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Teleradiology Industry Report
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2. Cover StoryThe leleradlology centre at Oiwan Chand Sons Private UmitedThe call centre at Teleradlology Solutionscountry.The po ential is immense." pregnant mothers receive ante-natal care. It is no wonderWith the imment consolidation of the healthcare that our IMR (56 per 1000 live births - more than double and diagnostic services, including radiology services in of China & Brazil) and MMR (44 -10 times of China) is India, one an witness a potential to integrate the small way behind even most developing countries and closer to town radiology centers with urban hubs. ''Technology-sub-saharan Africa. Use of tele-radiology by government enabled models like teleradiology organised in a hub- n- and private entrepreneurs is one way for us to reach clos- spoke would be the key driver," comments Kapil er to Millenium Development Goals. Khandelwal.TeleradioJogy expert and Independent BoardDr Kalyanpur remarks, 'We cover hospitals in loca- Member and Founder of Disease Management tions such as Croatia. Georgia (republiC in the former Association of India. "We are already wi01essing someUSSR) and in Iranagar, Arunachal Pradesh where radiolo- consolidation activity in Southern India States of Tamil gists are unavailable or in eXtremely short supply. Nadu,Andhra Pradesh and Karnataka," he affirmed. Diagnostic interpretations and as a result accurate treat-On the domestic from, the key driv- ment would be gready delayed in these locations were it er for teleradiology is an acute shortage of not for teleradiology." radiologists.As per DECD (an organisation by the developed countries) average of Advantage India 0.22 scans (CT I MRI) per annum per indi-For international outsourcing. India has distinct advan- vidual even if decreased to 0.12 - 0.15tages when it comes to teleradiology. scans (CT I MRI) per annum per individualCose "An MRI in India. performed on a State-of-the-art to factor the age difference in populations, scanner. costs Rs. 6,000 (approximately $ ISO USD). The we would need about 450,000 scans perprofessional fee component is usually 10-15 per cent, I.e., day and therefore 40,000 machines and a 15-25 USD,II states Dr Jankharia.At these rates, having an pool of 30,000 radiologists compared toIndian radiologist report outsourced scans can offer a sig- less than 3,500 radiologists currently.nificant monetary advantage."Reduced costs due to the Going forward considering 30 years ofeconomy of scale. For each small hospital to have a radi- By outsourcingradiologists' active professional life justologist awake all night to cover emergencies is prohibi-radiology reportingreplacement would require 1,100 newtively expensive. An outsourced model works Out to be to places such as radiologists to pass out each year com-far more cost-effective," opines Dr Kalyanpur: Australia. Europeand so e Asian pared to less than 300 new radiologistsCheap labour': ''The salary of an Indian radiologist coun nes including passing OUt each year.working in the field of CT and MRI, five years post-MD India hospitals in The most urgent need is for making(Indian board certification). would usually be close to or the US. the UK. and Singapore can beultrasound facilities available to the mass- less than Rs 2,00,000 per month (approximately $ 5.000 assured 0 es.Today. less than 10,000 USG machinesper month or 60,000 USD per year ; in contrast, a com-compelen and cater to about 10 million instiOJtional deliv- parably qualified radiologist in the US would be earningtimely professionalhelp eries, which represent only 44-4S per cent approximately $ 350.000 per year," says Dr Jankharia. of total deliveries. Only 52 per cent of Time difference: The time difference betWeen the US8 IN IMAGING AUGUST 2009 3. Images need to be acqUired. stored. transferred andCover Storyviewed. Acquisition of Images Today. Virtually all radiology equipment is fully DleOM compliant.Thus. images can be stored on a network or aand India is a distinct advantage. especially for nighthawkworkstation In the DleOM format. Lossy and losslessservices.When it is night in the USA. it is daytime in India.compression is possible. Varying degrees of loss ofThis means that it would be possible for an Indian radiol- information may be acceptable. depending upon theogist, working dUring the daytime. to interpret images modality and the clinical situation. ptain radiographswith better quality and a greater accuracy than would theobtained non-digitally may need to be scanned. Currently.US radiologist in his night shift hours. "The day nightmammography images remain the last barrier to reliableadvantage that India affords results in greater productivity teleradiology. This is due to the large file sizes and issuesof radiologists who are in short supply. II adds Drrelated to the image resolution required to detectKaJyanpur. "Moreover. with a number of US.based third- microcaJcifications.party teleradiology service providers already offshoring.Transfer of Imagesthey are creating capacity to support 'day hawking' or day-In the early days, transfer of Images was performed overtime services as well," affirmed Kapil KhandelwaJ. telephone lines using modems. sometimes with speeds asSkilled support staff: India also has a distinct advantage low as 2.400 bps. Today. high-speed lines are avaJlable.in the form of high 2 Mbps) has eased out that Insecurity: 'We are seeing many radiologists in the US issue now. and Europe fear about their future as the newer models Currently. the use of teleradiology within the coun- are operating models are emerging." says Khandelwal. Hetry is confined to practices with multiple centres transfer- comments, "From the offshoring perspective some of the ring images to each other or to a central hub. Rural-urban risks include outsourcing the wrong studies, outsourcing or generalists-to-specialists transfers are not yet very tOO many studies, choosing the wrong vendor. legal factors popular, mainly due t.o cost constraints. and resistance from in-house physicians." A Yale study 'The key to success of tele-radiology is the spread affirms that there are potential benefits for teleradiologyof radiological equipment to the interiors of India coupled and the concerns with respect to outsourcing through with the ability of masses to afford these services. teleradiology is fairly overstated.Therefore, unless medical technology is individualised to Level playing field: "Offore-based teleradiology servic- Indian needs. wherein cost of MRI scans can be brought es have tax. SEZISTPI benefits while third-party domesticdown and health insurance (both private and government player have to bear the service tax burden and compen- sponsored) takes off, tere-radiology is likely to remain a sate that cost disadvantage by either flogging the teleradi- technology with great potential. There needs to be a dif- ologist to do more reads:' opines Khandelwal.ferent approach from corporate based to a sector based.There should be sharing of collaborative effortS between Domestic Woesthe healthcare provider, telecommunications and health- The main issues affecting the growth of teleradiologycare technology. Only then there will be optimal utilsation within the country are the following:of resources," remarks Murli Nair, Partner. Business Cost Radiology studies in this country are priced low, Advisory Services Ernst & Young. and centres can find it difficult to afford the services of tel-For the domestic market. the costs of the teleradi eradiologists. Moreover, a large amount of the profitology services needs to be reduced and for the interna- earned goes as refferral fee to the doctor who has rec-tional market, for a player to be successful. one must be ommended the test at a particular centre. This. thus, pre- obsessed with quality! _ vents a large share of profits to be ploughed back.Also. healthcare is well-acknowledged as a [email protected] intensive industry with radiology being even more so and