Krishnan Ganapathy: Without India There is No mHealth

Posted by dsasaki on Jul 31, 2008

Krishnan Ganapathy, a practicing neurosurgeon, is the former president of the Neurological Society of India and current president of the Apollo Telemedicine Networking Foundation. He is also the co-founder of the Telemedicine Society of India, a member of the National Task Force on Telemedicine and an adjunct professor at IIT Madras and at Anna University. He is currently involved in preliminary studies on the clinical evaluation of patients based in rural areas of India, Bhutan, and Bangladesh using wireless telephony. Along with his colleague Aditi Ravindra, Dr. Ganapathy is one of the leading thinkers on mobile health in India and around the world.

What follows is an edited, abridged transcribe from a conversation we had at Rockefeller's Making the eHealth Connection conference. An MP3 of our entire discussion is available for download.

DS: A lot of people don't have an understanding of what mHealth is, what telemedicine is, and how mobile phones are being used by physicians, surgeons, and health care professionals. You've been on the cutting edge of all this for a long time ... can you talk to me about how the way you treat patients has changed over the years with the use of mobile phones?

KG: We really started using mobile phones very recently. Particularly in the developing world, the only way that you can ever provide secondary and tertiary medical expertise to the majority of people is with mobile phones. If you take India, for example, 750 million Indians live in suburban and rural areas where you just don't have specialists. Now I, as a neurosurgeon, am able to provide neurosurgical, if not care, at least advice to these people. Similarly, all other specialists are able to do the same. This is what we have been doing fairly successfully for the last nine years. We have started this whole concept of providing medical care from a distance, which is a revolutionary concept and very recent. In the last nine years we have done about 55,000 tele-consultations.

Also, in India, the growth of mobile phones is exponential. Last month the telecommunication authority of India said the tele-density of India was 30%. 300 million Indians have mobile phones. In the city where I live [Chennai], between 1998 and 2008, mobile phone penetration has increased by a factor of 133. Today mobile phones are no longer a status symbol, they no longer belong to the elites. They belong to everyone. The man on the street today has a mobile phone. So we thought, why not use this to provide health care?

Last year, as a pilot project, we worked with Ericcson. The Indian government is proposing to make 3G technology available possibly by the end of the year, most certainly be the beginning of next year. So we got a special license from the government and used 3G technology to see if we could transmit data - meaning: audio files video files, visual images, and so on - and we successfully looked after the health of 240 people in 15 villages in a very small experimental study in September, 2007. But this gave us tremendous confidence. We realized that in India it is possible to transfer an ECG and to listen to heartbeats via a stethoscope with the doctor and the patient several thousand miles away from each other using purely wireless technology on mobile phones. The greatest part of this is that villages in India which still do not have a landline, which still do not have a wired phone, are directly going into the 21st century by using wireless technology. Buoyed by our success last year we have now expanded. We have done a small project in Bhutan two weeks ago and right now one of my colleagues is in Bangladesh where we are doing a trial for the Bangladeshi government, trying to show them that, using mobile technologies, a doctor would be able to interact with the patient.

DS: Can you run me through that specific project to give us a better understanding of what is being done in Bangladesh, for example?

KG: Again, we got special permission to use 3G from the government of Bangladesh. Basically, a mobile van will be going from place to place and a paramedical worker from the van will be putting the stethoscope on the chest of a patient and, when indicated, ECG leads will be put on a patient and that information is transmitted to the doctor in Dhaka using a special chip which has been developed in India. So, the ECG, the heart sounds, the pulse rate, blood pressure, temperature, oxygen saturation all gets transmitted. Also, using an ordinary webcam we can focus the camera on the patient and if the patient has a lump or a bump or dermatological condition, these images are transferred to the doctor in the tertiary care center.

What I want to emphasize is that this is totally through mobile technology, through wireless networks, and therefore, theoretically, wherever the signals reach, it will be possible for a specialist to provide health care.

DS: But you still need the paramedic or nurse to go out there in the van and do the examination, which then gets relayed via mobile phone to the specialist?

KG: At this point of time, yes. But the day is not far off when we hope to devise an instrument which we have, over the last few days, given the name mDoc and we already have got the specifications. We hope that in the not too distant future we will be able to bring low cost affordable equipment to the masses. The mDoc will have certain sensors which will measure the blood pressure, the ECG, etcetera, transmit this totally non-invasively to their doctors and when this becomes a reality, a patient herself or anyone in the house can use this equipment so you do not even require a paramedic or a nurse.

DS: I should note that this idea for the mDoc device came out of this week's meeting, right?

KG: Yes. I mean, I had been toying with this idea for several years, but I never really thought it would come into reality. But during the last few days after meeting with several people across the globe, I realized that other people had similar ideas and yesterday we sat down for a couple of hours and designed all of the specifications and we hope that within a year we will make this a reality.

DS: Why do you favor a separate device rather than using existing mobile phones to build applications on top of?

KG: An mDoc will also make telephone calls. In other words, we will have a very specialized mobile phone with lots of added features. It doesn't make sense to have 6.2 billion people on this planet carrying an mDoc. It's just not practical.

DS: Another way of putting it, maybe, is that mobile phones right now don't have all the features that doctors need to provide mobile health care. So what are some of the features that the mDoc would have that mobile phones don't have?

KG: With mobile phones, one phone has one feature another has other features and so on. We are trying to integrate all the features in one simple mDoc. We would be able to check the blood sugar, the pulse rate, your lung volume capacity, ECG's, etc.

DS: Most applications of mHealth are still in the pilot phase and I think that when a lot of people think of these field tests of mobile health applications, they think about Sub-Saharan Africa, but you have been arguing that India is really the ideal place to do the pilot tests.

KG: Absolutely, for the simple reason that the whole world today acknowledges India as the leader in software development. 80% of the software developed for the United States is done by Indians, people of Indian origin. NASA depends entirely on engineers of Indian origin for their software. So we are in a unique position where we are a developing country, but not undeveloped, and most importantly we have not only hardware and software, but we also have an abundant amount of what I like to call brainware. English speaking brainware is in abundance at 50% of the international cost.

DS: So you think that India could be a center of innovation for mHealth?

KG: I don't think it could be a center for innovation, I think that without India there could be no mHealth. Pardon my arrogance, but I think it is based on facts.

DS: All of these pilot projects happening right now, all of these great ideas that you've been discussing, what is fundamental to make these pilots become an actual industry?

KG: That is the problem: scaling. We already have several pilot projects, but we're just not scaling up. I think one of the main problems is a lack of awareness. I think that only a minute portion of the health care community, of the ICT community, of the mobile phone community are aware of the enormous potential in which mobile wireless technology can be used for heath care. mBanking today is slowly being accepted. Among all the so-called mServices, mHealth is still unborn and I think that creating awareness in the form of conferences, publications, presentations, and meetings is key. I would like every single human being on this planet to know within three years from now that it is possible to get health care through a mobile phone. Once that has been achieved, I think the rest will automatically follow. Pilot projects will automatically become commercial. People will get interested, a business case will develop, and it will become a reality.

Krishnan Ganapathy

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