What started on an experimental basis at Yale University has lead to the creation of one of the foremost players in the teleradiology space. Teleradiology Solutions Pvt. Ltd. (TRS) interprets diagnostic reports such as scans, X-rays, MRIs and more through a remote process wherein radiologists sit in other locations. Conceived by Dr. Arjun Kalyanpur and his wife, Dr. Sunita Maheshwari in 2002, the Bengaluru-based company was rated as the number one teleradiology company in the U.S. this year, according to a report by KLAS, a Utah-based research firm that specialises in monitoring healthcare vendors. It also noted that TRS has the quickest average turnaround time of 34 minutes (15 minutes for emergency cases) among the nationally ranked vendors. Last year, it received endorsement from a different quarter, when its founders were among a small group of entrepreneurs invited to meet U.S. President Barack Obama during his visit to India.

In a country of one billion people, there are approximately 10,000 radiologists, which mean there is one radiologist for every 100 people. In the U.S., there is one radiologist for every 10 people, and they consider even that to be a shortage.

Taking the organic route

The company grew rapidly at a 50 per cent revenue growth rate in the initial years and has now begun offshoot businesses such as its technical arm TeleradTech, a multi-speciality outpatient clinic, RxDx and a teaching portal, RadGuru.net. “India’s healthcare industry has grown tremendously over the years but the availability of skilled radiologists has not kept that pace. In a country of one billion people, there are approximately 10,000 radiologists, which mean there is one radiologist for every 100 people. In the U.S., there is one radiologist for every 10 people, and they consider even that to be a shortage,” says Kalyanpur, chief-executive officer and chief radiologist, TRS.

TRS currently caters to about 100 hospitals in 20 countries with 99.85 per cent accuracy in its reports. It works with about 20 hospitals in India, of which 10 were added in just the last quarter. Initiated as emergency care services, it has also started focussing on niche segments like spinal, brain and cardiovascular with specialised radiologists, the growth of which has picked up in the last three years. “In the past three years, our growth has plateaued at 20 per cent but we are comfortable at this rate,” says Kalyanpur. The duo had decided to take an organic route, relying on internal accruals, that can be managed since teleradiology is a high-precision and high-risk business.

The company has also stepped up its marketing efforts since last year with a dedicated sales team both in India and the U.S. Its peer-reviewing system for reports and stringent processes ensure quality is not compromised. In 2005, it became the first teleradiology company to be credited by The Joint Commission, a U.S.-based organisation that credits healthcare facilities. TRS is also HIPAA (Health Insurance Portability and Accountability Act of U.S.) compliant to ensure security over electronic transactions.

Clarity in vision

In the 90s, both Kalyanpur and Maheshwari had studied in AIIMS, New Delhi and later did their residency and fellowship at Yale University, U.S. Kalyanpur first experienced teleradiology when scans were sent for reporting from another end of the university. The idea stuck on even when the couple returned to Bengaluru in 1999. While Maheshwari, a paediatric cardiologist, started work at a local hospital, Kalyanpur had a hard time finding the right workplace. He continued travelling to the U.S. to work for Yale and due to the shortage of radiologists on night shifts, the faculty requested him to join its team. As he insisted on working from Bengaluru, Kalyanpur started a live clinical project with Yale, where he analysed reports sent over the Internet. Eventually, this ended in eight months when people started opposing outsourcing. By then, the necessary structure for the concept fell in place.

In February 2002, the founding duo’s first move was to get a website designed by their nephew. It immediately gained hits and first to come on board was a hospital in Pennsylvania, U.S. Working out of home on their life savings of US $ 100,000, TRS’ network grew through internal referrals. Other challenges,especially India’s broadband connectivity often proved a major stumbling block and having multiple backups pushed up costs. “In the initial days, it wasa tough balancing act as I also had my hospital work. I took care of finances and human resources and got more involved after two years,” says Maheshwari, chief dreamer, RxDx and TRS. They started targeting doctors who were in the U.S. and were looking to move back to India. From two employees, TRS’ team strength has grown to 350 members, with 45 radiologists spread globally in places like Europe, the U.S. and Israel.

In 2005, the company became the first healthcare organisation outside of Singapore to be accredited by its government. With this tie up, the turnaround time for many hospitals in Singapore reduced from three days to one hour. In 2006, it moved into its own campus in Bengaluru.  In 2009, it started TeleradTech to outsource the technology to other organisations. “As opposed to TRS, TeleradTech is easily scalable and there is a separate CEO handling its affairs. We might look at outside investment for TeleradTech,” says Kalyanpur.

In 2008, RadGuru was initiated that provides internal training to radiologists. The content is then uploaded onto its website for others to access. TRS has also developed an e-learning tele-medicine platform in partnership with CISCO. RxDx was started about four years ago. “It is an outpatient centre, since we believe 90 per cent of health problems can be cared for in a clinical setting with specialists,” says Maheshwari. The Telerad Foundation began in 2007 and currently helps about five hospitals in areas in need with teleradiology services and develops low-cost technology to facilitate this process.

Widening reach

While its growth in the U.S. has been steady, the duo foresees more opportunities in Asia, Europe and Africa. “Our marketing strategy has been to approach hospitals where radiology is poorly staffed. In the past five years, we have gained momentum, especially in India where hospitals could not always afford the necessary technology,” says Kalyanpur. While newer players have entered the market, the couple hopes that first-mover advantage and having doctors at the helm will benefit TRS.

“Tele-medicine will see huge growth in the coming years and we hope this is an area that we can push forward,” says Maheshwari. Kalyanpur hopes to see more growth for its radiology workflow system RadSpa. And by tying up with colleges and vocational institutes, the company hopes to reverse the shortage of competent radiologists.

Dr. Kalyanpur speaks on the advantages of Teleradiology being doctor-led :

With respect to a niche and complex healthcare sector like teleradiology, it helps that, as doctors, we can better understand the healthcare space and our clients’ needs, especially with subspecialty services.

Have significantly greater awareness of quality in healthcare, as opposed to worrying too much about the bottom line.

We are used to the environment of the field that we operate in.