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India to be teleradiology hub!

April 26, 2005 14:50 IST

Imagine a radiologist sitting in Bangalore reporting on the CAT scan that was performed minutes earlier in the ER (emergency room) of a hospital in Philadelphia.

Sounds like science fiction? Not any more. At least that is what the United States-based Teleradiology Solutions is promising.

Teleradiology Solutions was started in 2002 to provide US hospitals with emergency reporting services, sometimes referred to as nighthawk services. The US is facing a shortage of radiologists with 20 per cent of vacancies for radiologists going unfilled in hospitals and increased imaging scan numbers related to a growing aged population.

'Teleradiology' is a means of electronic transmission of radiological images, such as X-rays, CTs (computed tomograms), and MRIs (magnetic resonance images), from one location to another for the purposes of interpretation and/or consultation.

Digital images are transmitted over a distance using standard telephone lines, satellite connections, or wide area networks (WANs). Teleradiology is therefore a facilitator for more optimal medical care. It is not a form of imaging but rather the technology or process of image transfer/transmission.

The company was the first in India to provide US hospitals with teleradiological services and is today a leader in the imaging markets field. Today Teleradiology Solutions is expanding into other markets such as Europe and Asia.

Recently, caught up with Dr Arjun Kalyanpur, an AIIMS graduate and faculty member at the Yale University School of Medicine, New Haven, and also the chief executive officer and chief radiologist of Teleradiology Solutions.

Kalyanpur clearly felt that India could well become the next hub for outsourced solutions in this space.

When you talk about teleradiology what kind of services are we talking about?

We provide teleradiology-based services such as diagnostic interpretation of all emergently and non-emergently performed non-invasive imaging studies, including computed tomography, MRI, ultrasound, X ray, nuclear medicine studies and conventional plain films (digital format).

These services are provided with a turnaround time of less than 30 minutes in the emergency setting. We are in constant verbal communication with our client hospitals and are highly accessible to all our referring physicians/hospitals at all times.

We believe that teleradiology is primarily a medical practice, and then a business.

How fast is this segment of medicine growing and for what reasons?

The Indian health imaging market is expected to double from the existing $350 million in the next five years, according to estimates by London-based market intelligence firm Tekplus.

In 2009, the imaging modalities of X-ray, ultrasound, CT, and MRI are collectively estimated to account for 68.6 per cent of the health imaging market, according to the firm's research report 'Indian Health Imaging Market'.

According to one estimate, approximately 50 per cent of the 6,000-odd hospitals in the United States still do not have the technology for teleradiology, and this therefore represents the future potential market size in the US alone.

When you say it is changing the landscape of healthcare globally and in India, can you explain how?

Teleradiology increases the efficiency of the doctor by ensuring that he spends the most part of his time delivering quality care to the maximum number of patients. One doctor based in one location can simultaneously provide services to several hospitals in multiple different locations.

It breaks geographical and time barriers and helps achieve accurate diagnoses in the shortest possible time.

Benefits to the USA:

  • Because of teleradiology, patients can be diagnosed and effectively treated at any time of the day or night, with a diagnosis provided from across the globe within 30 minutes. It is cost-effective to the hospital, as the need to recruit night shift personnel is minimised.
  • The quality of care delivered by a wide awake, alert physician working a day shift in India is far superior to that provided by a US-based radiologist who is up all night.
  • Sub-speciality opinions delivered to locations where the expertise is otherwise unavailable is an added benefit.

We started our operations in 2002 when there was an acute shortage of radiologists in the US.

  • Due to the development of new and faster imaging modalities, an ageing population and increase in the clinical applications for imaging, more and more radiologic imaging scans are today being performed in the US, requiring more radiologic expertise.
  • Training programs in the US have not kept pace with these changes. The numbers of training positions have remained relatively constant while the number of scans has exponentially increased. We stepped in to fill that void.  We are extending our reach into other markets such as the Middle East, Asia-Pacific and Europe now where we see great demand for teleradiology.
  • Teleradiology will help the US extend its high quality health care globally. Clinical medicine and research as practised in the US has a cutting-edge over other countries.
  • What teleradiology will do for the US is allow it to impart its world-class knowledge of medicine to doctors from around the world, who will then bring that expertise back to their countries. This will be America's greatest gift to the world.

Benefits to India:

  • Within India today, there is a problem of access to medical services as doctors prefer to live in cities and rural areas have no specialised or quality medical care. Inaccessibility should not be a reason to deny medical attention. Teleradiology Solutions intends to fill that gap. Many of the hospitals in India's districts have CT scanners but very few radiologists who are skilled in their interpretation.

Teleradiology Solutions aims to link all remote areas in Karnataka and other states as well with its hub in Bangalore to provide reporting services to the people of India that are on par with those anywhere in the world.

  • Additionally, if US radiologists of Indian origin wish to return to their home country they now have a wonderful opportunity to work for the US (or for India if they choose to) from a base within India.

