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When a patient visited a CCU, the GP on duty first took an ECG, which was transmitted to a specialist at NH or RTI. With the patient and the GP on the screen, the specialist then diagnosed the condition and advised the GP on the appropriate treatment. Patients who needed to be kept under observation stayed overnight at the CCUs, and specialists at NH and RTI conducted daily virtual checks on their condition. In serious cases, the patient, once stabilized, was transferred to NH or RTI for surgery. In very remote areas where videoconferencing facilities could not be set up, a network of around 100 family physicians was still able to use the software to transmit ECG images for diagnosis at NH.

Although telemedicine was not a new concept in India in 2001 (the Apollo Group of hospitals started using telemedicine earlier), NH and RTI made up the country’s largest network and were the only hospitals in India that provided the service free. The cost of setting up the CCUs was funded by AHF, as were the staff salaries and operation costs. Almost from the beginning, the project was supported by the Indian Space Research Organization (ISRO), a government agency that adopted telemedicine as a community project and provided connectivity for the CCUs free of charge. ISRO’s technology allowed telemedicine to operate by satellite connection, thus providing clearer images than the more expensive (and less reliable) phone lines—“the patient must see the compassion on the doctor’s face,” said Dr. Shetty.

In addition, the government of the state of Karnataka (in which Bangalore is the capital city) was so enthusiastic about NH’s work that the state planned to sponsor a further 29 CCUs. NH continued to monitor all CCUs closely—for instance, when they discovered that a CCU did not keep stock of streptokinase (an injection that had to be administered within six hours of a heart attack), the hospital set a policy of daily “virtual” rounds of CCUs to ensure all systems were working and ready.

“Telemedicine gives ordinary doctors the opportunity to accomplish extraordinary things,” Dr. Shetty said. Between 2001 and July 2004, the NH facility performed 9,591 teleconsultations and the CCUs had 4,077 inpatients, many of whom would not have received treatment otherwise. The telemedicine units were also linked to a clinic in Malaysia, a children’s cardiac facility in Mauritius, and a medical school in Hanover, Germany, with plans for new connections with Bangladesh, Tanzania, and Pakistan. And Dr. Shetty believed the concept could be extended across other medical areas. “If the patient does not require surgery, then the doctors may not need to touch him . . . once thousand of CCUs are networked, telemedicine can be self-sustaining for a few rupees per patient.”

While the telemedicine project utilized government infrastructure (i.e., the support by ISRO and the state government), the initial concept originated and was implemented via efforts at NH. To Dr. Shetty, this reflected the need for individuals and the private sector to take the initiative in areas where the government was typically held responsible. Dr. B.C. Bommaiah, a cardiologist at the hospital, agreed, although he added the need for the right attitude on the part of doctors to implement such initiatives. “Not all doctors will agree to take responsibility for patients that they do not meet in person,” he said. “But our doctors will care for someone they see on the screen.”

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