e-Newsletter August 2021

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

What is New?

Launch of Telehealth Diabetes Online Course by TSI

In its pursuit to promote telehealth training, Telemedicine Society of India has been conducting training for telemedicine since April 2020.

On the 30th July, during the 8th Edition of Dr. Mohan’s International Diabetes Update, the society launched Telehealth Diabetes online course for medical practitioners.

This is the second online course on Telemedicine launched this year by TSI. The course has interactive video lectures, power-point presentations and theory material and is divided into four broad segments as follows:

Module I- Introductory Primer to Tele-Diabetes
Module II. Setting up a Diabetes & Telehealth Practice
Module III- Legal & Ethical Aspects
Module IV – Optional Material

The total duration of this online course is four to six hours with post course assessment to get a proficiency certificate of completion of the course. The specialist course faculty include –
Dr. V. Mohan, Chennai
Dr. Jothydev Kesavadev, Trivandrum
Dr. Sanjay Sharma, Bengaluru

A short video of the course is included below. Those interested in taking up this course please click on the link below
https://tsi.org.in/courses/diabetes-and-telemedicine-practice/

Thank You.
Dr. Sunil Shroff
Chief Editor
President – TN Chapter – TSI


Webinar on ‘Ethical Issues in Telehealth Practice’

Dr. S. K. Mishra
Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow.

SGPGIMS has been conducting seminars on various aspects of healthcare and medical ethics. On August 14th, 2021, another program in this series was conducted through Videoconferencing on Ethical Issues in Telehealth Practice’. Telehealth is one of the evolving information technologies and COVID-19 pandemic has accelerated the use of telehealth globally. Telehealth can help decrease the burden of the healthcare system to a large extent. Prof R K Dhiman, Director, SGPGIMS, welcomed the participants and said that SGPGIMS has been a front-runner in establishing Telemedicine services not only for the Institute but also all over the country. He shared his experiences and informed that telemedicine is an important modality in patient care. Prof Vinita Agrawal, faculty in charge Bioethics cell SGPGI and moderator of the program, said that telehealth services can now aim not just for ‘sick care’ but also for ‘health care’. However, certain ethical concerns need to be understood for the use of this important technology as a means to improve access and quality of healthcare for all members of our society.

Prof S K Mishra, ICMR, Emeritus Scientist at the School of Telemedicine and Bioinformatics, SGPGIMS, who established the SGPGI telemedicine training and research facility, introduced the speakers and discussed the ethical aspects in Telemedicine. Dr Sunil Shroff, Managing Trustee of the MOHAN Foundation, a NGO that pioneered organ donation in India, talked about the scope of Telehealth and informed that the Telemedicine practice guidelines of the MoHFW discuss and cover the various ethical issues related to the use of telemedicine. Dr K Ganapathy, from the Apollo Telemedicine Network Foundation, said that the man behind the technology is more important and emphasized the need of maintaining standard of care and webside manners. Dr BN Mohanty, Honorary Advisor on Telemedicine to the Govt. of Odisha, talked about the responsibility of stakeholders to facilitate Ethical practice of Telehealth. The participants joined the program from within the institute and from the NMCN network. It was also streamed on YouTube.


Confidentiality and Data Protection in Telemedicine

Anay Shukla
Founding Partner, Arogya Legal – Health Laws Specialist Law Firm

Eshika Phadke
Associate, Arogya Legal – Health Laws Specialist Law Firm

As a concept, doctor-patient confidentiality is well established and widely understood by the medical fraternity. The principle, which is laid down in the MCI Code of Ethics, 2002 and the declaration that doctors take at the time of registration, also forms a part of the Charter of Patient Rights.

A doctor is duty-bound to maintain all information that a patient shares with him/her in utmost confidence irrespective of whether it pertains to their medical treatment itself or to their personal or domestic lives. The exception, of course, is when the doctor is of the opinion that keeping the information confidential would cause harm either to a specific person or society at large. This obligation has been explicitly adopted under the Telemedicine Practice Guidelines. While confidentiality has evolved to cater to telemedicine, it is still intuitive for doctors. However, data protection, which in the digital age goes hand in hand with confidentiality, is a new compliance for doctors.

The information that is collected in the course of a medical consultation (online or in-clinic), procedure, pathology or diagnostic test is recognised as “sensitive personal information” under the Indian data protection laws. This includes cases notes, test reports, diagnostic images, recordings, etc. Protecting this data has always been of utmost importance since a data breach would result in confidentiality being compromised. With the changes in the delivery of medical services, the responsibility of ensuring that the data is properly protected no longer vests only with the hospital administration.

The Telemedicine Practice Guidelines explicitly specify that doctors are required to comply with the data protection law, namely the Information Technology (Reasonable Security Practices and Procedures and Sensitive Personal Data or Information) Rules, 2011. While this may sound overwhelming, it is actually quite straightforward. The law merely expects that a person, in this case the doctor, takes reasonable actions and adopts appropriate systems to ensure that the data that they collect is with the consent of the person (i.e. the patient) and is protected. With clinics and telemedicine platforms becoming a lucrative target for cyberattacks, it is especially important to be cognisant of the best practices. The extent to which a doctor would need to be involved with data protection would vary.

