Mapping and visualizing the research contribution of India on telemedicine: A scientometric study

Abstract

Background:

The term ”Telemedicine” is being used in the medical and health sector to treat patients and to provide medical guidance remotely. The intellectual output from India in terms of publications was harvested from Scopus^® with the keyword “Telemedicine” and analyzed by using bibliometric techniques.

Methods:

The source data was downloaded from the Scopus^® database. All the publications on telemedicine and indexed in the database up to the year 2021 were considered for scientometric analysis. The software tools VOSviewer^® version 1.6.18 to visualize bibliometric networks, statistical software R Studio^® version 3.6.1 with the Bibliometrix package Biblioshiny^® were used for analysis and data visualization, and EdrawMind^® was used for mind mapping.

Result:

India contributed 2,391 (4.32%) publications on telemedicine to a total of 55,304 publications worldwide until 2021. There were 886 (37.05%) papers that appeared in open access mode. The analysis revealed that the first paper was published in the year 1995 from India. Steep growth in the number of publications was observed in 2020 with 458 publications. The highest, 54 research publications, appeared in the “Journal of Medical Systems.” The All India Institute of Medical Sciences (AIIMS), New Delhi, contributed the highest number of publications (n = 134). A considerable overseas collaboration was observed (USA: 11%; UK: 5.85%).

Conclusions:

This is the first such attempt to address the intellectual output of India in the emerging medical discipline of telemedicine and has yielded useful information such as leading authors, institutions, their impact, and year-wise topic trends.

Introduction

Telemedicine is the application of information and communication technology (ICT) in the medical and health service sectors. There is no one unique definition of telemedicine. The term was coined in the 1970s, which literally means “healing at a distance.”[1] This signifies the use of ICT to improve patient outcomes by increasing access to care and medical information.[2]

The medical sector has taken the benefits of ICTs for continuous tracking of patients, the status of their health, and the effects and the side effects of the prescribed medicines. It strengthens the close relationship between health professionals and customers. Further, it also increases confidence among health professionals which has undoubtedly benefitted their customers. Nowadays, telemedicine is more relevant considering the present lockdown situation during the coronavirus disease 2019 (COVID-19) pandemic.

Objectives

The study was undertaken for scientometric evaluation of the productivity of scholarly communications published by the authors having affiliation with various institutions in India in the field of telemedicine. The primary objective of the study is to analyze the trends in terms of publication growth, international collaboration, topic terminological trends, author's journal preference, most prolific authors, and the organization focused on telemedicine research.

Material and Methods

Data extraction

In the study, bibliographic data was collected from the Scopus^® online citation database (Scopus^® is a registered trademark of Elsevier B.V.) on January 23, 2022. The data was collected using the keyword telemedicine in the source title, abstract, and keywords. All the indexed scholarly literature in Scopus up to the year 2021 was taken into consideration for the study and analysis. A total of 55,304 publications were retrieved on the topic, out of which 2,391 publications were affiliated with India and ranked at seventh position in the global ranking. All publications were in the English language.

Data analysis tools

R Studio^® version 3.6.1 (Copyright © 2022 RStudio, PBC) with the Bibliometrix package Biblioshiny^® was used for Scientometrics analysis, and VOSviewer^® software version V1.6.17 (Copyright © 2022 Centre for Science and Technology Studies, Leiden University, The Netherlands) was used to construct and visualize bibliometric networks. EdrawMind^® (Copyright © 2022 Edrawsoft) was used for mind mapping.

Results

India contributed a total of 2,391 publications on telemedicine till January 2021. These publications include 1174 (49.10%) articles, 593 (24.80%) conference papers, 239 (10.00%) reviews, 9 (0.38%) books, 82 (3.43%) book chapters, 53 (2.22%) editorials, 163 (6.82%) letters, 64 (2.68%) notes, and 14 (0.59%) short surveys. The yearly average publications were 88.55, the average citations per document were 9.269, and the average citations per year per document were 1.71. The topic is mainly dealt with medicine (1342 articles); however, other subjects have co-relations such as computer science (785), engineering (584), health professions (203), biochemistry, genetics, and molecular biology (147), mathematics (116), social sciences (109), physics and astronomy (96), neuroscience (90), pharmacology, toxicology, and pharmaceutics (74). Out of 2391 publications, 886 (37.05%) were available in different open access models.

