'India has an optimal time advantage in providing emergency night shift services to US hospitals'

Set up in 2002 to provide teleradiological services to hospitals in the US, Teleradiology Solutions in a short span of three years has emerged a leader in the imaging market in the country. Today, the company provides teleradiology services to hospitals around the globe, including interpretation of all non-invasive imaging studies such as CT, MRI, ultrasound, nuclear medicine studies and digitised X-Rays via teleradiology from its ready facility in Bangalore. It has bagged outsourcing contracts from reputed national and international institutes. Dr Arjun Kalyanpur is CEO and chief radiologist, Teleradiology Solutions and Assistant Clinical Professor at the Yale university School of Medicine, New Haven, CT. He was the first radiologist to provide teleradiology services to US hospitals from India and has carried out extensive research in the field of emergency teleradiology coverage. His research has covered the feasibility of an international teleradiology model as an alternative to the Nighthawk Shift and evaluation of JPEG and wavelet compression for teleradiology transmission of direct-digital body, CT images. In an interview with Falaknaaz Syed, Dr Kalyanpur discusses India's position in providing imaging services to the west, the hurdles faced by entrepreneurs in providing teleradiology solutions, and the future of teleradiology in India.

What are the advantages of using teleradiology?

Teleradiology is a branch of telemedicine in which the goal is to transmit radiologic diagnostic images to a different location for interpretation. These images are typically already digital. In some situations, additional equipment/technology may be needed to digitise them. Transmission requires a high-speed telecommunications link and software to send these images. One also needs a high-level communication centre to co-ordinate between the sites of origin and interpretation of the image data, especially when the work is being done in the emergency setting. Teleradiology increases the efficiency of the radiologist by ensuring that he/she spends the most part of his/her time delivering quality care to the maximum number of patients. One radiologist based in one location can simultaneously provide services to several hospitals in multiple different locations.

How has the field of teleradiology evolved?

Teleradiology imaging services have seen a myriad of changes, since they first became popular in the West in the 90's. Firstly the technology has undergone a lot of advancement and refinement. The software for teleradiology has become versatile and efficient, resulting in improved image quality. The telecommunications infrastructure has improved worldwide and the costs have come down. Processes have overall become more robust.

How well equipped is India to win outsourcing contracts in teleradiology from hospitals in the US and other countries?

India has the primary advantage of having an optimal time advantage with the US in terms of providing emergency night shift services to the US hospitals. Our company has leveraged this advantage and has been providing emergency 'nighthawk' services to US hospitals for three years now. Other essential advantages that India possesses include a high-technology infrastructure base, skilled manpower and a lower cost of living.

What is the potential of teleradiology in India?

The potential is great. Within India today, there is a problem of access to specialist radiological services, as most radiologists prefer to live in cities, while rural areas have no specialised or quality medical care. Many of the hospitals in India's districts have CT scanners but very few radiologists are skilled in their interpretation. Inaccessibility should not be a reason to deny medical attention. The main hurdles relate to the lack of penetration of broadband connectivity to the peripheral areas. Satellite connectivity as provided for telemedicine services by ISRO can help bridge this gap.

What are the hurdles that Indian companies face while implementing teleradiology?
Some of the hurdles that Indian companies face while implementing teleradiology are lack of connectivity in remote areas, high cost of connectivity compared with the west and lack of awareness of the benefits of teleradiology by the medical community, and the public at large.

How economically feasible is it to set up a full-fledged teleradiology facility at a remote location and in an urban location?
In the US setting, teleradiology is a highly affordable solution to staffing issues. In India however, it is sometimes seen as a disadvantage. It is important to understand that the benefits outweigh the costs eventually and the system more than pays for itself over a short period of time. The costs of teleradiology are continuously diminishing, given the fall in broadband costs worldwide.

This will hopefully continue to encourage newer teleradiology facilities in India. Additionally, efficient web-based teleradiology systems today allow for rapid and economical distribution of radiologic images to radiologists located anywhere within a global office. The imaging software used for teleradiology is indigenous. 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.

Which are the other companies offering teleradiology services in India?

There is a lot of interest in this field and several groups/companies, including Wipro, are currently in or attempting to enter this space.

The US has stringent teleradiology outsourcing regulations. How easy is it to meet these requirements by Indian teleradiology companies? Does the US trust the credentials of Indian radiologists?

There is a rigorous local hospital credentialing process and state licensing process in the US. Indian teleradiology companies have to meet the US mandate in areas such as quality of personnel, equipment, licensing and quality control. There is at least a three-month delay in being chosen as a provider of night-hawking services. However, the time zone advantage between the US and India improves the quality of services provided by our teleradiologists.

Are you facing any hurdles in meeting these standards?

Teleradiology Solutions was set up when the US was facing a shortage of radiologists with 20 per cent of vacancies for radiologists going unfilled in hospitals to take care of a growing aged population. We conducted the world's first feasibility study on providing distance radiology services to hospitals.

This formalised the concept of teleradiology in the area of telemedicine. The company was the first in India to provide hospitals with teleradiological services and has become a leader in the imaging markets field. The services offered by the company are on par with that of radiologists in the US and we are more than equipped to meet any standards that are mandated by the US.

We have an exceptional accuracy rate of 99.7 per cent and are Health Insurance Portability & Accountability Act (HIPAA) compliant. We are currently undergoing the JCAHO accreditation.

What are the initiatives that the government needs to take to boost BPO market for teleradiolgy?

An improvement in urban infrastructure will definitely encourage more teleradiology companies to set up services in India. Improved urban infrastructure will allow people to get to their workplace safely and on time, will decrease power cuts and water shortage, reduce the cost of bandwidth. This will encourage overseas visitors to invest here.

Which are the hospitals in US and in India that you provide teleradiological services to?

We provide teleradiology solutions to 40 hospitals across the East coast and West coast. Some of the hospitals, we work with in the US are Albert Einstein Medical Center in Philadelphia, Altoona Hospital, Pennsylvania and West Georgia Medical Center in Atlanta. The company provides subspecialty consultations to hospitals in India, including Narayana Hrudayalaya, Bangalore; Ashwini Children's Hospital, Bijapur and to the newly opened Columbia Asia hospital in Bangalore. Currently we are diversifying into other geographical areas and collaborating with hospitals in South East Asia and Europe. We are planning to link as many remote areas in India as possible to our telerad hub in Bangalore.

falak@expresshealthcaremgmt.com