How big is your firm in terms of people and revenues and has it attracted venture funding so far?

We are a rapidly growing group with radiologists based in Bangalore, Delhi and several locations in the US, including Illinois, Georgia, Massachusetts and Connecticut. We have been approached by several VC firms but have thus far elected to grow organically.

About Bangalore being the next hub, can you elucidate the reason for your thinking?

Bangalore is poised to be the teleradiology capital of India with its strong infrastructure, high skills-set level among IT, qualified medical personnel and support staff. Some of the reasons why I see Bangalore becoming an extremely important centre for teleradiology are as follows:

Bangalore has a growing telecom and infrastructure base, which is at par with global standards.

It has a large pool of English-speaking manpower, which is being harnessed greatly by ITES hubs such as Singapore and Ireland.

Bangalore is a stimulating and cosmopolitan city that offers a unique environment for overseas Non-Resident Indian physicians to relocate to.

In addition, India can provide 24x7 services based on the country's unique geographic location that allows for leveraging time zone differences with the US.

India has a positive policy environment, which encourages investments and simplifies rules and procedures and a friendly tax structure. Today, the satisfaction of being a physician in India is unmatched.

There is a constant ongoing opportunity to give back to the community and help improve the lives of thousands of people, and the daily experience at work for a doctor in India is incredibly gratifying and rewarding.

Indian physicians have always proven that we could excel by any standards wherever in the world we may choose to move to. Today we are proving that we can excel by any standards, at and from home.

How successful can this be in a country like India?

India's healthcare sector has made impressive strides in recent years. It has transformed to a more than $17 billion industry and is surging ahead with an annual growth rate of 13 per cent a year (Source: CII).

According to forecasts, for the short-to-medium term, the projections are at a 10 per cent mark -- making India one amongst the fastest growing economies.

India's huge population of a billion people represents a big opportunity for healthcare. The spending on healthcare has increased, led by the rise in literacy rate; the higher levels of income; and an increased awareness through the deep penetration of media.

Today hospitals in India are using the latest technical equipment and the services of highly skilled medical personnel to provide a variety of general as well as specialists services.

These services are available at extremely competitive prices; encouraging patients not only from developing countries but even from a number of developed ones to come to India for specialised treatment.

The growth opportunities in India are immense. The days of brain drain in medicine are over. We have entered a phase of reverse brain drain. The kind of opportunities that exist in the medical field in India cannot be reproduced anywhere else.

At the Sathya Sai Hospital (in Puttaparthi) where I worked when I first returned from Yale, the radiology equipment I worked with was state-of-the-art by global standards and some of it newer than the equipment I had been used to working on in the US.

The technology gap between the West and the East has narrowed to the point that the work environment is very similar.

How costly is this system when compared to older systems and how is it advantageous?

Teleradiology is the way of the future. It increases the reach of the physician who can utilise his skills to the maximum number of patients rather than being confined by geography. The importance of teleradiology is that patients can be effectively diagnosed and treated at any time of the day or night, with a diagnosis provided within minutes.

The gratifying thing in this work is the immediacy of it. Also one doctor can cover multiple hospitals simultaneously making it a more efficient process.

While in the US setting, teleradiology is a highly affordable solution to staffing issues, in India, it is sometimes seen as a disadvantage. However, the system more than pays for itself over a short period of time.

Additionally, the costs of teleradiology are continuously diminishing, particularly given the fall in broadband costs worldwide. Efficient Web-based teleradiology systems allow for rapid and economical distribution of radiologic images to radiologists located anywhere within a global office.

Since the technology in teleradiology is digital and filmless, there can also be substantial cost savings in terms of ongoing/recurrent costs of film, processing, etc.

When we speak about an international teleradiology hub - what are we talking about and how innovative is this in terms of a concept? Is this the first time such a concept is being tried out?

The hub concept in teleradiology refers to a single physical location containing a number of highly trained specialist physicians providing high quality medical diagnostic services in a high technology infrastructure setting to a large catchment area or patient population, which can effectively encompass the entire globe.

The concept leverages the high cost of bandwidth to optimise its usage most efficiently and productively, while the size of the physician group ensures a higher degree of skill sets and wider range of physician expertise, which can benefit the patients whose studies are being remotely interpreted.

Within the US such hubs have been used over the last decade or so, to provide reporting services particularly in the overnight or after-hours setting. We are amongst the pioneers to have taken this innovative concept across the globe in an attempt to exploit global time differences to ensure that no radiologist must need to work a night shift.

We are now extending these services to other parts of the globe to ensure optimal diagnostic services for patients worldwide, particularly in those areas where a shortage of qualified radiologic personnel exists.

We are the first such organisation in India and among the first worldwide to provide such high-end medical services remotely. The gratifying thing in this work is the immediacy of it. We are dealing with people on the other side of the globe. Accessibility and interaction keeps this intellectually stimulating, challenging and satisfying.
Sanjay Krishnan