title: Telemedicine in the Himalayas: Operational Challenges-A Preliminary Report.
abstract: Nonavailability of quality healthcare in mountainous, isolated, inaccessible sparsely populated regions is a universal problem. In this project, remote virtual healthcare was provided at Keylong and Kaza in Himachal Pradesh (HP) in North India. This innovative public-private partnership (PPP) provides 24/7 affordable healthcare to an alpine community where people commute 20-50 km for primary and 250 km for secondary healthcare services. Following a need assessment study, an MoU was signed by Apollo Hospitals in January 2015 with the National Health Mission. The government paid for all services delivered, Capital Expenditure (CAPEX) and Operating Expenditure (OPEX). Noncompliance to auditable weekly and monthly program MIS would result in penalties.
  
  
  
  Apollo Telehealth Services customized a turnkey solution, end-to-end, on a program management approach with measurable milestones and monthly reports. Key health issues in the region were identified. Very Small Aperture Terminals were installed amidst landslides and subzero temperatures. In February and March 2015, staff recruited from the community and local government staff were trained in Chennai. A major cultural transformation had to be effected. Urban teleconsultants were sensitized for community interaction, while deploying cutting- edge technology.
  
  
  
  Case records were audited. In the first 42 weeks, 2,213 teleconsults were provided, including 171 emergencies. Telelaboratory services and telehealth education programs have also been added.
  
  
  
  Evaluation confirms that delivering remote healthcare in inhospitable terrains in a PPP mode is effective.
authors.affiliation: 1 Apollo TeleHealth Services , Chennai, India .
authors.forename: Krishnan
authors.initials: K
authors.lastname: Ganapathy
authors.affiliation: 2 Department of Health and Family Welfare, Government of Himachal Pradesh , Shimla, India .
authors.forename: Vineet
authors.initials: V
authors.lastname: Chawdhry
authors.affiliation: 1 Apollo TeleHealth Services , Chennai, India .
authors.forename: Satgunam
authors.initials: S
authors.lastname: Premanand
authors.affiliation: 1 Apollo TeleHealth Services , Chennai, India .
authors.forename: Arunabh
authors.initials: A
authors.lastname: Sarma
authors.affiliation: 1 Apollo TeleHealth Services , Chennai, India .
authors.forename: Jothivaithilingam
authors.initials: J
authors.lastname: Chandralekha
authors.affiliation: 1 Apollo TeleHealth Services , Chennai, India .
authors.forename: Kotte Yogesh
authors.initials: KY
authors.lastname: Kumar
authors.affiliation: 1 Apollo TeleHealth Services , Chennai, India .
authors.forename: Saroj
authors.initials: S
authors.lastname: Kumar
authors.affiliation: 2 Department of Health and Family Welfare, Government of Himachal Pradesh , Shimla, India .
authors.forename: Rajesh
authors.initials: R
authors.lastname: Guleri
mesh_terms: D003362:Cost-Benefit Analysis; D054521:Cultural Competency; D004632:Emergency Medical Services / Q000458:organization & administration; D006801:Humans; D007194:India; D020380:Needs Assessment; D017060:Patient Satisfaction; D055818:Public-Private Sector Partnerships / Q000191:economics / Q000458:organization & administration*; D019035:Rural Health Services / Q000191:economics / Q000458:organization & administration*; D017216:Telemedicine / Q000191:economics / Q000458:organization & administration*; D013686:Telemetry
keywords: telemedicine; telemedicine and public–private partnerships; telemedicine in the Himalayas