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. 

Technology-enabled healthcare delivery to under-served market

For the last about 2 years that iKURE has been working on technology solutions for healthcare delivery, we have straddled 2 very different customer segments – rural and urban. And it has surprised us that opportunities for advances in rural healthcare delivery exist through the use of a humble technology platform.

Why I used the term ‘under-served market’ in the title is because I wanted to highlight that rural people also pay out of pocket for their healthcare needs. Their ability to get quality healthcare is limited by Access and Affordability. Most good hospitals are built in urban centres and there also you will witness a huge difference in healthcare facilities available in metros and towns/cities. From my own healthcare experience I have realized that it takes many factors to create a quality healthcare system – Doctors, Nurses, Technicians, Engineers, Billers, Security, Waste Management, Medical Suppliers, Equipment suppliers and maintenance, IT etc. and many other supportive institutions like municipality, banks, electricity dept. among many others. And add to this the problem of high rate of attrition in medical and non-medical staff. So let’s admit that it’s not economically feasible to replicate an urban healthcare delivery system for rural setups in the near future. But rural masses deserve the same standards, yet access is limited because they need to travel a lot to avail of the services of hospitals in the urban setup. Affordability is another issue because one another aspect of the urban healthcare system or a hospital is that it is capital intensive and most of the costs are passed on to the patients. For city-based patients it is within reach because per-capita income level in metros/cities is much higher than those for towns and villages.

In such kind of circumstances, the easiest we can do is to enable patient in a village to seek health services from a city-based consultant without having to travel to the city and at a fraction of a cost of what it would be for a city-based patient. At iKure we leverage this through a hub-and-spoke model. For more information on this, please read the post ‘Health for remotest of areas – the iKure way’.

From our field experiments, we have come to a working model which is supported by Corporate Social Responsibility funds. So while the technology creates Access, the Affordability is taken care of by the CSR grant which subsidizes the treatment costs. It’s heartening to see how such partnerships create difference in the lives of our countrymen.

The scope of this model to radically change the rural healthcare delivery process is immense. Our concept is basically to create a technology platform to enable a rural doctor/health worker to collaborate with a city-based specialist doctor to deliver care to the village-based patient. In this process, we are able to uplift the confidence and credibility of the village-based doctor and significantly improve his decision-making abilities regarding his patients’ treatment. Our health partner also spends their resources in training these health workers/doctors to bring them up to the common communication level with the city-based doctor. The CSR partner funds the medicines, consultations and other health costs for the target community. But as a group, it is our endeavour to make the whole model self-sustaining by letting the community take ownership of the whole system.

As we make progress, we would like to explore opportunities where a fairly good number of spokes or village health centres/clinics are technology-enabled and these are connected to a series of specialized centres to provide quality healthcare to a larger set of population. Many more innovators can leverage this network, for example insurers, pharmaceutical companies, low-cost diagnostic device manufacturers, research institutions etc. As I said in the beginning of this post, there are a number of factors which contribute to make an urban healthcare delivery system. We are in the process of creating an ecosystem of partners and experts who will together create a rural healthcare delivery system which will materialize our vision of delivering quality healthcare services to rural people at a price point affordable to them.

If you share our vision, or you are an innovator passionate about this sector, please contact us at contactus@ikure.in