e-Newsletter Feb 2021

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

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.

Blockchain on the Horizon for Better Telehealth Solutions
Dr. B S RATTA
Paediatric Surgeon and Urologist, Certified Robotic Surgeon, Ruby Hall Clinic Pune, Fellow Institute of Child Health London, Fellow Texas Children’s Hospital Houston, Trustee Connecting, Past President TSI, Past President TSI Maharashtra, Past Chairman IAeHC, Past President Rotary club of Pune Riverside


Pradeep Goel

CEO SolveCare, Past CEO,COO,CIO,CTO, Innovative Technology Co.s, Programme designer Medicare,Medicaid, Entrepreneur of 4 Health IT C

“The science that we work with today must have the innovativeness, foresight and the vision for it to be the centre of technology that we develop tomorrow. In whatever field we work, we have to remain in the service of the common man whose well being is central to all human knowledge and endeavour.”

– Dr. APJ Abdul Kalam

Covid19 has put global economy into a tail spin. There is a big shift taking place in the healthcare industry. Blockchain can create massive social impact in crisis like Covid pandemic. With remote access and telehealth services being sought after to tackle issues such as hospital overcrowding and social distancing, accessibility to digital solutions is more important than ever. However, teleconsultations not only require remote access but a secure way of transferring information from patient to doctor and doctor to patient. This, coupled with the growing usage of mobile health and remote monitoring devices, presents an opportunity to leverage blockchain technology.

Blockchain, at its core, is an infinite and immutable data ledger. The data on a blockchain is stored and repeated onto different unrelated nodes creating a decentralized database that cannot be altered or controlled from any one node. A strict record-keeping technology that provides transparency and auditability by design adds more levels of oversight where issues can be quickly flagged.

Imagine a patient record in hospital or clinic which is written by an indelible ink and is password protected, records names of everyone who has opened ,edited the file is available anywhere, anytime anyplace. It can also integrate data from all types of healthcare services and thousands of healthcare ecosystems working in silos ,like Drs, hospitals, clinics in compliance with strict data privacy regulations.

The emergence of technologies such as blockchain is a game changer for the healthcare industry. This sunrise industry is a market disruptor, Telehealth solutions can be developed to allow for the provision of functionalities and services that are able to assist in making healthcare providers and their work more autonomous. When blockchain technology is used in conjunction with telehealth, it can create the most efficient possible interaction between patients and doctors, ensure the security and privacy of patient data, and most importantly, uphold the sovereignty of physicians.

The true revolutionization of healthcare brought about by implementing blockchain solutions is the ability to empower patients to make better-informed decisions, making the healthcare journey a more patient-centric one. Furthermore, such solutions can automate the enforcement of patient rights and privacy, while providing ownership over their own healthcare data. Data security and control are increasing concerns to patients around the world. Blockchain also allows, with patient consent, for doctors to immediately access a patient’s past medical records, reducing wasted time conducting repeat assessments and unnecessary medical tests. A patient retains access to their segment of data on a blockchain and retains the permission to revoke or track access to that data at all times. Patients don’t have have to entrust the safety of their information to institutions, or any other 3rd party that can be bogged down by having to track thousands, or millions, of patients’ data. This change in how we handle patient data will enhance our abilities in delivering better continuity of care and thereby improve patient outcomes.

The integration of blockchain technology with telehealth services gives us the opportunity to provide real-world solutions that break down barriers between patients, doctors, and institutions, while increasing accessibility and reducing inequality in healthcare. These solutions should be designed to meet the needs of doctors and patients alike, whilst minimizing paperwork and bureaucracy and respecting the rights and privacy of both parties. The need for greater patient empowerment and respect for the sovereignty of physicians has never been more pronounced. Access to quality healthcare should not be restricted by geographical, societal, or administrative barriers.

This is one of the great opportunities of our time, and it is up to us in the medical profession to ensure it reaches its full potential for the benefit of those who depend on us for their healthcare.


Telemedicine Enabled Clinics with Last Mile Healthcare Delivery

Doorstep Health Services (DHS) along with its Technology Partner- Remassis Solutions-is proud to announce the opening of its first Telemedicine enabled health centre in the North East -at Agartala.

While earlier concentrating around Pune, the dream is to provide accessible responsive care with last mile delivery across India-with a chain of clinics where the nurse is continuously supported by the Doctors on Telemedicine.

