SOCIAL FACTOR:

1. Demographic
Dispersed geography
Every kind of landscape
3 million sq. km area
29 states and six union territories
Difficult to deliver in the inhospitable geographical terrain
such as mountain region in north east, islands of
Lakshadweep and Andaman and deserts in northwest
Population
Population more than 1 billion and growing at 2% annual
rate.
75% population resides in rural areas lacking access to
health care
Telemedicine has greater scope of implementation with pilot projects
being carried out by GoI (Government of India), other big hospitals like
AIMS hospital and important bodies of India like ISRO .
2. Perception/attitude of people
Health privacy
Trust on telemedicine consultant and procedure
The limited options to tailor telehealth to individual patients
3. Human resource
Medical education and mentoring
Establishing and maintaining the networked organization
relationship
Experimentation and clinical learning
Collaborative knowledge sharing
Short fall of 600,000 doctors and 1,000,000 nurses to reach the
WHO recommended stand of 1 doctor for every 1000 people.
4. Staff perception and attitude
Frontline staff existence of tele-health is slow and fragile, they
also have negative perception
Experiencing patients and clinical benefits develops positive
attitude in staff
Guidance on the practice of remote care through technology
Concern about the impact on their relationship with patients
Perception that it will increase workload and make planning
difficult

Technological factors
1. Availability of hardware:
ISRO has deployed more than 225 nodes under GRAMSAT
Several other hospitals and private players are also present
providing services such as tele-radiology, tele-pathology, telecardiology, tele-surgery, tele-dermatology
These nodes include not only video conferencing component but
also digital stethoscope, BP, ECG, Echocardiogram and
integrated with a tele-radiology platform enabling Xrays/ CTs etc
to be transmitted to doctors.
2. Availability of software:
DICOM compliant PACS (Picture achieving and communication
systems) (e.g. CardioSpaTM, developed by Telerad tech,
Bangalore, India.)
HIS (Hospital Information Systems) and several other systems
are developed by software providers in Idia like C-DAC (e.g. WMT
by C-DAC, which provides telemedicine GUI)
3. Method of transmission:
Generally transmission carried out in two ways:
Point to point communication
Point to multipoint communication
Generally for radio cardiology, DICOM (robust compression techniques
without loss of data) is used to convert the high resolution images into
small size images (archived) which can be sent over even on slow
connections.
With RelianceJio launching 4G connections it might affect the tier 1 and
tier 2 cities but rural areas will depend on satellites launched by ISRO
and POTS.
Hospitals, service providers, pilot projects by government all depend
on the ISP of that area for their telemedicine network.
4. Patient referral systems:
Many kinds of patient referral systems are being developed not only for
telemedicine but also for hospitals. Following are features of one of the
patient referral systems for telemedicine developed by ACGIL
List of Hospitals with their specialties
Communication of Clinical Information of the system using HL7
messages
Sending the patient details by email

 Records the details of transportation of the patient.

Ensures patient transaction