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MARCH 11, 2007
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 BT Special
 Back of the Book

The centre is looking at removing the distinction between FDI and FII investments. This will impact sectors like asset reconstruction, real estate and aviation, where separate ceilings apply to FDI and FII investment. However, allowing FDI through the FII route in the realty sector could result in prices shooting through the roof. The Asian financial crisis of the '90s is still fresh in mind, and a method should be devised to moderate possible volatility in key sectors.

S&P And After
For the first time in 14 years, international credit rating agency, Standard and Poor's (S&P), has raised India's credit rating to investment grade. S&P is the last of the three major international rating agencies to do so. Moody's Investors Service did it in January 2004 and Fitch Ratings in August 2006. The upgrade is likely to spur the flow of foreign investment into power, steel and other industries, which receive less than a tenth of the funds going China's way.
More Net Specials

Business Today,  February 25, 2007

The Promise of Telemedicine
Quietly, telemedicine is circumventing the medical infrastructure problem by putting state-of-the-art healthcare within the reach of some of the poorest.
All wired up: Dr S.P. Murugappan with a telemedicine patient at his Tiruvallur hospital
In august 2005, when Dr Vikram Muralidharan was trying out the new telemedicine facility at his 25-bed hospital in Annamalai in Tamil Nadu, a bizarre case came up that would reinforce his decision to go in for the new-fangled technology. A tribal, who had been knocked about by an elephant, was wheeled into Dr Muralidharan's hospital, with lacerated bones and eyes popping out of their sockets.

As luck would have it, Dr Muralidharan was actually on a video conference with an orthopaedician in Chennai and an ophthalmologist in Hyderabad. When he was informed of the emergency case, Dr Muralidharan asked the other two doctors to stay online for consulting. Fortunately, the tribal patient had no serious internal injuries. So, with the help of the two specialists, Dr Muralidharan put the tribal's eyes back into their sockets and treated the lacerated bones as well. In just three days, the tribal was back home (determined, perhaps, never to cross the path of an elephant again).

Mauled by an elephant, saved by a mouse. The nature of the patient and the nature of the technology used to save the tribal's life drive home the promise of telemedicine in a country like India, where medical infrastructure is scarce and patients far flung. By allowing doctors-typically, specialists-to consult even the poorest of poor patients remotely, telemedicine can help not just spread healthcare to remote corners of the country, but maximise utilisation of the existing healthcare resources. A FICCI-Ernst & Young report on the sector says that telemedicine is "potentially, the biggest success story in the healthcare sector: telemedicine today has given ordinary doctors the capacity to do extra-ordinary things".

Dr Muralidharan would agree. Although his investment in telemedicine facility is, he says, relatively high at Rs 1.80 lakh and yet to break even, the doctor is happy with the results. He is able to tap online specialists at Madras Medical Mission or kg Hospital in Coimbatore, or expert diabetologists at MV Diabetes Centre for a second opinion. He is learning new treatment regimens every day (thanks to, instructions from super-specialists on patient treatment) and enhancing his own knowledge.

Bhardwaj's Space Hospitals plans to introduce mobile vans with V-Sat facilities to take telemedicine to remote areas

More importantly, his patients are happy. For a consulting fee of Rs 450, they are able to get a prescription from a super-specialist with whom they can speak online. "Without telemedicine, I would have lost my patient to a city doctor-he would never have come back to me,'' says Dr Muralidharan.

For patients, at least in small towns and villages, it's a terrific deal, too. They need not spend money commuting to a city hospital, waste time in the doctor's waiting room, or undergo a lot of routine tests. The same rigmarole can be avoided in cases where follow-up visits are required. Says Dr S.P. Murugappan, who runs a 20-bed hospital in Tiruvallur, 45 km from Chennai: "Earlier, trauma cases used to head straight to Ramachandra Medical College (25 km from Tiruvallur), but now my hospital has become the first destination."

Dr Murugappan speaks of a patient who came in with a heart attack on New Year's eve recently, and how telemedicine saved his life. After stabilising his condition, the doctor patched through virtually to a super-specialist at the Madras Medical Mission (MMM) who could monitor the patient's condition remotely.