All doctors who are offering teleconsultations in their individual capacity are responsible for ensuring compliance. First and foremost, their devices and browsers should be protected by a security software. If they are offering consultations via third-party text-based services, or video calling services, they must ensure that the service provider’s terms and conditions do not prohibit the use of the platform for telemedicine. If the consultations or information exchange is taking place via email, they must ensure that their email provider is reliable, that they use a strong password for the account and do not allow anyone else to access it. If the doctor offers consultations through their own website, they must ensure that suitable data protection systems are built in, and that they have a clear policy on the website outlining how the data is handled.

If a doctor is consulting through a telemedicine platform/aggregator or a hospital’s telemedicine services, it is most likely that the platform itself is looking into data protection. In such cases, the doctor should familiarise themselves with any restrictions that the platform may have placed to ensure patient data is protected. For example, several platforms prohibit doctors from storing patient records locally on their device and require that everything be stored on the platforms’ servers. Doctors should strictly comply with these restrictions, since failure to do so would weaken their defence in the event that a data breach occurs.

Remember that a doctor will not be held responsible for a breach of confidentiality, provided that he/she can prove that the breach of confidentiality was the result of a technological failure or the wrongdoings of a person other than the doctor. The caveat is that the doctor should be able to show that he/she has done their due diligence while selecting the technology service to use.

The takeaway is that prior to registering with a provider (which could range from a simple chat service provider to a dedicated telemedicine platform), the doctor should read the privacy policy to ensure that the data is being suitably handled to minimise the risk of data breaches.

References:

  • Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002
  • Telemedicine Practice Guidelines, 2020
  • Charter of Patient Rights (adopted by the National Human Rights Commission)
  • Information Technology (Reasonable Security Practices and Procedures and Sensitive Personal Data or Information) Rules, 2011

ISRO’s contribution for Indian Telemedicine Program from Concept to completion – Towards National Adaptation

Dr. L.S.Satyamurthy
Former Program Director, Telemedicine, ISRO.

Preamble

It was in November 2001 when I had just returned to India completing my Diplomatic assignment as Counselor of Space, Science and technology, at the Embassy of India, Washington D.C, USA. The then Chairman of ISRO, Dr.K.Kasturirangan called me and said “there is talk of technology and benefits of telemedicine services in the advanced countries like US, Europe, Russia and Japan and they have already initiated the Telemedicine programs. NASA and ESA have started projects which was a part of Space Medicine program for the benefiting the public at large and we at ISRO should not lag behind. As the Indian Space program is basically an application-oriented program for national development and as we are the custodians Satcom technology, we should move forward immediately and take up the challenge of ushering health care for the remote, distant and underserved rural population of our country through the power of Telemedicine using Satellite communication. “That was the beginning of the momentous Telemedicine/Tele health movement in India and rest is history”.

The daunting task of Telemedicine Program conceptualization, formulation and implementation in India was primarily spearheaded by the Indian Space Research Organization ( ISRO ) along with the support of some Govt and private hospitals, dedicated Doctors, Technologists, State governments and Health Administrators. The Telemedicine being new and a technology-based healthcare delivery system, the challenges for implementation and adaptation needed to be comprehensively addressed since the health care in India is a State subject whereas Central government being for national policies and funding.

Beginning

ISRO initiated Telemedicine program under Space Technology applications for societal benefits in the year 2001 adopting multipronged strategy of addressing some of the important issues like:

  • Resistance to change to new system of functioning and lack of infrastructure
  • Technology adaptation and evolving National Standards for Telemedicine practice
  • Creating awareness among Public, Doctors, Hospitals and Health administrators
  • Judicious application of Telemedicine technology at appropriate levels of healthcare system
  • Cost of service vis-à-vis affordability,
  • Sensitivity to fast changing technology and its obsolescence,
  • Training aspects for Doctors/ paramedics in the usage of the new technology in Medical care
  • Evaluation of Telemedicine service and community satisfaction.

The Telemedicine pilot project era started by ISRO in 2001 culminated into operationalization of telemedicine network in different states of our country during the year 2005-2008. The important factor of providing satellite connectivity free of charge by ISRO, Govt of India was the major boon for many of the specialty hospitals and state governments hospitals to come together in providing health care service through telemedicine for the benefit of rural and underserved population.

Telemedicine Implementation

ISRO’s Telemedicine network covered several states of J&K, Karnataka, Kerala, Maharashtra, TN, AP, Orissa, Jharkhand, Rajasthan, Gujarat, Chhattisgarh, MP, Punjab, Haryana, Uttarakhand, Jammu, Kashmir, Ladakh and North eastern states; UT of Andaman, Lakshadweep Pondicherry, Diu, Daman and Sylvasa connected to50 Specialty/Medical college Hospitals.