Trend analysis

Growth of scholarly literature

The study revealed that telemedicine is increasingly becoming a topic of research. Before the year 2000, India could publish only six research papers. The possible reason for the slow beginning may be the non-availability of adequate technologies. Figure 1 shows the publication growth over time. The first paper published on telemedicine was “Keynote address: Global connectivity through Telemedicine” by Rao, U.R. in the Journal of Medical Systems Volume 19(3) 1995, p. 295–304. Considerable growth was observed from 2015 onwards, whereas a slight (27.77%) decrease was reported in 2017. A significant increase in publications on telemedicine was recorded during the COVID-19 period from 2019 onwards. In 2020, a spike of 97.41% of growth compared with 2019 was reported. Compared to 2020, 2021 had an almost equal number of publications. It is also expected that the count will overcome 2020 figures, as there are few late publications. The average annual increase of India in intellectual output was 22.87% publications.

Figure 1.

The publication growth over time

Trend in international collaborative research by the Indian authors

The study revealed that Indian authors had noticeable research collaboration with international communities, mainly from the USA, UK, Australia, China, Canada, Italy, South Africa, Germany, France, Saudi Arabia, etc. The highest (263) collaborative publications were observed between India–USA, followed by India–UK (140) and India–Australia (67). The collaboration network is shown in Figure 2, and the list of countries with more than 20 collaborative publications is given in Table 1.

Figure 2.

Collaboration network of India with other countries

Table 1.

The top 10 foreign countries collaborated with India

Country/Territory	Publications	Country/Territory	Publications
India-USA	263	India-USA-UK	69
India-UK	140	India-USA-Australia	33
India-Australia	67	India USA-Canada	32
India-China	52	India USA-South Africa	32
India-Canada	46	India-UK-Australia	31
India-Italy	45	India USA-Italy	29
India-Germany	37	India-UK-Italy	26
India-South Africa	37	India USA-Brazil	25
India-Singapore	34	India-UK-Brazil	21
India-Brazil	32	India-UK-Canada	21

Topic trends and influential keywords

In relation to telemedicine, there are a few topics, and their influential time span is illustrated in Figure 3. From 2015 to 2020, the topic of telemedicine was at the top; from 2020, a new trend of COVID-19 and its related topics seemed to be influential. mHealth, telehealth was significant from 2017, whereas telehealth is still dominating. The Smart card was a hot topic in 2015 only. Internet of things (IoT) was a point of interest in telemedicine researchers from 2018 to 2019. Blockchain is the new topic of research among telemedicine researchers. Other influential topics are shown in the figure.

Figure 3.

Prominent topic trends from 2011 to 2020

The keyword networks

There are 5227 authors' keywords found, other than medical terms, including telemedicine. This topic had a more significant relationship with other keywords like India, mHealth, coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), IoT, healthcare, electrocardiogram (ECG), self-care, telehealth, lockdown, mental health, telepsychiatry, etc., as shown in Figure 4.

Figure 4.

Keyword network

Trend in journal selection

The top 20 preferred journals in the field are tabulated in Table 2. The “Journal of Medical Systems” published 54 (2.25%) articles, which attracted the highest 1789 citations, hence high h, g, and m index (27, 41, and 0.964, respectively). The core medical science sub-branch-specific journals “Indian Journal of Ophthalmology,” “Telemedicine and e-health,” and “Diabetes and Metabolic Syndrome: Clinical Research and Reviews” have a more significant impact on the topic and have 33, 31, and 26 publications, respectively. Among the listed resources, the journal “Diabetes and Metabolic Syndrome: Clinical Research and Reviews” had the higher citation over time. Other than “Telemedicine and e-health,” the core topic-specific journals “International Journal of Telemedicine and Applications” and “Journal of Telemedicine and Telecare” are less preferred; hence, having only 11 and 10 publications, respectively. The multi-disciplinary journal “PLOS One” ranked 16, having 184 citations from 11 papers. The ICT and computer science-related journals like “Multimedia Tools and Applications,” “Advances in Intelligent Systems and Computing,” “Procedia Computer Science,” “Communications in Computer and Information Science,” and “Wireless Personal Communications” having 16, 13, 12, 12, 10 publications and 268, 61, 149, 30, 177 citations, respectively, were also a good choice of Indian authors.

Table 2.

