Accidental Pioneer

Eleven years ago, when radiologist Dr Arjun Kalyanpur and paediatric cardiologist wife Dr Sunita Maheshwari returned to India, they had no idea that they were embarking on a roller-coaster ride which would result in a flourishing business that many would want to clone.

In fact, it was not so much a business idea than a way to re-connect to his patients and alma mater Yale where he practised before coming back to India. A system by which Dr Kalyanpur, being at Bangalore, would read and report radiology findings and interact with clinicians on patients diagnosis and treatment course. Today, he is joined by 45 radiologists around the world who do the same.

Arjun Kalyanpur, CEO of Teleradiology Solutions (TRS), is a name to reckon with. A pioneer in teleradiology in India, Dr Kalyanpur and Dr Maheshwari own a bunch of businesses other than TRS such as an IT company Telerad Tech, small clinic RxDx, as well as two NGOs Telerad Foundation and People4People.

Now Dr Kalyanpur, a true academic at heart, has found a way to be part of cutting edge research via his new venture, Image Core Lab (ICL). He is also planning to jump right back to teaching via e-learning modules and webinars through his teaching website radguru.net.

Relevant history

In 1999, when Dr Kalyanpur returned to Bangalore, not many opportunities greeted him. Most private hospitals were already staffed and he “did not want to simply open a diagnostic centre and do ultrasound scans”, rather he preferred to wait for a good opportunity, which came when he took over the position of the Chief Radiologist at Sri Sathya Sai Superspecialty Hospital in Whitefield, Bangalore. During the same period, inconvenience and difficulty of radiologists working night shifts at Yale, led him to the idea of nighthawk radio-diagnosis services from Bangalore.

The idea shaped into a pilot project that led to him publishing a paper on ‘Evaluation of JPEG and Wavelet Compression for teleradiology trasmission’. However, the project came to a screeching halt after a lot of questions were raised about radiologists losing jobs to off-shore radiology and patient safety. “I personally did not feel that this was an issue at all given that I was a US trained radiologist myself and had only brought my own job back to India with me,” he clarifies.

And he is right. A certified American Board of Radiology doctor, he is armed with a degree from AIIMS, a fellowship in abdominal imaging from Cornell University and another in neuroradiology from Yale.

Deviation from standard protocol

Not to be bullied by negative connotations, Dr Kalyanpur tackled the situation in his own way and changed the adversity into an opportunity. “During the 2004 US elections, the media made a great deal out of off-shoring jobs and we came under the focus of all the newspapers and TV channels. We felt that the best way to deal with this was to be open and to present the positive side of what we were doing, which was running a high quality radiology service from a different time zone which allowed for higher radiologist productivity and quality and therefore better service to US hospitals at night. As a result of this approach, the media scrutiny actually came to work in our favour, and resulted in a lot of positive publicity and visibility for us,” he shares.

Undoubtedly, he has proved to the world, through consistent performance over the past 10 years, that high quality reporting, of a calibre equal or superior to that provided by western companies, can be delivered from India using the day/night time advantage.

Fighting spirit

On the home front, he was tackling issues with infrastructure in terms of power, internet connectivity and bandwidth. Today, technology has become affordable and simple and no one could be happier than Dr Arjun Kalyanpur. Back when Dr Kalyanpur started reading radiology images first from home and then from a hired a room at a call centre technology was his biggest ally and enemy. Making calls to America and the bandwidth for their online service was expensive along with diffused software and regular power cuts. Security was another handicap.

In addition he had to manage other activities like fighting off acquisition bids. He received offers from a big IT company in Bangalore to buy his incubating business. “When we were less than an year old, one of the large software companies approached us with an acquisition offer. We were initially tempted, as the offer seemed attractive at the time, but our Board advised us to decline the offer, given that we had the potential to build something of great value on our own, as we had the necessary domain knowledge and understanding of teleradiology. The advice our board gave us at the time was that a technology company should really be our vendor and not our owner. So we said no thank you to the technology company and moved on. In retrospect the advice from our Board was excellent,” he shares. He fought his way through and worked endlessly to change his dreams into reality.

Clear read

Just like the tortoise in Aesop’s Fables ‘Tortoise and Hare’ story, the companies grew slowly and organically. Today, it has become one of the most successful teleradiology business around the world.