That was how ISRO started implementing the Telemedicine program during 2001 -2008 with the assistance of several medical institutions namely: AIIMS Delhi, SGPGI Lucknow, PGI Chandigarh, JIPMER Pondicherry, SRMC Chennai; Several State govt District/Taluk hospitals all over the country including North eastern states, Jammu, Kashmir and Ladak and Union territories of Andaman and Lakshadweep ; specialty hospitals like , Jayadeva Institute of Cardiology, Narayana Hrudayalaya, Sathya Sai and Fortis hospitals in Bangalore; Apollo, Shankara Netralaya, SRMC, Mohan Diabetic foundation at Chennai, Aravind Eye care and Meenakshi hospitals clinics in Madurai and Coimbatore, LV Prasad Eye care in Hyderabad; Amritha institute, Kochi; KEM, Tata Memorial Cancer Centre and Nanavathi hospital in Mumbai, Gangaram and Safdarjung Hospital in Delhi ; Armed Forces medical hospitals at he forward areas including Srinagar, Uri, Udhampur Kargil and Parthapur (Siachen) connected to R & R hospital Delhi and some of the IAF regional hospitals linked to Command hospital, Bangalore.

Further, ISRO provided the assistance for setting up of Telemedicine center at Kabul in Afghanistan under WHO sponsorship and at Male in Maldives under MEA sponsorship.

During the Tsunami in 2005, ISRO’s Telemedicine network provided the Satcom link for Andaman and Nicobar Islands were provided for both Telemedicine service and telecom support for connecting the mainland of India. ISRO was responsible for preparing the first project report for Pan Africa Telemedicine Project covering 48 countries in Africa on the advice of the then President A.P.J.Abdul Kalam, under MEA sponsorship, which was subsequently executed by TCIL, Delhi.

Other effort included Satcom linked Mobile Telemedicine Bus/Vans set up by ISRO in association with leading specialty hospitals covering various Medical disciplines like Ophthalmology, Diabetology, Cardiology, Mammography, General Medicine and Surgery and rural community.

ISRO virtually marshalled the various stake holders on a common platform for the cause of ushering healthcare to the remote, rural and underserved population of the country. During Tsunami in 2005 ISRO set up emergency satellite links to provide emergency care connecting the main land.

During that time 2005-2008, India had one of the largest Satcom based Telemedicine networks in the world network with about 400 remote/ rural/ district hospitals and 200 Village resource centers in most of 25 States connected to 50 Specialty/Medical college hospital located in major cities/towns in the country including 15 Mobile units covering the various medical specialties.

More than 10 Lakhs of Teleconsultation took place with several life saving instances during the period of 2002-2010.

Outcome of ISRO’s Initiative:

ISRO’s Telemedicine program initiatives resulted in the formation of National taskforce by the Ministry of Health in 2006, Government of India, for formulating policies and guidelines for ushering Telemedicine into the mainstream of health care delivery and future implementation in different states by the health ministries and departments. This also lead to Health Ministry, GOI, recognizing Telemedicine as an important application under National Health Mission (NHM) of the country under Ayushman Bharath.

Today many of the State Govt and Private along with the Specialty hospitals are proving Telemedical services with different connectivity options like Wireless and Mobile, to needy patients on clear business model as applicable for reaping the benefits of the initiatives ushered by ISRO.


Telemedicine Practice Guidelines – A Foundation Course for RMPs by TSI

To know more about the Telemedicine Foundation Course click on the link below:
https://tsi.org.in/courses/


Feedback for Telemedicine Practice Guidelines Course

The foundation online course for Telemedicine Practice Guidelines being conducted by TSI has been taken up by almost 160 registered medical practitioners. The feedback of the course has so far been excellent. To view these feedbacks please visit – https://tsi.org.in/course-feedback/

A snapshot is presented a below:

1. Did you find the live interaction useful?

 

 

 

 

 

2. Were most of your doubts cleared regarding telehealth practice?

 

 

 

 

 

3. Do you feel more confident to practice safe telemedicine?

 

 

 

 

4. Overall rating

 

 

 

 

 


Telemedicine – News from India & Abroad

India

India launches incentive scheme supporting 75 startups in telemedicine and digital health
WHAT IT’S ABOUT The announcement comes as India celebrates its 75th year of independence from the United Kingdom. Amid the celebration, Science and Technology Minister Jitendra Singh said identifying and supporting the 75 startups is the ministry’s “most appropriate” task that will promote research and development in the healthcare sector… Read More

International

Artificial Intelligence (AI) Enhanced Through Brain Networks
Cognitive tasks can be performed efficiently using artificial intelligence (AI) networks based on human brain connectivity as per a study at the Mcgill University, published in the journal Nature Machine Intelligence… Read More

New AI Blood Test for Lung Cancer Detection
A novel artificial intelligence blood testing technology can detect over 90% of lung cancers in samples from nearly 800 individuals with and without cancer. ‘The DELFI technology blood test for lung cancer can be a good way to enhance screening efforts.’… Read More

Mobile telemedicine unit found to be effective in treating opioid use disorder in rural areas
Rural regions in the U.S. have been disproportionately affected by the opioid epidemic, while also having the fewest number of programs to treat opioid use disorder. In an effort to remedy this dire health issue, University of Maryland School of Medicine (UMSOM) researchers reconfigured a recreational vehicle (RV) as a telemedicine mobile treatment unit to determine whether it could provide effective screening and treatment to individuals with opioid use disorder in rural areas… Read More

 


TN – TSI invites all the TSI Chapters and Members to submit information on their upcoming Webinar or Events (50 words), News related to Telemedicine (200 words) or short articles (500 words) for the monthly e-newsletter.

