Mapping and visualizing the research contribution of India on telemedicine: A scientometric studyPK Behera1, P Kaur2, SS Mishra3, SK Mishra4
1 PK Kelkar Library, Indian Institute of Technology, Kanpur, Uttar Pradesh, India
2 Central Library, Chandigarh University, Gharuan, Mohali, Punjab, India
3 Centre for Development of Advanced Computing (C DAC), Mohali, Punjab, India
4 Department of Biological Sciences and Bioengineering, Indian Institute of Technology, Kanpur, Uttar Pradesh, India
Keywords: Scientometric analysis, telemedicine, telemedicine - India
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.” This signifies the use of ICT to improve patient outcomes by increasing access to care and medical information.
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.
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.
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.
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.
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.
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].
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.
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].
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.
Prolific authors, institutions, and their impact
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.
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.
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.
A good number of researches were carried out on the bibliometric and scientometric studies on the global outcome of telemedicine and allied topics research.,,,,,,,,,,, Moser 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. Two studies were carried out to analyze the trends., Gonzalez and Castro conducted a scientometric study on Spain. In 2021, Tapera and Singh 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.
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
Conflicts of interest
There are no conflicts of interest.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
[Table 1], [Table 2], [Table 3]