"You can see the skin is still light," the girl's mother interjects, watching her daughter.

"That will go away," says the doctor, "It's very typical."

They talk some more. The doctor then readjusts the camera to have a closer look. "I think we're doing great," he says.

This is telemedicine - the healthcare delivery system of the future. .

Telemedicine - a definition
Derived from the Greek word 'tele' meaning 'at a distance' and 'medicine' which comes from the Latin 'mederi' meaning 'healing', telemedicine means 'the provision of healthcare at a distance using electronic communications for diagnosis and treatment'.

How does it work?
The Internet makes it possible for a doctor in one city or country to send text, images, and even video footage to a specialist in another city or country.

Telemedicine technology requires interactive voice and video. Due to the Internet, it is possible for a hospital in one country to send text, images and limited full motion footage to a hospital in another country. Once the transmission is complete, the specialist at the receiving end studies the images. After evaluating the data, he formulates a diagnosis and forwards the documentation to the patient and his doctor.

The case of a patient at Rajkot Civil Hospital is a perfect example. Doctors "referred" an emergency case to UN Mehta Institute of Cardiology and Research, Ahmedabad. But the patient did not have to go there! Rajkot doctors took digital images of his X-rays, CT scans and medical records and forwarded them to cardiologists at the UN Mehta Institute for analysis. The specialists in turn suggested suitable treatment on the basis of this data.

"The patient was the winner," says Rajesh Shah, chairman of the Online Telemedicine Research Institute (OTRI), Ahmedabad, which has developed the system.

Development of telemedicine in India
The first telemedicine centre in the country was launched in Aragonda village of Andhra Pradesh by Apollo Hospital, Chennai in 2000. Soon after, states like Gujarat, Maharashtra, Andhra Pradesh, Tamil Nadu and West Bengal also developed centres.

Dr Bunty Java of Telemedicine Technologies Centre, Mumbai, says, "The Government of India has initiated a project called the Development of Telemedicine Technology. We supply them with all the equipment. The project aims to link three major hospitals in North India, namely, All India Institute of Medical Sciences (New Delhi); Post Graduate Institute of Medical Education and Research, or Nehru Hospital (Chandigarh); and Sanjay Gandhi Post Graduate Institute of Medical Sciences (Lucknow)."

Almost all big hospitals, including Apollo, Escorts and Batra, are now involved in telemedicine. According to renowned heart specialist Devi Shetty, the telemedicine project at Narayana Hrudayalaya, Bangalore, is a non-profit one sponsored by Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS) Kolkata, Narayana Hrudayalaya Bangalore, Hewlett Packard, Indian Space Research Organisation (ISRO) and governments of the seven North Eastern states.

The specialists at both NH and RTIICS offer free services.

Advantages:
Dr Java finds it advantageous to both doctors and patients: "While patients benefit from the treatment, doctors worldwide get to discuss and share knowledge and information. Through video conferencing, I can sit at my office and see a surgery being performed in the US."

Conversely, when the son of a rich Mumbai industrialist had a bad road accident that completely damaged his face, his family was prepared to go to the US for plastic surgery. Just a few days before they left, they heard of this telemedicine institute and gave it a shot. Dr Java and a team of doctors sprung into action. Digital images of the patients face were sent to many specialists in the US. "Within the next couple of days, we received several responses. The surgery was successfully conducted in Mumbai with inputs from experts via video conferencing. This saved effort and money for the patient's family and was a great learning experience for us," says Dr Java.

Another benefit: Patients in rural areas can avail of a specialist's knowledge without having to travel to a city. The patient has access to pre and post-surgical evaluation of a specialist which was previously not possible. This technology provides better patient services that are also cost-effective and timely.

Disadvantages:
However, telemedicine needs sophisticated equipment that can be difficult to install. Hence, the initial costs are very high. There's also the cost and time required to train health centre staff.

According to Sanjay Sood, System Engineer-cum-Coordinator for the telemedicine project at CEDTI, Punjab, some of the bottlenecks with respect to the growth of telemedicine in India are:

1. Lack of health infrastructure and services.
   
   
2. Shortage of computer-savvy healthcare personnel.
   
   
3. Outflow of doctors. There are about 60,000 and 35,000 Indian doctors in USA and UK respectively.
   
   
4. Virtually no exposure to the applications of ICT (Information and Communication Technology) in curricula of medical colleges.
   
   
5. Poor quality of communication services in most cities.