Guidelines for submission to TN TSI Newsletter-

  • Report can be from 500 to 600 words
  • Report Should be relevant to Telemedicine or Medical Informatics
  • No promotion of self or any product
  • Avoid plagiarism
  • All references should be included
  • Provide any attributions
  • Visuals are welcome including video links
  • Send full authors name, degrees, affiliations along with a passport sized photograph of good resolution. If multiple authors only main author photo to be sent.

Submission may be sent to – tsigrouptn@gmail.com
Editors reserve the rights for accepting and publishing any submitted material.

Editor in Chief – Dr. Sunil Shroff
Editors – Dr. Senthil Tamilarasan & Dr. Sheila John
Technical Partner- www.medindia.net

 

e-Newsletter July 2021

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

What is New?

We had an excellent webinar on telemedicine technology by Mr. Mathur from Ahmedabad and the report is covered in this newsletter.

The self-learning course with live interaction with the course faculty has been already upgraded to Ver.2 with more interactive lecture videos to provide better learning experience.

The online self-learning course ‘Train to Practice Telemedicine’ is a foundation course for all practicing RMPs.

This month we are also launching a speciality course on diabetes and telehealth with help of Dr. V. Mohan, Dr. Jothydev Kesavadev, and Dr. Sanjay Sharma.

Please visit https://tsi.org.in/courses to view all the courses. If you wish to contribute as a TSI member you are most welcome to join us in development and delivery of these courses.

Thank You.
Dr. Sunil Shroff
Chief Editor
President – TN Chapter – TSI


Tele Rehabilitation : The Time has come

 

Prof. K. Ganapathy
Former Secretary and Past President Neurological Society of India, Telemedicine Society of India & Indian Society for Stereotactic & Functional Neurosurgery | Hon Distinguished Professor The TamilNadu Dr. MGR Medical University | Member Roster of experts Digital Health WHO | Director, Apollo Telemedicine Networking Foundation & Apollo Tele Health Services | URL: www.kganapathy.com | EMail: drganapathy@apollohospitals.com

“If I had known I was going to live this long, I would have taken better care of myself.” – Mae West

Rehabilitation, the process of restoring an individual to health or normal life through training and therapy, is a major component of Health Sciences. Rehabilitation services have been disrupted due to the COVID-19 pandemic. Even with unlocking and post vaccination, some form of physical distancing is likely to be part of the new normal. This review suggests that, Telerehabilitation (TR) will soon be a distinct stand alone sub speciality of Telehealth and is here to stay.

Introduction to Telerehabilitation Services

Digitalisation of health care is at an all time high, as is the exponential growth of Telehealth. TR is “the delivery of rehabilitation services via Information and Communication Technologies” . Reduced access to in-person rehabilitation, secondary to the pandemic, is resulting in TR growing exponentially. TR services include evaluation, assessment, monitoring, prevention, intervention, supervision, education, consultation, and coaching. TR services can be deployed across patient populations and multiple healthcare settings including clinics, homes, schools and community-based worksites. A Fortune Business Insights Report estimated a market value of USD 3.32 billion in 2019,with a Compounded Annual Growth Rate (CAGR) of 13.4% leading to USD 9.13 billion by 2027.

Advantages and Barriers in TeleRehabilitation

These include exercising from comfort of home, ability to work on one’s recovery irrespective of time schedule of health care professionals and improved quality of exercise instruction, as they are available for repeated review on video format. Access to high-quality care despite geographical isolation, reduced travel and waiting time, flexibility, and cost-effectiveness are additional benefits Limited computer literacy, unreliable internet connection, language barrier, inability to perform an actual physical assessment, patient privacy, and safety concerns are challenges Some participants were enthusiastic about TR as they could be in contact with their therapist and continue training.