The model is a Hub and Spoke model which works under the overall direction of the Enterprise. The Enterprise undertakes forecasting, planning, organizing and such higher management functions. It analyses and evaluated data, creates linkages with secondary and tertiary care, develops training modules, standard treatment guidelines etc. The hub provides doctor consultations and technical support to multiple spokes via telemedicine. The spokes are at the grass roots. The spokes work like health centres and are managed by a Nurse or care giver (if nurse is unavailable). The nurse besides managing the health centre, executes the instructions of the doctor, provides measurements, takes blood for investigation, does ECGs and even conducts home visits for patients who need it.


DHS believes that Telemedicine and last mile healthcare together are the most comprehensive way to provide better health in underserved communities. While telemedicine is important for improving access, responsiveness, retrievability and documentation, last mile health care delivery is crucial for timely initiation of treatment and support in terms of investigations and medication. Last mile delivery also helps provide the human touch which is so important and integral to patient care.

The model works not only in the rural space, but extremely well in urban areas-which also suffers due to lack of primary care. Urban areas have an advantage as lack of infrastructure, human resource, sociocultural mindsets, language, literacy and other such barriers are less encountered here.

We look forward to work with companies, CSR projects, hospitals, and like-minded philanthropists to make our dreams a reality.

For more information about us please visit www.doorstephealth.in or email care@doorstephelth.in

Dr (Gp Capt) Suchitra Mankar
Founder Director
Doorstep health Services, Pune, India.
suchitramankar@gmail.com


Radio & Marine Telemedicine
(History and Evolution of Telemedicine – 3rd 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)

In the evolution of telemedicine radio has played a significant role and has had an impact on saving lives of marooned sick marines on ships. For any big development or revolution to happen, there needs to be simultaneous multiple smaller revolutions. Similarly for marine telemedicine to happen the development of radio-telegraphy by Guglielmo Marconi in 1897 was important. This was soon followed by erection of coastal radio stations and the introduction of radio equipment on ships. For more than 100 years several radio medical services have provided and radio signals and Morse code have been used to help the sick.

On January 2, 1911 Captain McGray of the steamer Herman Frasch was stricken with serious ptomaine poisoning. A member of the crew asked the USA naval base 100 miles away to help but his message was received on board the Merida, which was 800 miles away. The surgeon of this ship gave his recommendations, thanks to which the captain was given the correct medicine and recovered quickly. This improvised teleconsultation occurred between the two vessels.

In 1920 Norway, used radio teleconsultations for seamen. Physicians not only made remote diagnoses and recommendations for treatment but also guided complicated surgical operations via Bergen Radio.

On November 3, 1920 Robert Huntington organized the service for radio consultations at sea for crews of merchant vessels. Captain Robert Huntington used to say: “It does not matter, where a vessel can be, after a captain asks for help over the radio, an ill seaman can get the most qualified medical consultation within 13 minutes“.

The first license for a radio medical service to ships was issued on November 18, 1920 to the Seamen’s Church Institute in New York and this service was called “How to help seamen Needing Medical Help.”

The first experience of radio medical assistance from a domestic to an international level occurred in Italy in 1935, with the constitution of the Centro Internazionale Radio Medico (International Radio Medical Centre, CIRM).

In 1958, the International Labor Organization (ILO) issued a Convention requiring all seafaring nations to have a service for radio medical advice to ships. The ILO Convention of 1987 released an important document that states that sailors should have health protection and access to medical care. The ILO Convention of 1987, art. 9 states that: “If one ship does not have a doctor, one or more people should be designated with specific duties and responsibility, such as medical care and administration of drugs as part of their normal functions. ‘Moreover, a person responsible for medical assistance on board…, who is not medical doctor’, shall have satisfactorily completed a course, theoretical and practical in medical skills, recognized by the competent authority”

Ship-to-shore transmission of electrocardiograms (ECGs) and x-rays was first reported in 1965. Marine telemedicine may offer some solution in providing to cross border telemedicine guidelines in the future.

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Telemedicine – News from India & Abroad

India

‘Telemedicine can help treat lockdown sleep syndrome’
TNN | Jan 10, 2021, 04.20 AM IST Printed from Chennai: Telemedicine can provide uncompromised care to existing patients and also help identify and manage the onset of new sleep problems, says a new study ‘Tele-Sleep Medicine: An Opportunity In A Crisis’ conducted by Dr N Ramakrishnan, director, Nithra Institute of Sleep Sciences. It also documents the emergence of ‘Lockdown Sleep Syndrome’, ie, the onset or worsening of sleep disorders often related to inactivity, fear of the disease, and generalised anxiety caused by the uncertainty of the future….. Read More

