title: Karnataka state telemedicine project: utilization pattern, current, and future challenges.
abstract: BACKGROUND
  The Telemedicine Network Project in the state of Karnataka was introduced in the year 2001. This is a value added service from the health department of the government of Karnataka. There is no data on its utilization pattern or its future challenges. This study was conducted from a nodal center in order to understand the above two issues.
  
  
  METHODS
  We used a 51-item survey questionnaire that captured data on infrastructure, technical aspects, and connectivity parameters, tele-consultations including emergency services, human resources, and coordination aspects both at the client as well as the nodal centers.
  
  
  RESULTS
  Services are operational in 25 district hospitals across the state for the past 3.3 (2.1) years. Space was ear-marked across all the client centers. Back-up power supply was present only in 10 (40%) of the client centers. Quality of satellite connection was acceptable in 18 (72%) centers. Approximately, 3.0 (1.8) phone calls had to be made to the nodal centers to obtain one appointment. Monthly maximum and minimum cases done over the past 2 year period were reported as 58.2 (66.2) and 13.5 (16.2) respectively. Each consultation lasted for 26.1 (13.9) min. Tele-consultation advices from nodal centers were carried out completely in only 9 (36%) centers. Only in 13 (52%) client centers, did doctors keep up with appointment regularly. All technicians reported that the training they received was inadequate. 16 (64%) technicians were asked to do works that were not pertaining to telemedicine. 19 (76%) technicians had frequently felt insecurities about their jobs.
  
  
  CONCLUSIONS
  The telemedicine service has been largely under-utilized and has failed to deliver the promise in Karnataka state. At present, the obstacles reflect both inherent limitations in the technology and also improper use of human resources. Successful implementation of the given recommendations may in the long run help optimal utilization and reach all end-users.
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: Bharath
authors.initials: B
authors.lastname: Holla
authors.forename: Biju
authors.initials: B
authors.lastname: Viswanath
authors.forename: Shanthaveeranna
authors.initials: S
authors.lastname: Neelaveni
authors.forename: T
authors.initials: T
authors.lastname: Harish
authors.forename: Channaveerachari Naveen
authors.initials: CN
authors.lastname: Kumar
authors.forename: Suresh Bada
authors.initials: SB
authors.lastname: Math
keywords: Challenges; telemedicine; utilization pattern