Clinical indications for TR include musculo skeletal disorders, low back ache, spondylosis, osteo arthritis, neck pain ,frozen shoulder and post joint replacement. Neurological conditions benefiting from TR include stroke, neuro trauma, neuro degenerative disorders, cerebral palsy, Post TB Meningitis, neuro muscular disorders, Gullian Barre syndrome, Deuchenne muscular dystrophy and demyelinating diseases. Chronic Obstructive Pulmonary Disorders, post ICU conditions, post Covid, cardiovascular disorders, visual, hearing, developmental disorders, speech and voice dysfunction, swallowing disorders and cognitive dysfunction also benefit from TR . Virtual assessments for pain, swelling, range of motion, muscle strength, balance, gait, and functional assessment demonstrated good concurrence with physical assessments. TR can provide high-quality personalized musculoskeletal physiotherapy. Knee osteoarthritis causes musculoskeletal pain and disability affects up to one-third of people aged over 60 years. Remote muscle strengthening exercises can significantly reduce pain, improve physical function and quality of life. TR for musculo skeletal conditions leads to reduced hospitalization and crowding in physio therapy departments. Musculoskeletal disorders (MSDs) are the second commonest cause of chronic pain and physical disabilities. Physiotherapy assessments that can be done through video include evaluation of pain, swelling, range of motion, muscle strength, balance, gait and functional assessment . TR for stroke, cardiac, pulmonary afflictions and swallowing difficulties

Tele Rehabilitation potential in India

India now has over 100 million senior citizens. The market for geriatric rehabilitation alone is high. Confederation of Indian Industries, in a report showed that 5.5% of seniors were staying at homes. 6% of seniors live alone. Of the 700 million active internet users, 70% access the internet daily mostly using mobiles. Interestingly communication technology is growing faster in rural rather than urban areas. were using smartphones in 2020. 77% of 500 million smartphone users were accessing broadband services. The National Institute of Mental Health and Neuro Sciences (NIMHANS), services delivered telemental health services during the COVID-19 crisis to ensure continuity of care for patients who were unable to avail outpatient services .. A report on 22 senior citizens from four Community Centers in Delhi showed that home-based TR could be used as an adjunct to continue follow up care thus improving outcomes.

Tele Rehabilitation; A peep into the Future

TR will eventually be integrated with Smart Homes in Smart Cities. Functional monitoring with bed sensors, activity/motion sensors and gait monitors will be a reality. This will be followed by Creating a connected home with pressure-sensing floors, smart furniture and medical sensors. Assistive robots, power wheelchairs, prosthetic limb controls, Home Automation systems and AI Chatbot companion at Home will add value providing “smarter care”. This will include encouraging activities and contacting caregiver/children in emergencies. Staying @ Home, better known as aging in place will lead to better health outcomes.

Conclusion

Understanding who will use TR, how it will help achieve customized, well defined and changing goals is critical. Beneficiary’s goals alone matter. TR is only a tool to achieve them. The Health Care Provider using TR should get into the minds of the the end user. It should never be forgotten that for digital natives, an octogenarian is from another planet. “Customer delight” is not a cliché used as a marketing ploy. TR is not a solution searching for a problem. Nothing can stop an idea whose time has come. Covid has ensured that Telerehabilitation is here to stay.

The Key Note Address is available @ https://youtu.be/RNEIZqc3w5A


Telemedicine and Its Applications for the Common Man during COVID Pandemic – A three-day virtual online lecture series by ISIE Ahmedabad

 

Mr. Anil C. Mathur
Group Director (Retd.),Space Applications Centre, ISRO, Ahmedabad | MD, Indian Space Industries Exhibitors, Ahmedabad-Ghaziabad | Email: antrixudyog@gmail.com

In this era of digital world, technology is going to play a big role in establishing India as a superpower. Telemedicine is one such area. Telemedicine, also known as telehealth or e-medicine, is the remote delivery of health services, including examinations and consultations, on telecommunications infrastructure. Telemedicine is the practice of medicine using technology to deliver care remotely. A physician at one location uses a telecommunications infrastructure to provide care for a patient at a distant location. Telemedicine allows healthcare providers to evaluate, diagnose and treat patients without the need to meet in person. Patients can communicate with physicians from their homes using their own personal technology or by visiting a dedicated telehealth kiosk.

A three-day virtual online lecture series on the theme “Telemedicine and Its Applications for the Common Man during COVID Pandemic” was organized by Indian Space Industries Exhibitors (ISIE) Ahmedabad from 10 July 2021 to 12 July 2021. ISIE is a micro-venture established under Micro, Small and Medium Enterprises (MSME). This organization has been founded by Mr. Anil C. Mathur, retired group director, ISRO Ahmedabad and alumnus IIT Roorkee. From the very beginning, ISIE has encouraged the public especially scientists, students, science communicators to adopt science and technology applications in daily life.

The programme was virtually inaugurated on the Zoom stage by the Chief Guest Shri B. S. Bhatia, Former Director,DECU/ISRO, Ahmedabad. In the inaugural session, Mr. Bharat Mehta, Editor-in-Chief of the journal “Space Industry” published by ISIE, gave information about the activities of ISIE and repeated strongly, the goal of all the organizers to bring the activities and benefits of space science and technology to the common man of the country. The Chief Guest of the inaugural session Shri B. S. Bhatia expressed his thoughts on the importance of telemedicine for shaping the diverse possibilities of a futuristically developed world. Mr. Dinesh Kumar, Chairman Institute of Engineers Delhi State Centre, also addressed the participants in the inaugural session as a special guest.