Most preferred journals for publications having 10 or more publications

Source	NP	TC	*h index	#g index	^m index	PY start
1. Journal of Medical Systems	54	1789	27	41	0.964	1995
2. Indian Journal of Ophthalmology	33	501	11	21	0.478	2000
3. Telemedicine and e-health	31	842	13	28	0.813	2007
4. Diabetes and Metabolic Syndrome: Clinical Research and Reviews	26	1718	14	26	1.556	2014
5. Asian Journal of Psychiatry	26	223	9	14	1.125	2015
6. Neurology India	25	199	7	13	0.389	2005
7. Multimedia Tools and Applications	16	268	9	16	1.286	2016
8. Studies In Health Technology and Informatics	15	75	6	7	0.240	1998
9. Indian Journal of Psychological Medicine	14	69	4	7	0.400	2013
10. Advances in Intelligent Systems and Computing	13	61	4	7	0.500	2015
11. Indian Journal of Medical Research	12	125	7	11	0.389	2005
12. Procedia Computer Science	12	149	6	12	0.750	2015
13. World Neurosurgery	12	91	5	9	0.556	2014
14. Communications in Computer and Information Science	12	30	3	4	0.231	2010
15. International Journal of Telemedicine and Applications	11	153	7	11	0.538	2010
16. Plos One	11	184	7	11	0.778	2014
17. 2013 Indian Conference on Medical Informatics and Telemedicine, ICMIT 2013	11	98	5	9	0.500	2013
18. Journal of Telemedicine and Telecare	10	186	8	10	0.381	2002
19. Journal of Diabetes Science and Technology	10	188	7	10	0.583	2011
20. Wireless Personal Communications	10	177	6	10	0.750	2015

^*h-index, ^#g-index, ^{^}m-index, NP: Number of publications; TC: Total citations; PY: Starting year of publications

Prolific authors, institutions, and their impact

Authorship pattern

The authorship pattern is elaborated in Figure 5. About 7535 authors contributed to the topic and appeared 11063 times. The documents per author were 0.317, the authors per document were 3.15, and the collaborative index was 3.39.

Figure 5.

Authorship pattern

Prolific authors

The top 10 authors from medical and non-medical research organizations published papers on telemedicine, which are listed in Table 3. The author Mishra, Saroj Kanta, had contributed the highest number of papers on telemedicine topic (24/206), which is 11.65% of his total contribution in various fields, whereas the author Ganapathy, Krishnan had contributed (18/52) 34.61% of his total publications. Among the prolific authors, Vaishya, R. (Vaishya, Raju) from Indraprastha Apollo Hospitals, New Delhi, also had the highest number of citations (560) out of 13 articles. Out of the papers published on the topic of telemedicine, the article “Eysenbach, G., (et al.), (2011) “ConSORT-eHealth: Improving and standardizing evaluation reports of web-based and mobile health interventions,” Journal of Medical Internet Research, 13(4), 2011, Article number e126” had attracted the highest citation (901); the author is affiliated to IIT Delhi. It was observed that papers published on COVID-19 in relation to telemedicine have more influence and more citations, among them the published paper “Dubey, S., Biswas, P., Ghosh, R., (et al.), (2020) “Psychosocial impact of COVID-19,” Diabetes and Metabolic Syndrome: Clinical Research and Reviews 14(5), pp. 779-788.” had attracted the highest citation (480). Figure 6 indicates the collaboration network among authors.

Table 3.

Top 10 prolific authors having publications on telemedicine (TMD)

Authors Name Overall h-index (#: Author’s Scopus ID)	Institute Affiliation	Pub. on TMD/Author’s total pub.	Total citations of TMD papers	Year/Highest citation
Mishra, S.K. (Mishra, Saroj Kanta) h-index: 26 #57200908330	Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow, Lucknow	24/206	236	2009/47
Manjunatha, N. (Manjunatha, Narayana) h-index: 14 #16307422500	National Institute of Mental Health and Neuro Sciences, Bengaluru	22/132	71	2018/14
Ganapathy, K. (Ganapathy, Krishnan) h-index=12 #36890862200	Apollo Telemedicine Networking Foundation, Chennai	18/52	187	2009/33
Math, S.B (Math, Suresh Bada) h-index: 22 #13610895500	National Institute of Mental Health and Neuro Sciences, Bengaluru	18/225	63	2018/13
Chakraborty, C. (Chakraborty, Chinmay) h-index: 14 #7005340424	Birla Institute of Technology, Mesra, Ranchi	17/85	310	2013/81
Kumar, C.N. (Kumar, Channaveerachari Naveen) h-index: 15 #25958681200	National Institute of Mental Health and Neuro Sciences, Bengaluru	15/158	47	2018/13
Vinekar, A (Vinekar, Anand S.) h-index: 21 #6506613550	Narayana Nethralaya Eye Hospital, Bengaluru	15/111	295	2014/115
Vaishya, R. (Vaishya, Raju) h-index: 27 #6602902951	Indraprastha Apollo Hospitals, New Delhi	13/296	560	2020/216
Gupta, B. (Gupta, Bharat) h-index: 12 #7402194979	National Institute of Technology Patna, Patna	12/58	188	2013/81
Majumdar, A.K. (Majumdar, Arun Kumar) h-index: 24 #36765250600	Indian Institute of Technology Kharagpur, Kharagpur	12/178	124	2009/41

