Introduction:

Doctor shortages are acute in developing countries, where disease burden is the greatest and resources for health care are limited. An absence of pathologists in these countries has lead to delays in diagnosis and misdiagnoses that unfavorably influence patient care and survival. The introduction of telepathology into areas with specialist pathologists shortage is however one of the approaches that can be utilized to reduce the problem.

Telepathology: How it is done:

Telepathology is the electronic transmission of computerized or digital images that can be utilized for education and diagnostic consultation. The system comprises of a microscope with a mounted digital camera linked to a computer. The pathologist selects the video images for analysis and and then submits a diagnostic report.

Telepathology systems are divided into three major types: static image-based systems, real-time systems, and virtual slide systems. Static image systems have significant advantages of being the most sensibly valued and are usable in most settings; however the downside is that just the chosen subset of microscopic fields are transmitted for review by the pathologist. Real-time systems and virtual slides permit a specialist pathologist the chance to evaluate the entire specimen. With real-time systems, the specialist effectively works a microscope located at a distant site – changing focus, illumination, magnification, and field of view at will. Virtual slide systems use a robotized scanner that takes a visual image of the whole slide, which can then be sent to another area for diagnosis.

Case study: From Assam to Karnataka:

Teleradiology solutions (TRS) based in Bangalore, India provides radiology reporting services to hospitals and diagnostic centers across the world. With its team of experienced radiologists, TRS has a decade long large cumulative experience in interpreting non invasive diagnostic imaging studies including digital radiographs, CT, MRI, sonography, and nuclear medicine studies including PET-CT. With an experience of reporting for over 3 million patient studies and an understanding of technology usage in health care, TRS extended its domain to the pathology space.

Rangia is a small town in the Kamrup rural district in the Indian state of Assam. People in Rangia had no radiologist in the neighboring area to provide diagnostic assistance. A medical entrepreneur in Rangia who set up pharmacy, ultrasound, X-ray and a pathology lab approached us for teleradiology services in 2012. After 3 years of successful teleradiology and tele ECG coverage, we found that they did not have a pathologist who could interpret their hematology slides. They had to take blood samples to a pathologist at a lab located 70 kilometers away from the clinic. After hearing about this situation, using our understanding of technology for teleradiology (RADSpa), we created a solution for telepathology (PATHSpa). And proceeded to set up a new platform for Telepathology in this small town in Assam. The camera fixed on the microscope and the unit configured to the computer was the basic investment for the clinic. Hence with minimal investment, the clinic in Assam had the basic set up for a digital pathology reporting unit.

Initially technicians at Rangia had difficulty in preparing the peripheral smear and staining it. However, with training this improved. The diagnosis and reporting of the patients was quick with the help of Telerad’s pathologist. The digitally signed reports were then sent back to the clinic through the PATHSpa platform.

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AEC- Absolute Eosinophil count, CBC- Complete Blood Count, TC- Total Count, DC- Differential Count, ANC- Absolute Neutrophil Count, P.S- Peripheral Smear

A Total of 131 Telepathology reports (As shown in the figure above) were generated over a period of six months. PATHSpa was the platform used for the Telepathology service.

Challenges of rural and semi rural India:

Most of the 620 million of rural Indians lack access to basic health care facilities as 70% of total population in India is living in villages. The Indian government spends only 0.9% of the country’s yearly total domestic product on health, and little of this spending reaches remote rural areas. The poor infrastructure of rural health centers makes it difficult to retain doctors in villages, who feel that they maybe professionally and socially isolated if positioned in remote areas.

One of the solutions for this is low cost telemedicine technology coupled with robust medical service delivery. However, telemedicine activity in India has not been free of difficulties and controversies. There are certain challenges associated with the introduction of new systems and technologies. Despite the fact that the systems are easy to use, there is initial trepidation in handling computers and other digital equipment. There is a fear that the setup costs may be high and therefore monetarily not practical. In addition, there may be specialized hitches, for example, low data transfer capacity, bandwidth and electricity outages and absence of interoperability standards for software.

However, there is a significant potential for delivering medical services in rural areas of India using Telemedicine methods. At Teleradiology Solutions we developed a customized teleradiology and later a telepathology solution, which overcomes the barrier-technological as well as professional and financial-to Telemedicine. This case study demonstrates that the benefits of teleradiology can be extended to the space of pathology as well.

Pathologist view:

Dr. Seema Pavan, MBBS, MD Pathology: I am glad to be a part of Telepathology, and to help patients in Assam where diagnostic facility is not available. Here we visualize the videos sent by the clinic technician and send them the reports. The quality of the images is good, as the blood smear is of good quality which is prepared by the technicians.

Dr. Anamika Pal, MBBS, DCP Pathologist: It’s amazing to see that with the use of technology we are able to serve patients where healthcare is scarcely available. These slides and videos are as good as personally seeing slides under microscope. There are cases where Coulter gives us wrong reports and it should be verified by a pathologist. Now Telepathology makes it possible for us to reach patients even in Assam.