Teleradiology Solutions announces reporting volumes and revenue bounce back post pandemic
3 February 2021 BENGALURU, India, Feb. 3, 2021 /PRNewswire/ — Teleradiology Solutions, a leading provider of teleradiology services, reports its volumes, which had seen business shrunk by 80% of pre pandemic volumes, have almost returned to normalcy.….. Read More

International

In-person medical visits waning because of COVID-19 safety concerns
MORGANTOWN — Morgantown’s two largest health care providers –WVU Medicine and Mon Health – said people should not be afraid to seek medical treatment because of the pandemic. “If you have a chronic condition, don’t put off your care,” said Dr. Michael Edmond, WVU Medicine’s chief medical officer.….. Read More

Global Telemedicine Market- Industry Analysis and forecast 2027: Product Type, Shape, Operating System, End-Users and Region
Maximize Market Research has recently published a “Global Telemedicine Market 2019 Industry Research Report. It is comprehensive analysis of past and current status Telemedicine Market’ with the forecast till 2027. The report covers the past market from 2017 to 2019 and forecast of 2020 to 2027 with key developments, key trends, M&A activities by value and their strategic intents. The report has analysed complex data and presented in simple format to make it easier to understand… Read More

Doctor visits online not expected to end following pandemic
The coronavirus pandemic brought with it a boom of doing things virtually — education, work, happy hours and even routine doctors’ visits. While some have returned to in-person school and work days, medical experts told the Dayton Daily News they expect telemedicine will stick around long after the pandemic ends.….. Read More


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

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.

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

 

 

e-Newsletter Jan 2021

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

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.

In continuation to the Dec2020 issue this issue is covering highlights of a few sessions of The TELEMEDICON 2020

TELEMEDICON2020 – Highlights
‘From the Fringes to the Mainstream’

TELEMEDICON2020: Highlights of a Some Sessions
By Dr.Sheila John

The TELEMEDICON 2020, the 16th International Annual Conference of ‘Telemedicine Society of India’ was conducted from 18th December to 20th December, 2020. This was the first International level Tele-Health conference after the Govt. of India’s notification of ‘Telemedicine Practice Guidelines’ during this ongoing COVID pandemic.

The three-day web conference was organized by the Tamil Nadu, Delhi-NCR, Rajasthan, Maharashtra and Karnataka chapters. The virtual conference attracted over 1200 participants across India and abroad.

The first session was “CME – COVID Pandemic and Telehealth Challenges in India” and was chaired by Dr. Meenu Singh and Mr.Bijoy, and the Moderator was Dr. Umashankar Subramaniam. Dr. Susheel Oommen John discussed “Digital health interventions for COVID19 public health response”; Dr. Naveen C Kumar spoke on the topic of “Mental Health and Telepsychiatry”; and Dr. Anoop Amarnath spoke on “Telemedicine During Covid 19 – The Karnataka Experience.” Dr.B.N Mohanty spoke about “Telemedicine Activities in Odisha during Covid-19 Pandemic”; and Dr. Sangeeta Desai spoke about “Coronation of Digital Pathology during Corona pandemic.”

The second session examined “CME – Data Breach.” The session covered “Cyber Security for doctors – Basic Precautions and how to keep consultations and records secure.” The session was split into 2 sections with a 20 minutes section devoted to how and why doctors are targeted, and basic information on “Cyber Security For Doctors.”

The second section was chaired by Dr. Krishna Kumar, Dr. Ikramullah and moderated by Mr. Manick Rajendran. The panelists, Cmdr. K. K. Chaudhary, Lt. Col (Dr.) T.K Das, and Mr. Alok Jha discussed on the topics of “Laws and implications on what is relevant for Doctors,” “Precautions and how to keep sensitive data and records secure,” “Best Practices for Doctors,” and “What is “Due Diligence” and how can it help.” A third section was a Q & A session open to the audience.

Col. (Dr) Ashvini Goel (Retd ), President Elect spoke about “Telehealth Standards – Work in Progress.” Dr. Anup Wadhawan, IAS, Commerce Secretary to the Government of India discussed the merits of “Telemedicine and its Role in Leveraging Healthcare Economy” and “Inauguration of Virtual Exhibition.” The session was presided over by Dr. A. K. Singh and Col. (Dr.) Ashvini Goel (Retd.) and moderated by Mr. Vimal Wakhlu.

Dr. S. Prakash, MD at Star Health and Allied Insurance, also spoke on the topic of Health Insurance Reimbursement for Telehealth.

Some international speakers of note were: Prof Thais Russomano (UK), Russomano, Co-Founder & CEO, InnovaSpace UK; Prof. Pramod Gaur (USA), Prof. Pramod Gaur, Pace University (former VP of Telehealth at UnitedHealth), New York, NY; and Mr. Pradeep Goel (Ukraine), CEO Solve.Care.