The company that started in a corner of his house with two employees has become the best in ‘Klas’ teleradiology provider in America. With radiologists based in Israel, US, Europe and India, it covers over 150 hospitals in 20 countries globally. It recently started covering hospitals in Africa ­ Tanzania, Nigeria and Djibouti.

In 2005, the company became the first healthcare organisation outside Singapore to be accredited by the Ministry of Health of Singapore and provides teleradiology services to 11 medical centres in Singapore under the National Healthcare Group.

In the same year, it became one among the first teleradiology companies to be accredited by The Joint Commission, a US-based organisation that accredits healthcare facilities. The company was showcased to US President Barack Obama during his visit to India in November 2010 as an example of innovation in action.

Teleradiology Solutions is a company with a difference. It has evolved from being a pure nighthawk US teleradiology group to being at the forefront of several innovative technology and healthcare initiatives. For the coming decade, TRS aims at adhering to its new title –“Best in Klas”, innovating continuously, reaching needy patients around the world and widening its scope globally to include all facets of technology and health – teleradiology, telecardiology, tele-medical, e-teaching, telemedicine and more.

New ventures

The birth of Image Core Lab (ICL) is an extention to Dr Kalyanpur’s academic acumen. Imaging has long been used in therapeutic drug development, particularly in the early phases of drug development (e.g., phase 1 and phase 2 trials). More recently, imaging studies have been proposed for use in phase 3 trials, often as a component of the primary or secondary endpoints. Presumably then ICL is a logical step ahead for TRS. “A few years ago, we were contacted by an oncology research centre in the US who requested us to interpret scans performed to track patient response to an investigational cancer therapy. The success of this project led to the launch of Image Core Lab (ICL), our venture dedicated to imaging in clinical research,” shares Dr Kalyanpur. “This is a new and exciting venture which is of particular relevance in the rapidly growing and evolving field of clinical research. “Especially for the clinical trials industry today as the regulatory requirements to standardise data have led to the strong need for centralised imaging where robust protocols are followed and continuous training takes place to ensure consistency, accuracy and reliability of image analysis,” he adds.

ICL leverages the strong in-house radiological expertise and the decade-old experience of Teleradiology Solutions in global multi-site teleradiology and its technology wing, TeleradTech. ICL provides services in the protocol development and study design stages of global clinical trials, as well as in activities such as site coordination and site training.

Although Kalyanpur is completely dedicated to TRS he misses teaching and the academic environment. “What I liked about Yale was the academic environment, the support for research, and love for teaching that all the professors manifested. Also the energy of the teaching conferences, where anyone could state an opinion and question a senior without fear of rebuke. This, to me, is the great thing about the American academic system, ” he states.

Despite this he finds time to go back to his books. “I do love teaching, and in fact have lot of opportunities to practice it even today. We conduct regular CME courses in topics such as emergency radiology, cardiac imaging and advanced MR imaging, as well as PG refresher training courses, which are very popular. And through our teaching relationship with the Sri Sathya Sai Institute, I am involved in postgraduate teaching in the DNB programme there,” he reveals.

He feels that the internet is the best medium for spreading education in the field of radiology, and for addressing the shortage of radiology educators. Their teaching website (www.radguru.net) provide a rich archive of teaching material for radiology postgraduates as well as practising radiologists. “We also use YouTube as a medium for sharing our expertise. In addition, through our Cisco-driven e-learning portal, we conduct and are developing a curriculum of e-lectures on all subjects within radiology by international and domestic faculty and we are happy to be the pioneers in this space”.

Novel landmarks

Recently, Telerad Foundation, announced that the total number of radiology scans read pro bono for poor patients in remote areas of India crossed 20000 this July. “God has given us a lot, we are blessed to be able to use our domain knowledge for those who are less fortunate.” he says.

Telrad Tech’s flagship work-flow improvement productivity solution- “RADSpa” has over 50 installations worldwide and this year they launched the RADSpa version 3.1. Telerad Tech is also the managed service provider for Cisco’s HealthPresence telemedicine platform in India and started operations in Eastern India benefiting more than 100 patients.

Over the last decade, Kalyanpur has superposed himself indelibly onto teleradiology solutions, and thereby onto Indian telemedicine. Then again he has been exigent in his mission to deliver taking TRS to new heights.

mneelam.kachhap@expressindia.com