kapil khandelwal teleradiology industry report

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Teleradiology Industry Report

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  • 1.Cover StoryTeleradiology: IPE SPECT VEDespite the huge potential the teleradiology market in India is still in itsinfancy, BY SONAL VIJ WHEN a patient in a hospital at Philadelphia needsthese countries are not sufficient to match the growing an emergency brain scan in the middle of the night, a doctordemand. Reportedly, In the US, while the number of scans in Bangalore, India, is asked to interpret the results within being performed has been increasing. there is a persisting minutes.shortage of radiologists. In Singapore. there is a paucity of Welcome to the world of Teleradiology! radiologists for night coverage. In the UK, a radiologist 'Teleradiology' is a means of electronic transmission oftakes 21 days on average to submit an MRI report. radiological images, such as X-rays, CTs (computed tomo-The immediate availability of diagnostic services. grams). and MRls (rpagnetic resonance images). from one which Is extremely important during medical emergen- location to another for the purposes of interpretationcies, is a big advantage that outsourcing offers. and/or consultation.Outsourcing of 'on-call' night reporting is popularly called Digital images are transmitted over a distance using'night-hawking.' Standard telephone lines, satellit.e connections, or Wide Demand in the West: According to an estimate. Area Networks (WANs).Teleradiology is therefore a facil-approximately 50 per cent of the 6,OOO~odd hospitals in Itator for more optimal medical care. It is not a form of the US stiff do not have the technology for teleradiology. imaging but rather the technology or process of image and this therefore represents the future potential market transfer/transmission.size in the US alone. While our country has over 4,650 Teleradiology increases the efficiency of the doctortrained radiologists and Indian nighthawk companies are by ensuring that s/he spends the most part of his timeable to offer reports in 20-30 minutes in cases of emer- delivering quality care to the maximum number ofgency.ln 2009, the imaging modalities of X-ray,. ultrasound, patients. One doctor based in one location can simultane- CT and MRJ are collectively estimated to account for 68.6 ously provide services to several hospitals in multiple dif-per cent of the health imaging market. according to esti- ferent locations.It breaks geographical and time barriers mates by London-based market intelligence firm Tekplus and helps achieve accurate diagnoses in the shortest pos- research report 'Indian Health Imaging Market'. sible time. The Rural Arm Potential GaloreRural India does not have good radiological services and There are multi-faceted reasons for the potential in tele-personnel. Even if enough machinery would be available radiology there. the local 'not-so-competent' radiologist dominates Regulations: Apart from the demand and supply gap.the small town. But with tele-radiology. this skill deficien- what triggers the growth of the teleradiology market is cy can be overcome by using more experienced person- the fact that in the West it is mandatory to proVide 24-7 nel in the larger centres in the cities. Speaking on the need radiology services. Says Dr Bhavin Jankharia, Consultantof teleradiology. especially in remote areas, Dr Arjun Radiologist, Plramal Diagnostics - Jankharia Imaging, ''The Kalyanpur, CEO and Chief Radiologist, Teleradlology Health Care Financing Administration (HCFA) in the US Solutions, says. "Many remote parts of India face significant mandates round-the-clock services in every hospital. By heaJthcare challenges related to non-availability of trained outsourcing radiology reporting to places such as radiologists. Teleradiology bridges the ruralurban divide AustraJia. Europe. and some Asian countries (includingand allows rural India to have access to the best quality India) hospitals in the US, the UK. and Singapore can bediagnostic skills in radiology in a timely manner. Our serv- assured of competent and timely professionaJ help."Thereices to the Ramakrishna Mission Hospital in leanagar, is an increase in demand for radiology services in coun-Arunachal Pradesh. have been of great value to the pre- tries like the US, the UK and Singapore.The radiologists in dominantly tribal population of this remote part of ourAI 1(':1 JC:T ,nnQ IN IMAC.INC. ,