The sense of urgency created by the COVID-19 pandemic has spurred medical establishments to overhaul their healthcare delivery systems in pursuit of maximizing patient care and minimizing the risk of infection.


CME on Cyber Security for Doctors and Medical Staff

By Cmdr. K. K. Chaudhary, Lt. Col (Dr.) T.K Das, Mr. Alok Jha

Due to the highly valuable information in medical industry, patient health data (PHD) has become the prime target of hackers. Hackers are continuously trying to breach the defense of hospitals and medical facilities to harvest the information of patients and doctors. As per the statistics, patient health data is sold in Dark Web at 10-20 times the premium of financial data.

Some of the biggest healthcare data breaches of 2020 that forces us to deliberate more seriously on the safety of PHD are

• Inadequate Security, Policies Led to LifeLabs Data Breach of 15M Patients
• Magellan Health breach of 365,000 patients
• Dr Lal PathLabs leaks millions of patients data in public domain

According to Telemedicine Guidelines 2020 – Govt of India “it is doctor’s responsibilities to ensuring data privacy, ethics, and maintaining records of all the patients whose records are being collected during medical examination”. Similarly Digital Information Security in Healthcare Act (DISHA), which is in draft stage of formation and the personal Data Protection Bill-2019 have placed the onus of security of patient’s data on those who store and handle such data.

The relevant part of the amendment is as follows:

3.7.1 Medical Ethics, Data Privacy & Confidentiality: Principles of medical ethics, including professional norms for protecting patient privacy and confidentiality as per IMC Act shall be binding and must be upheld and practiced.

3.7.1.2 Registered Medical Practitioner would be required to fully abide by Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002 and with the relevant provisions of the IT Act, Data protection and privacy laws or any applicable rules notified from time to time for protecting patient privacy and confidentiality and regarding the handling and transfer of such personal information regarding the patient.

3.7.1.3 Registered Medical Practitioners will not be held responsible for breach of confidentiality if there is a reasonable evidence to believe that patient’s privacy and confidentiality has been compromised by a technology breach or by a person other than RMP. The RMPs should ensure that reasonable degree of care undertaken during hiring such services.

With reference to the above, the speakers highlighted why it is important for doctors to understand the underlying risk of holding PHD.

• Patient data can be stolen, lost or intentionally or un-intentionally transmitted.
• Why custodians of DHD & PII are bound by National (DPDA/DISHA) and International (HIPAA) regulations
• Intent and Pre-emptive action that can help
• For this Awareness about basic digital Hygiene is very important
• Ignorance of underlying technology of Internet
• Connected to Internet-based Health Equipment

Speakers also highlighted various methods/tricks, such as Phishing, Vishing, Mail/Phone spoofing, Social Media Postings, Hacking computers/smartphones and Hacking the Internet-connected equipment.

It was concluded that the only safety for any medical practitioner in case of a data breach happens, is to prove that due diligence was done and all possible care to protect such data were taken by the data custodians. Hence, it is essential that doctors and medical staff must be aware of simple security steps can not only prevent a data breach but also prove ‘due diligence’ in case of such breaches.


Release of TSI – PRACTO Joint Report on Reinventing Health Care Delivery Telemedicine During the COVID-19 Pandemic

On the 19th Dec a report to provide a glimpse of telehealth consultation during the COVID pandemic was released jointly by Telemedicine Society of India (TSI) and Practo in presence of Maj Gen (Dr) AK Singh, President, Col (Dr) Ashvini Goel (Retd), Dr.Girdhar Gyani, Director General, AHPI, Dr.Vijay Agarwal, President, CAHO and Dr. Alok Roy, Chairman, Medica Group Hospitals

This was a 25 page document and the key Insights included the following:

• Physical appointments went down by 32%
o Visits to secondary care specialists like neurosurgeon, somnologist, cardiologist and oncologist grew dramatically

• 3x increase in the number of people using online consultations
o 26% of the consultations were with GPs, followed by Dermatology (20%) and Gynecology (16%) and others like Gastroenterology, ENT, Pediatrics stood at 7% each
o The fastest-growing health concerns included ophthalmology, ENT, orthopedics, pediatrics and gastroenterology
o Delhi, Mumbai, and Chennai – saw an average of 16x growth in queries for ENT specialization

