INTERVIEW OF THE MONTH
INTERVIEW WITH DR. K. GANAPATHY(M.Ch( Neuro) FACS, FICS, FAMS, Ph.D)
PRESIDENT APOLLO TELEMEDICINE NETWORK FOUNDATION
SENIOR CONSULTANT NEUROSURGEON, APOLLO HOSPITALS, CHENNAI
Dr. K. Ganapathy M.Ch( Neuro) FACS FICS FAMS Ph.D, President of Apollo Telemedicine Network Foundation and Senior Consultant Neurosurgeon at Apollo Hospitals, Chennai has many firsts to his credit. He was the first in South Asia to start and develop Stereotactic Radiosurgery in 1995, first to start and develop Clinical Telemedicine (2000) and first to get a PhD in Neuroimaging. He has been elected by peers as President of three National Societies, Secretary of a National Society and Secretary General of the largest continental society of neurosurgeons. He has delivered 143 guest lectures overseas and 391 in India, authored over 74 papers in peer reviewed journals, 16 chapters in text books and over 171 articles in newspapers and magazines. He was responsible for initiating Telemedicine in the Armed Forces, is a member of 13 high level Government of India Committees and 3 International Committees in tele-health. He has received over 15 awards, orations, and national recognitions and is a winner of several prizes, awards and distinctions. He is an adjunct professor at IIT Madras, Anna University and the Tamilnadu Dr MGR Medical University (Please check www.kganapathy.com for full CV)
In an interview with Illuminar, Dr Ganapathy expressed his candid views and opinions on various matters including why Telemedicine has not seen the kind of adoption it deserves and what needs to be done to get this to mainstream.
Telemedicine has been around for a number of years, but it doesn’t seem to like a common option for patients to receive care. Could you provide some insights on what it would take to get this to mainstream, especially considering the immense possibilities for healthcare inclusion in a country like India
Healthcare has traditionally involved a one to one relationship between the doctor and the patient. In today’s digital world thanks to technology there is a very real danger of this sacrosanct human relationship being replaced with interpretation of scores of data useful and not necessary useful!! Selling healthcare is not the same as selling a product on e-commerce portals. The human element is often lost sight of. Interaction of both the doctor and the patient at a deeper level is imperative to the success of telemedicine. However in most telemedicine/ digital health/ e-health conferences, there are more participants from the industry (hardware device vendors, software / application specialists, network specialists etc.) rather than doctors who conventionally still directly interact with a patient. Most of the conferences I have attended are often initiated, led and managed by the ICT industry. Less than 15% of attendees are practicing doctors. Consider the M-health Summit in 2011 and 2012 held in Washington DC for instance. Of the approximately 3500 attendees from 170 countries who participated in this three day-long conference, active clinicians would have been just about 100-200 people.
We don’t have a Stethoscope Society of India. The stethoscope is an integral part of the doctor’s armamentarium. It is a means to achieve an end, not an end by itself. Similarly telemedicine should not be viewed in isolation, not as a silo, but as an enabler, a means to achieve an end – namely to extend the reach of urban specialists to suburban and rural India. Doctors need to be a part of the initiative in bigger way. How many doctors today are really asking for telemedicine? We have over 200000 members in the IMA but probably only 200 to 300 doctors are enthusiastically adopting telemedicine. It is imperative for a larger commitment and passion from the doctor community towards telemedicine for this to become mainstream. The current telemedicine storyline is only emphasizing on the “tele” part and not so much on the “medicine” part.
For every stakeholder in the eco system, WiiiFM needs to be addressed “What is in it for me?” Both a carrot and a stick need to be deployed to significantly further the use of telemedicine. There is an acute shortage of doctors – most doctors are already overworked. An incentive for adoption of telemedicine will go a long way. The US has proved this beautifully – ever since teleconsultations were approved for reimbursement by insurers, the adoption and utilization has gone up 25 times. This needs to happen here. We need to get more doctors and patients on board.
Also nothing can happen without political will. For example, how many questions have been raised in the Parliament regarding what the Government is doing to support telemedicine? Telemedicine should be given even more importance than it is at present by the Government.
Given that Apollo has been an early entrant in Telemedicine, could you share some key learnings around what works and what doesn’t? What are some of the barriers to a wider adoption and how have you overcome it?
