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In remote areas of India, Telemedicine is used to diagnose and treat Retinopathy of Prematurity (RoP)

December 28, 2010 | Chris Payatagool
iphone_telemedicine.pngIn remote areas of India, Telemedicine is used to diagnose and treat Retinopathy of Prematurity (RoP) - a condition that can lead to blindness and affects nearly a tenth of the 27 million children born every year   

17 December 2010.  Bangalore, India. Four 4-months -old Tabassum, a premature baby, weighing less than 2,000 grams at birth, is being screened by specialists using a software developed by a Bangalore based start-up i2i Telesolutions. The software links ophthalmologists at urban centres with patients in remote areas.

Sham Banerji, CEO of i2iTeleSolutions, says:"This is Telemedicine 2.0, moving ahead from the earlier system of videoconferencing to live streaming of data and images onto the mobile phone of the doctor. The company is partnering with Narayana Nethralaya, a Bangalore-based ophthalmology center, to pilot a series of initiatives to detect and treat retinopathy of prematurity (RoP) -- a condition that affects nearly a tenth of the 27 million children born in India every year.

"Roughly if 100 critical cases are screened, 15-20 % may require treatment to prevent blindness," says Dr Anand Vinekar, pediatric retinal surgeon, Narayana Nethralaya, who has screened and treated nearly 3,000 babies over the past year using this new software.

"To prevent blindness, a child should be screened within 30 days of birth and treatment initiated within 48 hours of screening as ROP is a progressive condition," says Dr Vinekar.

The i2i platform requires a trained technician to take retinal photographs of the babies and upload them on the move to a secure remote server using a data card, from where they can be downloaded onto a phone or a regular computer to a specialist who diagnoses and provides corrective feedback within 15 minutes of the image being first uploaded.

Using this data transfer of medical images from ophthalmology to sonography, specialists at partner hospitals such as MediScan Systems in Chennai can diagnose potential birth defects in fetuses by screening pregnant mothers within the first 13 weeks.

In India, which has the largest concentration of blind people in the world, there is one ophthalmologist for every 10,000 people. "The country is now experiencing the third epidemic of ROP with technology-driven health care emerging as the best option to arrest this," says Dr Vinekar.

To begin with, the hospital had a basic system where photo images of children affected with the condition were sent in as email attachments to specialists who in turn diagnosed the condition and reverted with no universal screening of all premature children.

Vijay Govindarajan, professor of international business at the Tuck School of Business at Dartmouth, who has blogged about i2i's teleophthalmology solution on the Harvard Business Review blogs. He also notes the recently-introduced hand-held ultrasound machine, VSCAN from GE, which uses the same chip architecture that powers most smart phones.

Apart from the rapid growth of mobile phones in emerging markets, he also lists the evolution in technology platform from the older picture archiving and communication system (PACS) to a tele-PACS system that can help multiple specialists to simultaneously view and report on a single image, as the prime influences of this growing trend.

"Technology now increases the scale of impact. I can view images of more patients, number of diagnosis rises rapidly and also allows me to source second opinion immediately on any of my cases," says Dr Vinekar.

"We built this software initially on the proprietary Apple platform for security and advanced graphical capability. We are looking to extend this to Android platforms now," says Banerji. His company has been approached by makers of Blackberry phones and Samsung to have these applications embedded on their devices. i2i is now looking to make this technology platform agnostic.

Currently, this i2i model has been adopted as part of the National Rural Health Mission (NRHM) in Karnataka and Tamil Nadu with primary health centers across 23 districts having this capability. Banerji sees opportunities to expand in these markets in India as well as abroad and is seeking investors to help him grow his start up company.

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