Non-metros saw the highest growth of 7x in online consultations, as compared to the same period in the previous year
o During the same period last year, the split between metro:non-metro consultations stood at 75:25. This year, it is 60:40, demonstrating that the number of consultations from non-metro cities is on the rise
o Tier 2+ cities like Manjeri, Arrah, Balasore, Etah, Orai, Khopoli, Jagtial and Shivpuri used telemedicine for the first time in this time period
o Cities like Meerut, Jammu, Srinagar, Nellore, Kochi, Gorakhpur, Kakinada, Tirupati, Bhagalpur, Gaya and Shimoga recorded a 10x growth

• Among metros, Chennai witnessed the highest growth of 4x as compared to the previous year
o Bengaluru, Delhi-NCR, Mumbai, Pune, Hyderabad and Kolkata grew by more than 300% as compared to last year

• More and more elderly people are now getting used to technology
o There was a 502% spike in online consultations from people above the age of 50 during this crisis, who contributed to 12% of overall consultations, as compared to just 5% the previous year

• More women are going online
o Last year the men:women ratio stood at 75:25, while this year it’s 68:32
o Gynecologists and General Physicians were two of the most consulted specialists by women in 2020

• Online mental health consultations and queries continued to rise during this period
o There was a 302% increase in overall mental health-related queries
o Women contributed to 33% of overall queries for mental health specialists

• More consultations at late hours
o 25% of online consultations were recorded between 10 pm and 4 am when people are not burdened with work responsibilities
o One of the top specialties consulted during late-night hours was Psychiatry

Preferred day(s) to consult doctors online were Tuesdays, Wednesdays, Saturdays, and Sundays, while Saturdays, Sundays, and Mondays preferred for in-person appointments.


Training for Telemedicine in India for Registered Medical Practitioners – Seminar

By Dr. Sunil Shroff, Ms. Bagmisikha Puhan, Wg Cmdr (Dr) Lavanian Dorairaj (Retd), Mr. Mayank Agarwal, Mr. Manick Rajendran, Dr. Ravi Modalli, Dr. (Gp Capt) Suchitra Mankar, Mr. P Ramkumar

This important session provided an overview of training conducted for registered medical practitioners (RMP’s) by Telemedicine Society of India (TSI) after the announcement of the Telemedicine Practice Guidelines (TPG) on 25th March 2020 the Board of Governors in supersession of the Medical Council of India. These Telemedicine Practice Guidelines, were subsequently notified by the government as a gazette on May 14, 2020, as an amendment to the Indian Medical Council. The regulation requires all medical practitioners intending to practice telemedicine in India to take an online course and get certified within three years from the date of notification.

Training of 1.1 million RMP’s in India poses a huge challenge and to address the issue of training in telemedicine, a course called “Train to Practice” was designed by the TSI. This project was voluntary efforts by the members of the society though online structured webinars and was helped by a member (Dr.P.Ramkumar) offering his education platform to house the activities. It was announced within two weeks after the TPG was announced . TSI executive body with senior members designed four modules for training of RMP’s to get familiar with the guidelines and use it to follow ethical and safe standards of practice of telemedicine as a means to increase their outreach and foster increased access to healthcare.

The candidates had to register and create an account. Once this was done they were expected to take a pre course quiz to assess their knowledge about telehealth. This was followed by 150 minutes of an online face to face course that had four modules and these included –
Module 1: Legal Aspects & Telemedicine
Module 2: Clinical Aspects & Telemedicine
Module 3: Tele-triage & Telemedicine
Module 4: Technical Application & Telemedicine

Each module was delivered as a lecture for about 20 to 30 mins and this was followed by a question answer session. Once the face to face webinar course was over the participants were provided with post course assessment and finally if they obtained 80% marks a certificate of completion of the course was issued. The course also put together FAQs that went through several stage of iterations before being given out to the trainees as a reference document and could be used at any time before they took the online test or afterwards as a reference document. A feedback form was also included at the end of the course.

There were 35 training sessions that were conducted in 6 months from April to Sept 2020. Majority of 80% were offered free (28/35) and a small number or 20% were paid or sponsored sessions (7/35). 2946 candidates took the course. The total time spent for the delivery of the course by the faculty was 142 hours. Four sessions were also undertaken free of cost, to train the Army Medical Corps medical officers and specialists.

The total monetary value of the course was Rs.3.74 Million (or US$ 51,233 ). Most of the course was subsidised and offered free. There were seven paid or sponsored sessions that paid the society Rs. 0.84 Million ( US $ 11,507 ) . The course was subsidised by Rs.2.9 Million ( US $ 39,726 ). The overall rating from the course was 4.7 out of 5.

The training course was the first of its kind course in India and was received enthusiastically by all the doctors who came from different specialities. The level of knowledge on telemedicine was variable and most had some basic understanding of the subject. Most RMP’s were not sure if cross state tele-consultations required registration with other states. Most were anxious to understand the legality of telehealth consultations.