In this virtual series of lectures, online addresses were given by eminent doctors, scientists, technical and industrial experts of the country in the sessions organized between 10 am IST to 4 pm IST on all three days. In this three-day virtual online lecture series, the experts tried to portray the future India’s telemedicine healthcare technology to capture the imagination of the audience, especially the students, by giving their address session wise as follows according to the schedule:

India’s Space programme and History of Telemedicine in India by Mr. A. K. Sangal, Retd. Group Director, DECU/ISRO and former President, Telemedicine Society of India; Telemedicine Society of India , its training activities and Relevance of Telemedicine in the Covid pandemic by Dr. Ashvini Goel, Retd. Colonel (Dr.) Indian Army, and Current President, Telemedicine Society of India; Applications of Telemedicine in Surgical care and Skill transfer by Dr. S. K. Mishra, Founder President, TSI and Senior surgeon and Dean at Sanjay Gandhi PGI, Lucknow; Telemedicine – Accessible and Affordable Healthcare for All by Dr. Sunil Shroff, President Telemedicine Society of India, Tamil Nadu Senior Consultant Urologist Madras Mission Hospital; Role of Videoconference in Telemedicine by Mr. Bijoy M. G., Managing Director, Unarv Telemedicine & Healthcare Services (P) ltd, and Secretary Kerala state chapter of Telemedicine Society of India; Tele-health activities during Covid-19 pandemic-Odisha Experience by Dr. B. N. Mohanty, Hon. Advisor to the Odisha Government and former president of Telemedicine Society of India; Merits, demerits and problems associated with Telemedicine Network and System by Dr. T. N. Ravishankar, Specialized family physician and currently Director Sudar Hospital; Applications and Usage of advanced Artificial Intelligence(AI) technology in Health Care by Dr. Masood Ikram Doctor turned entrepreneur and expert in applications of AI in the Healthcare industry; Telemedicine-During and after COVID pandemic by Dr. Sanjeev Mehta Senior pathologist, Ahmedabad and Member Telemedicine Society of India; ISRO’s Telemedicine Network by Mr. Arvind Tyagi Scientist/Engineer, DECU/ISRO, Ahmedabad; NavIC, Telemedicine and the COVID by Dr. M. R. Sivaraman Retired Scientist/Engineer ‘G’ and DPD, SAC/ISRO, Ahmedabad; Lessons from Covid-19 for Community enabling to counter infodemic by Mr. J. Venkataramaiah, Retd. Sci./Engr. ISRO. Alumni & Mentor, International Space University. Currently associated with PSF; Clinical Applications of Telemedicine by Dr. N. K. Agarwal Professor of Endocrinology and Nodal Officer of Regional Resource Centre of Telemedicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi; Block Chain in Healthcare by Dr. Bhagwant Singh Ratta Pediatric Surgeon/Urologist and former president Telemedicine Society of India; Continuing Medical Education through ISRO’s Telemedicine Network and Tele-consultations during Covid-19 by Dr. Maulesh Gadani, Medical Officer, SAC/ISRO, Ahmedabad; Telemedicine- What really works by Mr. Mayank Agarwal CEO, M/s Smart Square Tech., NOIDA; Televital Journey and Latest Trends in Telemedicine Technology Mr. Sateesh Bhatt Solution Architect, M/s Televital India Pvt. Ltd., Bangalore; Telemedicine and Privacy by Ms. Bagmisikha Puhan, Technology Lawyer and Privacy Practioner, EC member Telemedicine Society of India.

The concluding session of this lecture series on 12th July, was presided over by Dr. Velchamy, Founder ‘Krithin Foundation’, Trichy, Tamil Nadu. Dr. SK Mishra, former Head of the Department of Endocrine Surgery and Nodal Officer Telemedicine Program, S.G.P.G.I. Lucknow; Shri AK Sangal, Former Scientist SAC, ISRO, Ahmedabad; Shri Vikram Desai, Former Director DECU ISRO; Shri VK Jain, President BES Ahmedabad Chapter; Shri Anil C. Mathur, Managing Director, ISIE expressed their views while discussing the future roadmap of telemedicine through panel discussion.

On all three days of the lecture series, BES Ahmedabad Chapter President Shri VK Jain conducted the entire program with technical support from the team of Space Geeks led by the Founder Shri Chintamani Pai, Dr. Vaibhav Rawat and Shri Hari Tejas Iyer. At the end of the program Shri Amritanshu Vajpayee, Founder Coordinator, Ignited Minds VIPNET Club-Farrukhabad presented a formal vote of thanks and then the end of the three day virtual lecture series was announced by the organizers. Due to this unique effort of ISIE in the midst of the worldwide pandemic of COVID-19, this three-day virtual online lecture series can be considered as an effort to reach out to the masses through participating audiences belonging to different fields.

