Telemedicine or WHIMS: Which solution is superior?

To most people to whom we introduce iKure, WHIMS appears to be telemedicine. Telemedicine has become synonymous with technology in rural healthcare. At times one feels that the whole concept of rural healthcare technology has been overshadowed by the concept of telemedicine. If does have a compelling proposition, but there is immense scope of innovation in delivery models. WHIMS is an attempt at providing an alternate to telemedicine when the costs outweigh the benefits of telemedicine.

The topic of this post asks a question, which approach is better – telemedicine or WHIMS? But the matter of fact is that these solutions can’t be used interchangeably. WHIMS is a low cost collaborative IT platform which enables a rural doctor/health-worker and a city-based specialist doctor to exchange data pertaining to a patient’s health. The model doesn’t demand either of the two sides to be available all the time. The rural doctor places the patient’s data on the cloud server and the city-based doctor accesses it whenever he has time or at a pre-defined time each day or as a response to an SMS sent to his mobile automatically when a case is escalated to him. WHIMS therefore is an extremely flexible collaboration model.

Telemedicine is a better known model which enables a doctor present anywhere in the world to consult a patient in a far-flung remote area through the use to audio-video medium. The consultant can view the patient in front of him and can seek assistance of the doctor present at the rural clinic to examine the patient as per his instructions and can get a feedback instantly. Telemedicine replicates the traditional healthcare model where doctor and patient have to be present simultaneously at a point (physically or virtually). While telemedicine has a huge potential, it puts a constraint on the consultant that he has to be present when the patient is there, or the patient has to be present when the consultant is there in the clinic. Also, telemedicine puts a lot of demand on infrastructure. The network should be able to support a bandwidth that can enable an audio-video communication between the two points. But it can be said that the patient has a lot of assurance because he/she has been ‘seen’ by the doctor and has received an instant consultation from the specialist.

When we designed the hub-and-spoke model for WHIMS, we defined hubs as tertiary, or even secondary, care hospitals and spokes as the rural kiosks which would carry the technology and portable diagnostic bits of the overall network. We also left the scope of a sub-hub, i.e. an intermediary between the hub and the spoke. We imagined the role of telemedicine at the sub-hub level.

Such a scenario can be imagined as the rural clinics serving as the last mile primary care centres which provide generic and specialist consultation using WHIMS. In cases where the consultant needs to have a look at the patient, rather than sending the patient 50-70 Kms. to a tertiary care set-up (hub), we can create an intermediate sub-hub with telemedicine support. So such cases where doctor needs to physically observe the patient, he can request them to visit the sub-hub which would be relatively closer to their villages, say 20 Kms. Upon further consultation, if he feels that the patient needs to travel or if there are any complications, he can ask them to visit the hub hospital, 50-60 Kms. from the village.

As explained above, we see the role of telemedicine as complimentary to WHIMS and both technologies can co-exist in the same network with a common overlap, i.e. patient data. 

Remote Health Monitoring

We have come across data that shows paucity of healthcare professionals and healthcare infrastructure in rural and semi-urban areas of India. We also know that it would take generations for us to remove this disparity. In this kind of scenario, any possible solution should work around constraints and bring in a game-changing proposition.

The constraint here is the scarcity of specialist medical help in rural and remote areas. The healthcare parameters in such areas are extremely poor and the traditional solutions offer little respite. The game-changing proposition we offer is the technology-enabled monitoring system for remote patients.

Wireless Health Incident Monitoring System (WHIMS) is a humble piece of technology which enables a city-based specialist doctor to monitor the health of his patients. A trained health worker or a rural doctor provides the primary care to the patients and records information related to their health in WHIMS’ application. WHIMS can be accessed through internet or through mobiles. Low-cost portable diagnostic devices empower the primary care providers to capture precise health information of the patients and provide it to the consultants. While we do not use any tele-medicine interface, the same can be built into the system.

Remote Health Monitoring has the potential to create a viable scalable healthcare model for rural areas because the scare specialist resources are utilized efficiently. Better care can be delivered to the patients at a fraction of the cost to an urban patient.

While the opportunity is real, we must also realize that this is not the solution in totality. Some percentage of patients will require emergency care and in-patient treatments. In some other cases, high-end diagnostics may be required. Even towns do not have such facilities. Clearly, government’s role in creating such an infrastructure cannot be negated. Public-private partnership (PPP) can also be a model where government supports and encourages private players to create such an infrastructure.