Figure 6.

The collaboration Network among authors

We have observed some discrepancies in analyzing individual author contributions based on Scopus' finding using R and VOSviewer; e.g., the authors having similar surnames such as Kumar A has also incorporated other authors whose first name starts with A. Similar is the case with the authors Kumar, R, and Gupta R. This kind of phenomenon is observed with many Indian authors; hence, we have taken author data directly indexed on the Scopus website and placed it in Table 3. We have also observed that the Scopus indexing can be misleading also, e.g., author Math, SB (18 articles) is differently figured with Math S (7), which is excluded in the table, but the author is one. Hence, we recommend in-depth analysis only of prolific authors.

Most productive organizations

The most productive organizations that contributed 20 or more publications are tabulated in Figure 7. The data showed that medical science and technical institutes contributed to telemedicine. The development of remote access technology played a vital role in connecting remotely located patients. Among India's premier medical institutions, the All India Institute of Medical Sciences (AIIMS), New Delhi, contributed the highest number (134) of publications. Other medical institutes like the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh (88) followed by the Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow (57), the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore (51) were the leading institutions contributing in the field. Other private medical institutions like Aravind Eye Hospital, Madurai (21) and Indraprastha Apollo Hospitals, New Delhi (20) also contributed. Contributions from premier technological institutes like the Indian Institute of Technology (IIT), Kharagpur (47), Vellore Institute of Technology (VIT), Vellore (37), and Indian Space Research Organization (ISRO), Bangalore (22) were also observed. Other educational and technical institutes like Manipal Academy of Higher Education (MAHE) Manipal (39), Sathyabama Institute of Science and Technology (SIST), Chennai (39), Anna University, Chennai (37), SASTRA Deemed University, Thanjavur (39), Amity University, Noida (20) were also ranked among the top contributors in the topic. The Public Health Foundation of India (PHFI), Gurgaon (23), was a public–private partnership institute, also ranked among the top 17 institutes.

Figure 7.

The most productive organizations that contributed twenty or more publications

Discussion

A good number of researches were carried out on the bibliometric and scientometric studies on the global outcome of telemedicine and allied topics research.[3,4,5,6,7,8,9,10,11,12,13,14] Moser[15] analyzed the publication output from 1964 to 2003 and tried to find a relation between telemedicine and Human Development Index (HDI). Another study was conducted to know the authorship pattern in telemedicine.[16] Two studies were carried out to analyze the trends.[17,18] Gonzalez and Castro[19] conducted a scientometric study on Spain. In 2021, Tapera and Singh[20] carried out a similar study focusing on sub-Saharan Africa and BRICS (Brazil, Russia, India, China, South Africa) nations.

The analysis revealed considerable growth in the topic was observed post-COVID-19 pandemic. Nearly one-third of articles are open access. In 1995, India contributed its first article on telemedicine. More than 90% of publications result from collaborative/joint authorship. The authors from medical science professionals contributed more, but the contribution from the ICT and engineering sectors was also observed. Besides premier medical institutes, the topic is also a research area for engineering and ICT researchers. Indian researchers were more collaborative towards USA and UK. Authors from the medical, engineering, and ICT sector started focusing on the topic, which resulted in the strong co-relation between telemedicine and other topics like blockchain, cloud computing, image processing, decision support systems, etc.

Conclusion

Looking at the rising trends in telemedicine research publications coming out of India in the last decade, it is expected that the topic will keep on influencing academics from diverse disciplines and society, resulting in the emergence of a new multi-disciplinary subject of study. The findings of this scientometric study would be undoubtedly beneficial to the researchers, policymakers, students, and librarians working directly or indirectly in this area. However, an in-depth study on the authors' profiles needs to be carried out separately to avoid misinterpretation of data.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.