Broadcasters Engineering Society Ahmedabad Chapter, Space Education and Research Foundation, Space Geeks Mumbai, UL Space Club, IITR Alumni Association Ahmedabad, UOR77 Batch Foundation New Delhi, Space Education and Research Foundation Ahmedabad, Ignited Minds VIPNET Club -Farrukhabad were the collaborating organizations as knowledge partners and Sunrise India Samachar – New Delhi was associated as a media partner for the programme. Many serving and former scientists of ISRO as well as representatives of different collaborating institutions graced the occasion. The live broadcast of the event was arranged by the organizers on the YouTube channel of Indian Space Industries Exhibitors, viz., https://youtube.com/c/ISIEIndianSpaceIndustryExhibitors. The entire virtual lecture is available for public viewing on the channel above.


Medical Negligence in the Telemedicine Era

 

Anay Shukla
Founding Partner, Arogya Legal – Health Laws Specialist Law Firm

Eshika Phadke
Associate, Arogya Legal – Health Laws Specialist Law Firm

 

In our previous articles, we discussed the legal considerations and compliances that must be followed to practice telemedicine in India. In this article, we are going to examine a less pleasant but equally important subject: how does a doctor protect themselves from allegations of medical negligence while practicing telemedicine?

It is important to first understand what medical negligence is. When a doctor-patient relationship is formed, a duty is cast upon the doctor to act and provide treatment to the patient as per the applicable standards of reasonable care. Any act (including a failure to act) by a doctor that is in a breach of the standard of care, which results in the patient being harmed, would constitute medical negligence.

Standard of reasonable care

The standard of reasonable care that is applicable to a doctor differs based on specialization, level of education and amount of experience, and is ascertained on the basis of what would be considered reasonable by a responsible body of professionals in that specialization for a doctor with ordinary skill.

For telemedicine, the jurisprudence around the “standard of reasonable care” is still in a stage of infancy in India, since telemedicine was only legitimized in March last year. The Telemedicine Practice Guidelines (“Guidelines”) make it clear that the professional and ethical norms that are applicable to in-person care are also applicable to telemedicine, bearing in mind the intrinsic limitations of telemedicine. So, while the principles of medical negligence for traditional consultations remain the same, they must be adapted to virtual consultations.

At a fundamental level, deviating from the practices laid out in the Guidelines would be considered a breach of standard of reasonable care, and if it results in harm to the patient would constitute medical negligence. Doctors should familiarize themselves with telemedicine guidelines for their specialty to get a clear understanding of what is recognized as the standard of reasonable care.

Documentation and Consent

Similar to in-person consultations, documentation is of utmost importance, not only because it is required under the law, but also because it serves as the doctor’s primary defense should a patient make allegations of negligence or deficiency in service in court.

While consent for the consultation is implied when the patient initiates the consultation, explicit consent must be sought in all other cases. For instance, if the patient’s caregiver or another healthcare professional initiates the session. In such cases, consent ought to be recorded. As a precautionary measure, doctors should also record if a patient refuses to act as per instructions, which may result in their condition worsening. In particular, if a doctor deems an in-clinic visit necessary but the patient refuses, the doctor should obtain, in writing, a declaration from the patient that he/she has been informed of the risks of proceeding via telemedicine and has been advised to visit a doctor’s clinic, but is electing to proceed with telemedicine.

Delay in seeking treatment

The most likely scenario that would result in allegations of negligence is if a doctor does not recommend that a patient see a doctor in-clinic, when it is evident that it is required or fails to communicate the urgency with which the patient ought to seek in-person care. If the patient’s condition deteriorates as a result of the delay in receiving the treatment that they require, the doctor with whom the patient did a teleconsultation with will likely be held for negligence.

Incorrect mode of teleconsultation

The Guidelines recognise video, audio, real-time text and asynchronous interactions between a doctor and patient as telemedicine. While a doctor is at liberty to select which mode to adopt, it is essential that they act prudently while doing so and ensure that the mode allows them obtain all the information required to take a decision. If required, it is perfectly acceptable to switch to another mode. If failure to adopt the most appropriate mode results in a failure to diagnose or misdiagnosis or incorrect treatment, it would likely be considered negligence on the doctor’s part.

Prescriptions

It has been held that prescribing a drug without following the due process to arrive at a diagnosis amounts to (criminal) medical negligence. Doctors must be especially wary of this before prescribing a course of treatment via telemedicine, and must ensure that they have gathered all the relevant information (which may include shifting to a different mode of teleconsultation or requesting the patient to visit a doctor for a physical examination, and ordering diagnostic tests) prior to writing the prescription. Doctors should also ensure that they strictly adhere to the limitations specified in the Guidelines in relation to drugs that may be prescribed via telemedicine.

REFERENCES

1.Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002.
2.Telemedicine Practice Guidelines
3.Deepa Sanjeev Pawarskar & Anr. v. The State of Maharashtra (Bombay High Court)


Birth of Tele-Radiology (History and Evolution of Telemedicine –9th Milestone)

 

Dr. Sunil Shroff, MS, FRCS, Dip. Urol (Lond.)
President, Tamil Nadu Telemedicine Society of India,
Editor, www.medindia.net,
Consultant Urologist & Transplant Surgeon, Madras Medical Mission Hospital, Chennai, India (shroffmed@gmail.com).