Further modules are to be developed in future that would cover common medical specialities that use telemedicine along with a few topics of general interest to include diabetes & telemedicine, Cardiology & Telemedicine, Paediatrics & Telemedicine, Obstetrics – Gynec & Telemedicine, Home-healthcare & Telemedicine, ICU and Telemedicine, Recent Advances & Future of Telemedicine, Legal Cases in Telemedicine and Standards for software and Hardware.


Teleophthalmology Symposium – An overview

By Dr. Sheila John

The COVID-19 pandemic dealt a big blow to the healthcare sector worldwide. With everyone concentrating on managing the pandemic, patients with non-COVID-19 diseases suffered due to a dearth of healthcare access. Previously reserved for underserved areas, tele-health now has become mainstream now because the pandemic has left a vast majority of people remote and underserved.

Dr.R.Kim, Chief Medical Officer, Senior Medical Consultant, Retina & Vitreous Services, Aravind Eye Hospital, Madurai took the podium for the afternoon session of day 1 of the virtual meet. He spoke about the importance of Tele- screening for Retinopathy of Prematurity. Retinopathy of prematurity (ROP) affects developing retinal vessels in premature infants and can lead to severe and irreversible visual loss if left untreated. Screening of the premature babies is the first step in ROP management. In India, tele-screening techniques can bring premature babies from both urban and rural areas into the screening network.

On day 3, the twelfth session featured a symposium on Tele -Ophthalmology (Parallel Session) Dr.R.Kim was the moderator of the session. Dr. Sheila John discussed the topic of “Teleophthalmology to reach the unreached – Mobile Teleophthalmology.” The major role in this endeavor is to provide an ophthalmic service to remote rural areas, where people cannot afford to go to a hospital because of unawareness and poverty. In remote rural areas, ophthalmic services are nearly impossible. The teleophthalmology unit can be a very useful tool to improve eye care delivery in rural areas.

Dr. Kim is the director of Arvind’s telemedicine network and IT services. He discussed “Teleophthalmology to reach the unreached – The Vision Center Model,” In a lot of developing countries, teleophthalmology enables ophthalmologists to provide good eye care to the unserved remote rural and underserved urban populations. Technological innovations through the years have led to advances and teleophthalmology has progressed from a research tool to a clinical tool.

Dr. Padmaja Kumari Rani spoke about ‘Teleconsultation experience in the COVID Era.” The COVID-19 pandemic dealt a big blow to the healthcare sector worldwide. With everyone concentrating on managing the pandemic, patients with non-COVID-19 diseases suffered due to a dearth of healthcare access. Previously reserved for underserved areas, tele-health has become mainstream now because the pandemic has left a vast majority of people remote and underserved. During the pandemic crisis, there was an almost 500% surge in online consultations from people above the age of 50. Older persons accounted for over 10% of overall consultations, as compared to just 5% the previous year.

Padmashri Prof. Dr. S. Natarajan, is renowned for his skills as a vitreoretinal surgeon, keen academic mind and for his philanthropic initiatives in prevention of blindness. He spoke on the topic of “Offline AI using a Smartphone for Diabetic Retinopathy (DR) Screening. India has pioneered the development and validation of artificial intelligence-based algorithms in DR. Likewise, the study done by AJFTLE has shown promise in the use of an offline AI system in community screening for referable DR with a smartphone-based fundus camera and it is a practical way to provide more patient satisfaction as it saves time and cost.

Dr. Senthil CEO welcare system discussed about the various business models for Teleophthalmology like Teleconsultation, ROP Screening, Diabetic Retinopathy Screening and Tele refraction. Diabetic Retinopathy Screening has been the most successful model and he discussed in detail regarding the implementation and outcomes has been followed by Welcare system. The business model has been implemented at 275 Locations and they have screened more than 12.5 lakh patients.

The keynote on Tele-Ophthalmology was provided by Prof. Mingguang He is Founding Chairman, Asia-Pacific Tele-Ophthalmological Society, Managing Director, and Asia-Pacific Academy of Ophthalmology. Cataract, glaucoma, age-related macular degeneration, diabetic retinopathy, and retinopathy of prematurity are among the common causes of blindness in many countries. The session was moderated by Dr. T. Senthil, Dr. Gunda Srinivas, Dr.Vikas Gaur, and moderated by Mr. Mayank Agarwal.

Teleophthalmology, the branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology, includes access to eye specialists for patients in remote areas, ophthalmic disease screening, diagnosis and monitoring; as well as distant learning.


