Introduction - ECG Acquisition and Automated Remote Processing - page 11

Some references are obtained from published articles regarding the afore-
mentioned causes. In [ 10 ], a detailed statistics is provided for the opportunities and
scope of improvement of telemedicine services in India. It mentions that around
80% of the main health-care centers are based on cities, which host only 30% of
the total population. Doctor-to-patient ratio in India is typically 60 per lakh,
compared to 250+ per lakh in advanced countries [ 11 , 12 ]. In another developing
nation in Asia, i.e., Bangladesh [ 13 , 14 ], having the highest population density in
the world, almost similar scenario exists. Around 77% of the population in this
country lives in rural areas, and the rural health-care units lack in adequate
infrastructure. The population per physician is around 3,000, and population per
nurse is around 6,500. The rural health-care centers are sometimes headed by
untrained infirmary technicians. In south-Saharan Africa (SSA), the mortality rate
of the health-care personnel is another serious issue of concern [ 15 ]. The SSA
carries 25% of the global burden of disease. In some countries, the death of nurses
constitutes almost 40% of annual output from training. The doctor-to-patient ratio
is as high as 1:5,000-1:30,000, whereas in developed countries, this is around
1:200-1:500. In [ 16 ], an analysis of health infrastructure for two American
countries, Peru and Nicaragua, is provided. The study points out that access to
major health establishments as one of the major problem, added with little
experience of the health staff.
There are two principal modes of telemedicine, viz. real-time interactive mode
and 'store and forward' type. In the first case, a real-time feedback is possible by
the use of a video link between the 'called' and 'specialty' center by the use of a
high-speed dedicated communication link. The expert can consult with the patient-
side physician and visually examine the patient. In the other mode, called 'store
and forward' type, the patient data is transferred to the consulting hospital using
different teletransmission links for storage and offline assessment by experts. The
feedback becomes available within a time span of few hours to 3 days.
In most of the developing nations, a three-tire health-care framework is noticed,
although the nomenclature varies among the continents. The first and lowermost
layer of health-care units is placed in remote rural districts, named primary health-
care center (PHC) in India, health posts (HP) in Africa, with non-specialist phy-
sicians (sometimes trained/untrained paramedics) and elementary level infra-
structure. Most of the PHCs do not have telephone connections and admission
facility for long-term checkup. In Asian countries like India, around 100 PHCs are
administered by district level hospitals, normally one in each districts, serving
around 1-3 million population. The hospitals are having telephone lines, some
specialist doctors, better health-care facility, and admission for patient monitoring.
The city-based hospitals, residing at highest level, are equipped with specialist
doctors, advanced diagnostic and patient monitoring facilities. In case of critical
diseases, the patients are referred to city hospitals by rural clinics. However, due to
poor connectivity and/or transport facility between rural distracts and urban areas,
patients are unable to visit city-based hospitals. The poor health-care infrastructure
of remote rural clinics and non-availability of physicians deprive the poor