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Cancer treatment on-air in India

19 June 2009

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Need to connect regional cancer centres to remote areas has led a prominent health institution in India to provide expert cancer care on-air. With user-friendly equipment and instantaneous service, the telemedicine network is delivering faster and quality treatment to patients.

Using the satellite-linked telemedicine network, expert oncologists at Tata Memorial Hospital in India are able to deliver quality cancer care to patients all over India.

Oncology on-air
Image credits: FutureGov / Expert oncologist on-air

Wealthy Asian industrialists often like to build hospitals to address the health concerns of the poor. For that reason, in India, the Tata Memorial Hospital (TMH) was established by Sir Dorabji Tata Trust in 1941.

However, the stark rural-urban contrasts in India mean that patients often have to spend a fortune to travel great distances to Mumbai for diagnoses and treatment from the TMH, the oncology specialists now run by the government.

Sixty per cent of TMH’s patients are not from anywhere near Mumbai. In fact, 20% of patients are from Eastern and Northeast states (Mumbai is on the West coast).

Rekha Batura, Assistant Medical Superintendent of TMH, hoped the emergence of telemedicine would reduce costs and give patients access to the service even in remote or rural hospitals dotted all over the country.

Under the National Cancer Control Programme launched in 1975, India has developed 26 regional cancer centres (RCCs) with links to peripheral health infrastructures.

Tata Memorial Hospital Cancer Telemedicine Network (Cantelmed) was initiated in 2003 to connect the RCCs and other remote centres.

"The project aimed to standardise and ensure evidence-based expert cancer care through interactive sessions"

The project aimed to standardise and ensure evidence-based expert cancer care through interactive sessions, as well as ensure that cutting-edge cancer protocols and procedures were available to all.

The client institution sends the patient details to TMH; the Cantelmed site office then arranges a multimodality consultation with TMH specialists. Any decision taken is recorded using software.

The network is also designed to serve as a distance education tool and to benefit research activities.

“The idea was to reduce the isolation of doctors in remote areas and provide the opportunity to offer expert treatment to patients and improve the quality of care,” Dr Batura explains.

From plan to action

Dr Batura says that the first step was to sensitise the RCCs to the concept of telemedicine and the project plan.

The details of the objectives and timelines were communicated and feedback was requested. Each centre appointed a dedicated staff member to liaise with the Tata Memorial Hospital.

Based on the feedback from these centres, the implementation was planned in phases to ensure the gradual acceptance and integration of the telemedicine services with the cancer care delivery system at the participating institutions.

The network now covers 30 institutions, all of which were provided with documented processes and procedures to be followed for consultation.

Dr Batura reveals that the most important challenge the project team faced during the implementation was the financial commitment.

“Choosing the communication network and the electronics was a prolonged debate,” she says. The situation lasted until the Indian Space Research Organisation (ISRO), a government agency, stepped in and offered 386 kbps satellite connections.

“The ISRO’s telemedicine network provides the maximum penetration and usage in India, free of charge,” Dr Batura reveals.

In addition to the equipment and bandwidth, the ISRO extended its support by agreeing to maintain the equipment after the network members suggested that they’d be unable to do the work.

The performance criteria were then formulated based on this connection for evaluation and selection of servers and software.

Quality service

The important aspects considered included user-friendliness, reliability, error tolerance, security and privacy, service availability as well as service quality.

“Actually it can be effective with a simple webcam and a telephone link,” Dr Batura says. A simple solution does help, although it wouldn’t provide the depth and breadth of coverage that the current combination of systems offers.

The equipment provided has proven to be robust. Breakdowns, which were not unexpected, have been kept to a minimum. Initially, the TMH clinicians expressed varied degrees of doubts over the feasibility and benefits of such a network. In addition, as staff at the centres was not very technology savvy, many were unable to identify or arrange the appropriate facility and manpower to operate the system.

As the centres gain confidence in the system, so the rate of telemedicine usage grows. Dr Batura has seen the initial hesitation of clinicians diminish the more they use the system.

In most centres there is an equal number of patients that require initial assessment and follow-ups.

Now only 6% of patients seen at remote sites have been advised to come to TMH for further screening or initial treatment, since the system was introduced. Significant savings for patients, in terms of time and money, have been made.

"With telecast lectures and symposia, doctors patients and plan surgery or other treatment"

A rural outreach programme, helped with telecast lectures and symposia, has enabled doctors to assess patients and plan surgery or other treatment.

This has allowed timely diagnosis and treatment – critical for cancer patients. The educational function of the telemedicine network is also picking up.

Most hospitals in the network started requesting conference broadcasts of meetings, teaching programmes, seminars and symposia as soon as the system was up and running.

Lectures have been delivered by eminent guest speakers located as far as in Pittsburgh and Paris.

And advice was not only solicited for patient care. One centre has asked expert opinion from TMH for technical evaluation during equipment procurement through the network.

Another has used sessions for administrative monitoring of the population screening and educational programmes.

Satisfied patients, content physicians

Over time, TMH discoveredthat physicians were always on time for scheduled consultations.

The close proximity of the telemedicine centre to the outpatient department area (around 60 metres) made access easy for consultants.

Over the years, 56 consultants have been involved in more than 300 sessions – no legal or ethical issues have come up, yet.

“The consultations in the Cantelmed setting have been physiciandriven, which could be the reason why responsibility and accountability have been with the physician while treating the patient at the remote setting,” Dr Batura says. Initial privacy and security concerns have now been laid to rest.

“Patient satisfaction and comfort levels overall are very high,” Dr Batura says. Scheduling a telemedicine appointment proved to be as easy as scheduling a face-to-face consultation at TMH.

Source : FutureGov

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