2. Cover StoryThe leleradlology centre at Oiwan Chand Sons Private UmitedThe call centre at Teleradlology Solutionscountry.The po ential is immense." pregnant mothers receive ante-natal care. It is no wonderWith the imment consolidation of the healthcare that our IMR (56 per 1000 live births - more than double and diagnostic services, including radiology services in of China & Brazil) and MMR (44 -10 times of China) is India, one an witness a potential to integrate the small way behind even most developing countries and closer to town radiology centers with urban hubs. ''Technology-sub-saharan Africa. Use of tele-radiology by government enabled models like teleradiology organised in a hub- n- and private entrepreneurs is one way for us to reach clos- spoke would be the key driver," comments Kapil er to Millenium Development Goals. Khandelwal.TeleradioJogy expert and Independent BoardDr Kalyanpur remarks, 'We cover hospitals in loca- Member and Founder of Disease Management tions such as Croatia. Georgia (republiC in the former Association of India. "We are already wi01essing someUSSR) and in Iranagar, Arunachal Pradesh where radiolo- consolidation activity in Southern India States of Tamil gists are unavailable or in eXtremely short supply. Nadu,Andhra Pradesh and Karnataka," he affirmed. Diagnostic interpretations and as a result accurate treat-On the domestic from, the key driv- ment would be gready delayed in these locations were it er for teleradiology is an acute shortage of not for teleradiology." radiologists.As per DECD (an organisation by the developed countries) average of Advantage India 0.22 scans (CT I MRI) per annum per indi-For international outsourcing. India has distinct advan- vidual even if decreased to 0.12 - 0.15tages when it comes to teleradiology. scans (CT I MRI) per annum per individualCose "An MRI in India. performed on a State-of-the-art to factor the age difference in populations, scanner. costs Rs. 6,000 (approximately $ ISO USD). The we would need about 450,000 scans perprofessional fee component is usually 10-15 per cent, I.e., day and therefore 40,000 machines and a 15-25 USD,II states Dr Jankharia.At these rates, having an pool of 30,000 radiologists compared toIndian radiologist report outsourced scans can offer a sig- less than 3,500 radiologists currently.nificant monetary advantage."Reduced costs due to the Going forward considering 30 years ofeconomy of scale. For each small hospital to have a radi- By outsourcingradiologists' active professional life justologist awake all night to cover emergencies is prohibi-radiology reportingreplacement would require 1,100 newtively expensive. An outsourced model works Out to be to places such as radiologists to pass out each year com-far more cost-effective," opines Dr Kalyanpur: Australia. Europeand so e Asian pared to less than 300 new radiologistsCheap labour': ''The salary of an Indian radiologist coun nes including passing OUt each year.working in the field of CT and MRI, five years post-MD India hospitals in The most urgent need is for making(Indian board certification). would usually be close to or the US. the UK. and Singapore can beultrasound facilities available to the mass- less than Rs 2,00,000 per month (approximately $ 5.000 assured 0 es.Today. less than 10,000 USG machinesper month or 60,000 USD per year ; in contrast, a com-compelen and cater to about 10 million instiOJtional deliv- parably qualified radiologist in the US would be earningtimely professionalhelp eries, which represent only 44-4S per cent approximately $ 350.000 per year," says Dr Jankharia. of total deliveries. Only 52 per cent of Time difference: The time difference betWeen the US8 IN IMAGING AUGUST 2009 3. Images need to be acqUired. stored. transferred andCover Storyviewed. Acquisition of Images Today. Virtually all radiology equipment is fully DleOM compliant.Thus. images can be stored on a network or aand India is a distinct advantage. especially for nighthawkworkstation In the DleOM format. Lossy and losslessservices.When it is night in the USA. it is daytime in India.compression is possible. Varying degrees of loss ofThis means that it would be possible for an Indian radiol- information may be acceptable. depending upon theogist, working dUring the daytime. to interpret images modality and the clinical situation. ptain radiographswith better quality and a greater accuracy than would theobtained non-digitally may need to be scanned. Currently.US radiologist in his night shift hours. "The day nightmammography images remain the last barrier to reliableadvantage that India affords results in greater productivity teleradiology. This is due to the large file sizes and issuesof radiologists who are in short supply. II adds Drrelated to the image resolution required to detectKaJyanpur. "Moreover. with a number of US.based third- microcaJcifications.party teleradiology service providers already offshoring.Transfer of Imagesthey are creating capacity to support 'day hawking' or day-In the early days, transfer of Images was performed overtime services as well," affirmed Kapil KhandelwaJ. telephone lines using modems. sometimes with speeds asSkilled support staff: India also has a distinct advantage low as 2.400 bps. Today. high-speed lines are avaJlable.in the form of high 2 Mbps) has eased out that Insecurity: 'We are seeing many radiologists in the US issue now. and Europe fear about their future as the newer models Currently. the use of teleradiology within the coun- are operating models are emerging." says Khandelwal. Hetry is confined to practices with multiple centres transfer- comments, "From the offshoring perspective some of the ring images to each other or to a central hub. Rural-urban risks include outsourcing the wrong studies, outsourcing or generalists-to-specialists transfers are not yet very tOO many studies, choosing the wrong vendor. legal factors popular, mainly due t.o cost constraints. and resistance from in-house physicians." A Yale study 'The key to success of tele-radiology is the spread affirms that there are potential benefits for teleradiologyof radiological equipment to the interiors of India coupled and the concerns with respect to outsourcing through with the ability of masses to afford these services. teleradiology is fairly overstated.Therefore, unless medical technology is individualised to Level playing field: "Offore-based teleradiology servic- Indian needs. wherein cost of MRI scans can be brought es have tax. SEZISTPI benefits while third-party domesticdown and health insurance (both private and government player have to bear the service tax burden and compen- sponsored) takes off, tere-radiology is likely to remain a sate that cost disadvantage by either flogging the teleradi- technology with great potential. There needs to be a dif- ologist to do more reads:' opines Khandelwal.ferent approach from corporate based to a sector based.There should be sharing of collaborative effortS between Domestic Woesthe healthcare provider, telecommunications and health- The main issues affecting the growth of teleradiologycare technology. Only then there will be optimal utilsation within the country are the following:of resources," remarks Murli Nair, Partner. Business Cost Radiology studies in this country are priced low, Advisory Services Ernst & Young. and centres can find it difficult to afford the services of tel-For the domestic market. the costs of the teleradi eradiologists. Moreover, a large amount of the profitology services needs to be reduced and for the interna- earned goes as refferral fee to the doctor who has rec-tional market, for a player to be successful. one must be ommended the test at a particular centre. This. thus, pre- obsessed with quality! _ vents a large share of profits to be ploughed back.Also. healthcare is well-acknowledged as a [email protected] intensive industry with radiology being even more so and