 

 

 

Tele-radiology has been an integral part of development and advancement of telemedicine. The advantage has been that it can use asynchronous technology of store and forward to transmit the heavy images to another location for reporting. Important early milestones I the development of Tele-Radiology have included –

In 1929 – Dental x-rays were transmitted with the help of telegraph to a distant location

In 1959 – Canadian radiologist reported diagnostic consultations based on fluoroscopy images transmitted by coaxial cable

Radiologist Joseph Gershon-Cohen and inventor Austin Cooley spent 2 years testing a system invented by Cooley to connect Chester County Hospital to Philadelphia, PA, 28 miles away through wire and radio circuits. The early process was described by Bashshur RL as follows:

‘Primitive by modern standards, the equipment consisted of a glass drum with a clamp on top to attach the film while the drum rotated at a uniform speed of 180rpm. A beam of light illuminated tiny elemental areas of the film and picked up by a photo cell inside the cylinder and connected with a preamplifier to produce the full picture. The image was passed through an output amplifier before connecting it to a telephone line or radio transmitter.’

The two authors eloquently described the essence of their invention: “Consultation between the roentgenologist and surgeon, twenty-eight miles apart, took place over the same telephone circuit, with no more delay than a similar consultation would entail with the surgeon and roentgenologist present together in the hospital.”

It was in 1993 that the American College of Radiology (ACR) and the National Electrical Manufacturers Association (NEMA) brought minimum standards for medical images and metadata, with respect to handling, storing, printing, and transmitting images and other medical record information. This was called ‘Digital Imaging and Communications in Medicine’ (DICOM). DICOM is today an internationally accepted standard for medical images and applies to a number of key aspects of the digital radiology enterprise. It also has standards for file format and network communications.

In India, the first successful use of teleradiology transmission was done in 1996 was done from Jankharia Imaging in Mumbai where image was transferred to the homes of the individual doctors for reporting emergency CT scans.

Reference

1.Sending dental X-rays by telegraph. Dent Radiogr Photogr. 1929;2:16. monitoring (Davis et al., 1961)
2.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5107673/
3.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2747412/

 


Telemedicine Practice Guidelines – A Foundation Course for RMPs by TSI

To know more about the Telemedicine Foundation Course click on the link below:
https://tsi.org.in/courses/


Telemedicine – News from India & Abroad

India

Artificial Intelligence (AI) Unfolds the New Dimension of Social Development
‘Artificial Intelligence (AI) proves as an inevitable tool in achieving Sustainable Development Goals (SDGs – 17 interlinked global goals for a better future). A global virtual event organized by Amrita Vishwa Vidyapeethamprovided excellent and up-to-date research for all AI enthusiasts from the industry, academicians, and students to realize the importance of AI in all fields. ’….. Read More

International

Recent Improvements In Pharmaceutical Sector
AI and big data/analytics are identified by healthcare industry professionals as the top technologies that will transform pharmaceutical drug discovery and development processes, according to a survey by GlobalData, a leading data and analytics company……….. Read More

Machine Learning-powered Imaging Helps Diagnose Thyroid Cancer
A new non-invasive method to distinguish thyroid nodules from cancer by combining photoacoustic (PA) and ultrasound image technology with artificial intelligence has been devised by scientists…. Read More

AI-powered emotion analysis technology to help diagnose mental health conditions in seniors in Singapore
Through video calls, Opsis Emotion AI’s software will be used by counsellers to help diagnose mental health conditions such as anxiety, stress and depression. Emotional analysis technology developed by software solutions provider Opsis Emotion AI will be piloted over the next two years in a programme targeting more than 4,300 seniors in Singapore.….. Read More

New Revelation About Brain Activity During Sleep
Using an artificial intelligence approach, scientists at the University of Geneva (UNIGE), Switzerland explained the brain activity during sleep. They provided strange evidence that sorting out of things during the day time takes place during deep sleep by combining functional magnetic resonance imaging (fMRI) and electroencephalography (EEG).….. Read More

 


TN – TSI invites all the TSI Chapters and Members to submit information on their upcoming Webinar or Events (50 words), News related to Telemedicine (200 words) or short articles (500 words) for the monthly e-newsletter.

Guidelines for submission to TN TSI Newsletter-

  • Report can be from 500 to 600 words
  • Report Should be relevant to Telemedicine or Medical Informatics
  • No promotion of self or any product
  • Avoid plagiarism
  • All references should be included
  • Provide any attributions
  • Visuals are welcome including video links
  • Send full authors name, degrees, affiliations along with a passport sized photograph of good resolution. If multiple authors only main author photo to be sent.

Submission may be sent to – tsigrouptn@gmail.com
Editors reserve the rights for accepting and publishing any submitted material.

Editor in Chief – Dr. Sunil Shroff
Editors – Dr. Senthil Tamilarasan & Dr. Sheila John
Technical Partner- www.medindia.net