in the peripheral clinic. Satellite links are still far beyond the reach of even the upper class hospitals like Apollo and Narain Hridualaya who depend on subsidies to use it.

Clinics are using software at several places in our country. These applications are only used for the maintenance of their organization. They cannot transfer information to other applications.

On the other hand, most software maintained by hospitals are used only for administrative or billing purposes which do not record or input patient data especially pertaining to the medical problem faced by the patient. If a hospital wants to refer a patient elsewhere, the patient details should also be sent. Some times a simple review of the patient data is enough to get an opinion and the patient can be saved the cost and time of travelling. So far although Telemedicine is a possible solution but incompatibility between different users as well as type of software means that this transfer has to use manual means of transport, which consumes lot of time. Even if tele transfer is done, only partial data may be transferred. Time plays a critical role. This method may also be expensive. It can some times lead to the death of the Patient. Telemedicine will be the ultimate solution for all these problems.

The separation of the three types of medical based applications (Telemed, EMR and HIS) means that each entries are isolated and repetitive effort is required for maintaining or sending data even when it is similar. Over and above that, the lack of uniform standards between manufacturers of various telemedicine applications also adds to the problems of sending data across.

All the above facts have contributed to Telemedicine being a virtual non starter in our country despite heavy investments and a great push by the Central and State Governments, Ministry of IT, ISRO and other stakeholders. We are attempting to rectify this situation and are presenting a review of our ongoing project.

Objectives

  • Create a basic EMR which can store all patients records as well as serve as a common application which can transfer patient’s medical data through online method, between different locations
  • To allow interchange of data between pre - existing users of different EMR as well HIS systems
  • The present app should be able to function as an independent EMR In the absence of a pre existing software available with the user,
  • The application should be low cost or free to enable a large number of users
  • It should be simple and easy to use on a daily basis for all patients
  • Sending patient data should not require extra effort for creating or writing the data at the time of transfer
  • It should be able to link up with off the shelf free or commercially available video conferencing systems
  • It should be de-linked with the connectivity option and use any which is easily available at the site. It may be E Mail, Broadband, ISDN or satellite connectivity. Wimax and Mobile Wifi are eminently suitable newer connectivity solutions
More information on the concept is available through related articles at http://www.iami.org.in/journal1/plan.asp and
http://www.iami.org.in/journal1/hlxtelemed.asp


1.2 Market Analysis

1.2.1 Market Opportunity – Problem being addressed, Size of the Target Market

Specify the exact healthcare problem being addressed by your idea. Who are the end users for your proposed solution? What critical issues are faced by the end users – highlight only those relevant ones ?

The problems are as outlined above. The entire healthcare market in our country is the target. With time, the barriers to this market like, low penetration of connectivity as well as IT in Rural areas are being addressed. Government expenditure for healthcare is a pitiable 1% of the budget .

(Ref : http://www.thehindubusinessline.com/2006/09/19/stories/2006091901451100.htm )

While actual Healthcare expenditure in India constitutes is 5.2% of the GDP (compared with 2.7% in China) it is widely believed that can go upto 15% of the budget of most families. In rural areas, much of the expenditure is wasted on the transportation to the nearest healthcare facility. China has managed to bring down the healthcare costs through its team of barefoot doctors and effective utilization of Telemedicine – a fact that is not widely reported. This cost reduction being indirect is dificult to monetize. But even being conservative, we beleive that this household expenditure can be diminished from the 15 % by at least 1 -2%.

Our potential end user starts from the Rural Health workers but goes upto Medical Doctors/ Specialists/ Super-specialists and their staff in clinics, nursing homes, hospitals. Thus they are indirect beneficiaries of an already hidden cost benefit. What we do know (and have already tested in our previous project) is that while all healthcare practitioners are willing to utilize Tele medicine as part of their practice, they are unwilling to spend money on it. Thus the need for a low cost or free application – especially if bundled with other hardware /software software purchases is a very required initial step to tap this vast market.

Training and implemetation of the users of the software functionality shall be the main ongoing cost and if managed well can lead to huge sales of the add on higher end products.

Describe the main characteristics of your (potential) stakeholder/customer base and their demand; if segmented, describe the different segments. Why did you select this group/these groups?

This tool is basically to help any person working in Rural areas be it the ANM/ Dai /Quack or MBBS doctor.

India also has a system of care provision through local Healthcare practitioners who are relatively untrained. We have to accept that a person who has spent time in a city for training (read MBBS and other trained doctors) needs very strong reasons to go back to a rural area. Over and above that the higher the skill base, the larger the catchemtn area required to get a suitable number of patients to sustain ones practice. These conditions do not and can never exist in a small community. So the immediate medical help will always be a relatively untrained practitioner – be it one with a Unani degree or a diploma. China realised this long back and started the barefoot doctor scheme which we beleive is very succesful. In India it exists albiet without offical sanction.

Improved access to primary healthcare and its gate-keeping function lead to less hospitalisation, less utilisation of specialist and emergency centres and less chance of patients being subjected to inappropriate health interventions. 70% of healthcare in India is in private hands. Untrained healthcare workers or those with local degrees like Ayurved, Unani etc constitute the bulk healthforce (90%) of the private sector.

He is the person actually providing care and shall continue doing so for a long time. A method to upgrade his skills and also to provide timely help when he cannot solve the problem will improve health services in rural areas. Characteristics of these are:

  • Semi-skilled/Trained
  • Equipped to handle basic medical needs
  • They can expand the cases they handle if support is provided through telemedicine
  • Follow up of cases admitted in a specialist facility can also be managed by them through online support e.g. how to do the dressing, minor modification of drug schedule based on some recent problem etc

Their demands are:

  • A Cost effective tool to retain even those patients requiring speciality treatment
  • A simple, non complex, easy to use system to create and maintain records/history

The rural poor although not our direct customers shall have better healthcare decreasing the need for travel. They shall also know who is the best doctor to show to as and when the need arises rather than be lead by the commission dependent rickshaw driver.

Similar application has to be provided to the expert doctors who will provide telemedicine services. This will help them widen their reach and getting patients relevant to their own speciality earlier in their carrier graph. Thus, the less busy expert doctors who are starting practice are also potential costumers.

Describe the market size (i.e. is it a growing market, is it stable or subject to change, etc), and the trends for the target market in a 3-year outlook. Describe the market potential for your product/service in this target market.

The Allopathic healthcare workforce (Read MBBS and above doctors) constitute 5 lakhs. This is however only 10% of the healthcare provider workforce which means that there are around 50 lakhs health providers. This is growing with the population growth of our country. It is all largely untapped. We had done a survey of IT usage in MBBS doctors and found that while PC owner ship was fairly high, its usage for Patient care and especially of Electronic Medical records (EMR) was pitiable (see chart).

The plan for provision of IT based servics through 100000 Common Service Centres (CSCs) in India’s 600000 Villages is an obvious target. Unfortunately this plan is getting delayed for, we beleive, similar reasons we are trying to solve i.e. high costs and not enough trained persons and those willing to IT. While, healthcare is only one component of the CSCs but it has been quoted to be the most important one. A project like this can rejuvinate the CSCs project also.

 

Usage of IT amongst MBBS

" WHO World Health Report 2000 "Health Systems : Improving performance "
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