I wish to recollect a phrase I often use – “Nothing can stop an Idea whose time has come”. Retrospectively, we were just too far ahead of the time – it was in 1998 when I first ever heard the word telemedicine from an IIT professor when I was delivering a lecture at IIT Kanpur. When I returned, I discussed this with Dr. Pratap Reddy – he is a man with so much foresight and vision. The rest as they say is History!! In March this year, we are celebrating the 15th anniversary of having initiated the world’s first VSAT enabled village hospital at Aragonda (birth place of Dr. Pratap Reddy). For two years from 2000 to 2002, we did a proof of concept validation for ISRO – almost 1500 consultations were done in these two years. Mr. Bill Clinton was the one who formally commissioned the VSAT unit from Hyderabad when he came here as the President of the United States. Fifteen years seems to be a long time and Apollo as a group itself has grown immensely in these fifteen years, however telemedicine has not grown as much. If you consider the most successful telemedicine centers in the country, these have primarily been due to the work of a few individuals. If you ask me for a list of reasons for the lack of adoption between say power, funding, people, technology etc. I strongly believe that it is the lack of motivated, passionate human resources. For instance, Arvind hospitals and Sankara Nethralaya do several hundred teleconsultations in Ophthalmology every day 10% of India’s telemedicine units do 90% of India’s teleconsultations. This is purely because this whole initiative is individual driven. We need people who believe in it, who are passionate about it and who will not take no for an answer. We therefore need to train, excite and get a second generation of people who will do this.
How can technology play a bigger role in taking this initiative to the next level? What kind of collaboration is required in the form of a working framework to get this to reality?
It is interesting that one of the things that we forget most often is the importance of health literacy. I realized the significance of health literary when I met Prof Muir Grey, Chief Knowledge Officer of NHS and Lord Nigel Crisp, CEO of NHS – the world’s biggest health employer. If health literacy is promoted, the impact on healthcare outcomes will be 25 times more. Even as of March 2015 in Chennai, we see patients who come to us with a devastating stroke because they were not aware they were hypertensive. Even today in Chennai, where the literacy rates are high, complications relating to diabetes is high. 60% of admissions to any big hospital – could perhaps have been reduced if they were diagnosed much earlier. This is purely due to lack of awareness.
I had suggested in an article in the British Medical Journal that of the 225000 doctors in India, if 1% of the doctors give 1 hour a week for free teleconsultations to remote parts of India, the situation would be looking better. We need a lot of support and help. P&L and ROI are certainly important, but telemedicine should be looked as something providing tangible and intangible benefits to millions who will never ever have access to quality affordable health care to anyone, anytime anywhere. For instance, if corporates invest in this initiative as a part of their mandatory CSR investments, that would make a big difference. Over the last 16 months in a project with the M S Swaminathan Research Foundation – over 10,000 villagers have listened in to 43 sessions wherein Health Literacy has been promoted. We need to escalate this over a 1000 times. If only the 1.2 billion Indians are aware of health related diseases and preventive care, that itself will make a huge impact. Today we can do this with technology.
Let’s take an example – we have the National Medical College Network. 160 Medical Colleges in India are interconnected under the National Knowledge Network (NKN) with 1 GB per second connectivity. But unfortunately, the government mandates that only Government medical colleges can use this network. 95% of the medical colleges who are connected to this network are not using this connectivity adequately. Extending this connectivity beyond government medical colleges will go a long way in promoting wellness.
What are your thoughts around the play that a broader ecosystem can have in offering Telemedicine – for instance insurance companies for cashless services or the nearest local pharmacy for medicine delivery? What is your opinion on the readiness by these ecosystem players to get to a working model?
We need to have a strong business model that makes commercial sense for all the ecosystem players that is both revenue generating and self-sustaining. Philanthropy can at best only start something, but can never sustain on its own. As an example, under the Rural Connect Program, we have collaborated with Common Service Centers (CSC) to deliver primary and preventive healthcare to rural patients through teleconsultations. This is a mega initiative started about seven years ago by the Government of India to internet enable over 1,00,000 villages – as of now about 70,000 villages are already connected. Apollo Telemedicine has signed a contract with the Government of India, under which we will provide healthcare at 10,000 of these villages. About 6,000 villages have already been familiarized with the concept of tele health. We hope that eventually we’ll be able to provide specialist consultation to remote villages in India.
What kind of productivity improvements and / or cost reductions have you experienced at ATNF as a result of your investment in Telemedicine? What is your vision for growth going forward?
We need to reach a mega scale and size to significantly reduce costs – we should get there. We’re looking at 1000 teleconsultations per day, sometime in the not too distant future.