TELEMEDICINE IN DIABETES CARE Symposium

Dr. Jothydev Kesavadev, Dr. Mohan V, Dr. Sanjay Sharma

The first talk by Dr.V.Mohan covered Experience with Telemedicine for Diabetes during Lockdown (COVID-19).

The COVID-19 had played havoc on the health care sector globally. The hurdles imposed by COVID-19 restrictions on health care professionals were discussed among the diabetics especially among the high-risk group of COVID-19: type 1 and type 2 diabetes patients, adults above 65 years of age, people with multiple comorbidities, unstable HbA1c ≥8.5% and smokers.

Telemedicine helped provide a relief for diabetes care.. The study by Dr. Anjana et al on the ‘acceptability and utilization of newer technologies and effects of glycemic control in type 2 diabetes: lessons learnt from lockdown’ conducted in 3000 subjects summed up the challenges, acceptability and utilization of telemedicine in diabetes patients. Research outcomes highlighted that 82% of the patients who adhered to telemedicine were satisfied with the telemedicine services, out of which 58.1% is interested to continue the telemedicine services in the future. There was a significant improvement in clinical and biochemical parameters in diabetes population during lockdown. During the lockdown, the number of patients performing SMBG increased from 15.5% to 51.3% which led to a significant improvement in glycemic control and other metabolic parameters. Take-home message included:

  1. The challenges imposed by Covid-19 restrictions include lack of motivation to monitor blood glucose, reduced access to lab testing, ineffective implementation of a healthy lifestyle such as improper diet and lack of exercise, insufficient guidance and awareness and spread of fake news and fear which in turn affect their quality of life.
  2. Telemedicine is a proven treatment modality for diabetes care.
  3. Effective implementation of telemedicine can result in a significant improvement in glycemic and other metabolic parameters.

The second talk was on Dr. Jothydev Kesavadev covered 23 Years of Telemedicine Practice in Diabetes its merits and demerits.

Diabetes Tele Management System (DTMS®) was launched in 1997 with an intention to better manage diabetes when the prevailing status of care was disappointing with an average A1c above 9%. By way of successful partnership with technologies, over the next ten years, DTMS® evolved into a decision support system; the major components being electronic medical records, personalized diabetes care and a multidisciplinary team consisting of trained physicians, nurses, dietitians, diabetes educators, pharmacists and psychologists. Telemedicine in diabetes care was not widely accepted due to several challenges which included funding, the reluctance of patients to pay, long duration of consultations etc.

Effective use of telemedicine resulted in more than 86% of the patients successfully reaching the customized targets of A1c, Evidence demonstrated significant reduction in A1c without hypoglycemia, preventing the progression of diabetic kidney disease, sustainable benefits for over 15 years, prevention of microvascular complications, benefits regardless of the geographical location and above all cost-effectiveness.

The key take-home message included:

  1. Diabetes is the most important non-communicable disease where the expensive complications can be successfully averted with the implementation of telemedicine.
  2. Telemedicine in diabetes care will invariably help in reaching targets when conventional therapy is failing in the majority.
  3. Sufficient evidence from India proves the superiority of telemedicine in diabetes over conventional care.
  4. There is a robust reduction in cost and complications. However, hospitals and doctors need to be adequately compensated for their time and services for the sustainability of telemedicine in diabetes.

Third party platforms for telemedicine need to be engaged cautiously due to fear of breach of confidentiality and probable commercial interests.

The third talk covered ‘Tele Wound Care for Diabetes Foot Ulcer. By Dr. Sanjay Sharma

Tele wound care was critical in India as the statistics reveal that there are 120 million people in more than 60 age group and 1 in 5 has diabetes. Approximately 22 lakh patients have diabetes foot ulcer and about 500 lakhs require wound dressings.

Diabetes foot care is worsened by the unexpected outbreak of COVID-19 which posed logistic and travel challenges and needs special attention as even the slightest negligence may raise the number of leg amputations.

On an average, to heal a chronic wound, it takes 12-28 weeks and may go up to 52 weeks, which ultimately results in 24-84 clinic visits. These numbers emphasize the necessity for implementing tele wound care for diabetes foot care; the advantage being effective utilization of technology to guide patients to manage wounds at their dwelling places.

Development of various apps such as Foot 360 and Wound360 and its integration to existing therapeutic measures paved the way for patients to share the information regarding their wound such as size, nature, associated complications and the images. The challenges in tele wound care in Indian scenario lies in the willingness and perseverance of physicians, patients, and caregivers in accepting the technology, skill of the patient/caregiver, patient’s environment at home, nutrition status, family and care support.