After a couple of days, the patient was transported to MMM, where an angiogram was performed, followed by a bypass surgery. And within a week of his admission to Murugappan's Surya Hospital, the patient was back home in Tiruvallur. "A lot of red tape relating to admission was bypassed because the specialist was already familiar with the condition of the patient even before he arrived,'' says Dr Murugappan.

Not Just New Technology

Yes, I can hear you: Neemrana in Alwar gets its first telemedicine center
Telemedicine is not new, and some of the bigger hospitals such as Apollo Hospitals, Manipal Hospital Group and Wockhardt Hospitals have been using it for some years now. But, typically, they use it within their own hospitals and for their own patients. Helping connect the larger, tertiary hospitals with the smaller, secondary hospitals is a Chennai-based firm called Space Hospitals. Despite its name, Space Hospitals is not a hospital but a third-party service provider. The smaller hospital is required to invest in equipment such as a personal computer, scanner, web cam and a black box (for measuring blood pressure, ECG and the level of oxygen in blood) that is then connected to Space Hospitals' network. Often, there is a separate telemedicine room with a bed for the patient.

At present, Space Hospitals has 16 major hospitals in its network (including Asian Heart Institute in Mumbai, and Rajiv Gandhi Cancer Institute in Delhi) and dozens of smaller ones (like Samatha Nursing Home in Nellore, Andhra Pradesh, and Apna Hospital on nh-21 Ghagas-Bilaspur, Himachal Pradesh). Sanjay Bhardwaj, President & CEO, Space Hospitals, expects the network to grow rapidly in the years ahead. He explains why. According to him, only 10 per cent of India's total doctors (5.92 lakh) are specialists. Worse, almost all of them are in the metros. "Out of every 10 patients who consult with a super-specialist, only six really need his validation. The other four can be served by a general physician in their own towns," says Bhardwaj. In Space Hospitals' brief 12-month history, only eight of the 1,800 telemedicine consultations had to be moved on to bigger hospitals after two weeks of monitoring. "Just imagine how much time, money, and energy was saved for patients," he says. Adds Dr Muralidharan: "This is the basic ethos of the concept that we are selling.''

In March this year, Space Hospitals plans to introduce its own mobile vans with v-sat facilities. These vans will serve as Space Hospitals hubs for tele-consultations, and go around villages and, much like a medical camp, identify patients and initially give them free treatment and also free medicines, which would be procured from the city and couriered where necessary. The idea is to popularise telemedicine among villagers.

With the government planning to build an internet kiosk at every panchayat in the country, telemedicine may find its feet in rural India much faster than most people expect. Under the model that Space Hospitals has in mind, the kiosk operator would offer the black box facilities, and a local doctor would issue a prescription based on the recommendations of a small-town hospital doctor or even a super specialist, if need be. Some private equity investors, including an NRI investor from Singapore who does not want to be named, have already put in seed money behind Space Hospitals. But Bhardwaj says bigger venture capitalists have expressed interest in greater investments.

Dr Raghupathy's G. Kuppuswamy Naidu Memorial Hospital has implemented Asia's largest PACS facility and has a digital storage capacity of 3 terabytes, or 3,000 giga bytes

Another area where patients, poor and rich, are going to be seeing a lot of progress is digitisation of medical records. G. Kuppuswamy Naidu Memorial Hospital, a charitable 600-bed hospital in Coimbatore run by the Lakshmi Mills Group, has implemented Asia's largest PACs (Picture Archiving Communication Services) facility. PACs is nothing but digitisation of diagnostic records the minute a test is completed, so that doctors can access it off a central server anytime and anywhere within the hospital. "We are not counting immediate benefits in our investment in technology, but in the long term, several benefits would definitely accrue," says Dr Ramkumar Raghupathy, Dean of the hospital, which has a digital storage capacity of 3 terabytes (that's 3000 GB).

There are other hospitals such as Vallabhai Patel Chest Hospital in Delhi (it was the first to implement PACs in India), the Asian Institute of Gastroenterology, and Wockhardt Heart Hospital that are using PACs. Larger hospital systems such as Apollo are also maintaining electronic medical records. Apollo, for instance, has scanned 10 lakh records. Wockhardt allows round-the-clock remote monitoring of patients by specialists. Its ambulances have the capability to transfer key patient data en route to hospital so that treatment can be planned without loss of time.

Clearly, information technology is going to dramatically change the way healthcare is delivered to millions of people in the country.