Teleradiology’s role in access to primary health care

The article is authored by Arjun Kalyanpur, Teleradiology Solutions, Bengaluru

The recent pandemic has revealed two fundamental truths about health care. The sobering reality it has exposed is that we are frighteningly vulnerable as a population to new diseases that can spread rapidly and overwhelm our healthcare systems, however advanced they may be. But in parallel it has highlighted how we in the healthcare system also possess within our grasp the tools needed to rapidly respond to such a crisis. One such tool is telemedicine - and a key byproduct of the pandemic has been a newfound appreciation of the benefits that telemedicine offers. Teleradiology has been at the forefront of the telemedicine revolution, and a review of its value proposition in addressing our current healthcare challenges seems appropriate at this time.

Teleradiology has been at the forefront of the telemedicine revolution, and a review of its value proposition in addressing our current healthcare challenges seems appropriate at this time.((Miguel Medina / AFP))

Health care in India has always been faced with a conflict. The challenge before our country, given the size of our population, has been how to simultaneously provide basic primary health care for all as well as deliver tertiary care at a level that our population needs and deserves, and that our highly competent physicians are capable of providing. How and where to allocate sparse physician resources is the difficult choice at the centre of this dilemma.

Fortunately, thanks to information technology, a solution is available in the form of telemedicine, which has been led and driven by the success of teleradiology. The implication of ‘tele’ in telemedicine lies in increasing the reach and impact (in terms of geography and productivity) of the physician, critical in a physician–scarce environment such as we are currently in, and will be for the foreseeable future. In radiology, with less than 20,000 radiologists in our country to serve a population of 1.3 billion, the need for increasing the reach and capacity of our existing radiologists is paramount. Teleradiology is the enabler for this. The vision for teleradiology, in terms of the areas where it has made impact and will particularly deliver value to our country in the future are as follows:

1. Remote access- 70% of India lives in its villages, and so correspondingly the majority of our country is deprived of radiologist access given that radiologists overwhelmingly reside in metros and larger cities today. The National Digital Health Mission provides an infrastructure and vision that can translate this into access to quality radiology diagnostics for this 70% of our population that needs it the most. The greatest power of teleradiology will be unleashed through such a large scale deployment initiative.
2. Emergency care – India is sadly today the trauma capital of the world, given overpopulation and the traffic on our roads. Further, emergency conditions such as stroke and cardiovascular disease are steeply on the rise. In these situations, every second counts in getting a correct diagnosis, but the radiologist may not be immediately available. By instantly bring the images to the expert radiologist teleradiology provides the immediate diagnostic access necessary for diagnosing critical elements such as bleeding in the brain, arterial blockages that prevent oxygen supply to vital structures, and patterns of decreased blood flow to critical organs. The vision of a nationwide network for immediate quality diagnosis in stroke and trauma can be transformational to our country’s health.
3. Tertiary care and sub-specialty medicine-- As standards of sub-specialist health care, such as cardiology, orthopedics, neurology and oncology rise across the country there needs to be a corresponding supply of expert radiologists to support these sub-specialties and provide high quality diagnosis. However, there is a significant shortage of sub-specialty radiologists in India. In this resource-constrained scenario, teleradiology provides the opportunity to extend the reach of these few subspecialists and allow them to deliver quality diagnostic services across the country to a much larger population than they otherwise could. Magnifying and optimizing the impact of a scarce resource (sub-specialty radiologists) is where teleradiology can deliver major value.
4. Screening for cancer and TB-- While communicable diseases such as tuberculosis remain endemic and continue to plague our population, in parallel noncommunicable diseases such as cancer are also increasing. Breast cancer is today the commonest cancer among Indian women and late diagnosis mainly contributes to its high mortality in our country. The common factor needed to rein in these public health menaces is population screening, by chest X-ray in the former and mammography in the latter, to ensure early detection and cure. Teleradiology is a facilitator to ensure that the large volumes of studies from screening programs are reported accurately and in a standardised manner leveraging information technology so that maximum public health impact can be achieved.
5. Driving Artificial Intelligence (AI) utilisation- The true paradigm shift in health care delivery going forward will be the integration of AI algorithms into workflow to mitigate physician shortages, and radiology tends to benefit most significantly in this regard. Deployment of such diagnostic algorithms into teleradiology workflow will provide the greatest magnifying effect by allowing the benefits of such algorithms to be realized at a national or global level, thereby magnifying their reach and impact most effectively.

While the past two decades have slowly but surely established telemedicine as an important if not critical solution for the efficient implementation of healthcare delivery, the recent pandemic has effectively set it firmly atop the pyramid of innovative healthcare delivery processes and practices. Among the specialties of medicine that benefit most greatly from the telemedicine model has been diagnostic radiology. Teleradiology, given its digital foundation and its diagnostic focus, has consistently been the flagbearer for telemedicine.

The vision of teleradiology as being a technology enabled solution that allows radiology as a medical specialty to be practised safely and effectively on a national scale is a profoundly potent and impactful one, and represents an idea whose time has come.

(The article is authored by Arjun Kalyanpur, Teleradiology Solutions, Bengaluru.)