Take-home message included:

  1. The effective management of diabetes is possible with the advent of cost-effective technologies.
  2. Diabetes foot ulcer is a major diabetes complication leading to increased number of leg amputations.
  3. Tele wound care and apps support patients and health care professionals to have better treatment outcomes with reduced face-to-face consultations.


Panel Discussion on DIGITAL AYUSH

By Moderator, Arjun Bhaskaran, Country Manager – India & Middle East, Gamasec, Israel

The panel on Digital AYUSH discussed the possibilities, constraints, way forward for implementing the Telemedicine Guidelines from CCIM, CCH, CCRYNS in AYUSH sector. The key points discussed were:

  1. With the acceptance of Yoga under the United Nations, the potential for providing Telemedicine in Yoga is immense. This along with the wide presence on the NRI diaspora, the potential for accelerating AYUSH telemedicine for NRIs needs to be urgently leveraged.
  2. AYUSH being rooted in Socio, cultural settings can provide low-cost, medical interventions and guidance for 3 million expatriate workers in Middle East in vernacular medium like Ayurveda Telemedicine in Malayalam and Siddha Telemedicine in Tamil to 2 million NRIs in Malaysia, Singapore.
  3. AYUSH Telemedicine could make a strong beginning with AYUSH Medical Colleges as Telemedicine Providers. AYUSH Colleges have experienced Faculty to deliver Telemedicine, as per the guidelines on CCIM, CCH and CCRYNS.
  4. AYUSH PG & UG students are digital-natives who will adopt and evangelize AYUSH telemedicine faster.
  5. With the Insurance Regulatory & Development Authority making it mandatory from April 2020 for all insurance companies to provide 100% coverage in Sum Insured for AYUSH under AROGYA SANJEEVANI Scheme, AYUSH Telemedicine will get a big boost from Insurance. AYUSH Telemedicine can play a key role in achieving Universal Health Coverage.
  6. AYUSH can leapfrog in Telemedicine, EMR as it has very few baggage IT systems.
  7. There is a need for a strong IT Platform run by a Neutral, Credible Market Aggregator to promote AYUSH Telemedicine. Care needs to be taken to ensure adequate visibility is provided in the IT Platform for all credible, experienced AYUSH doctors, all of whom may not be market-savvy or technology-savvy to promote themselves in Social Media.
  8. The panel identified Bangalore, Kerala and Chennai as suitable Telemedicine ecosystems to implement Proof-of-concept Telemedicine practices – Kerala has state-wide acceptance of AYUSH as mainstream medicine, Bangalore has over 10+ AYUSH medical colleges and a vibrant AYUSH clinical practice, Chennai has the strong support of Tamil Nadu Government in promoting Siddha.
  9. The panel recognized that AYUSH Telemedicine should steer clear of COVID19 related controversies and complications.

Virtual General Body Meeting of Telemedcine Society of India

For the first time in the ere of new normal Telemedcine Society of India held its meeting virtually. There was enthusistic participation by the offcie bearers and members of the society.


Announcements


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.

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
Design – Sankara Nethralaya
Technical Partner- www.medindia.net

 

 

e-Newsletter Dec 2020

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

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.

The December issue of TN-TSI Newsletter is dedicated to TELEMEDICON2020

TELEMEDICON2020 – Highlights
‘From the Fringes to the Mainstream’

 

 

 

 

 


Dr.Sunil Shroff, Organising Secretary, TELEMEDICON2020

The 16th International Annual Conference of ‘Telemedicine Society of India’ (TELEMEDICON2020) was held virtually from the 18th December to 20th December, 2020. This was the first International level Tele-Health conference after the notification of ‘Telemedicine Practice Guidelines’ by the Govt. of India in this ongoing COVID pandemic.

Since Lucknow could not do a physical conference due to the ongoing pandemic, it was decided to go ahead with a virtual meeting and Tamil Nadu chapter along with four other TSI state chapters which included Delhi-NCR, Rajasthan, Maharashtra and Karnataka took up the responsibility and mandate to conduct this web conference. The time was very short and the task herculean,however due to cooperation from many this was accomplished successfully.

As an organising body we created various committees and the scientificcommittee met over six times to put forward a compelling program with an objective to capture the essence of the theme of the conference on how Telemedicine in India had moved from the very ‘Fringes to the Mainstream’ within a very short span of few months.

Scientific committee Meeting on Zoom

 

The Conference was graced with the stellar presence of Hon’ble Justice of Supreme Court ShripathiRavindra Bhat, Mr. AnupWadhawan, IAS, Secretary, Ministry ofCommerce and Industry; Dr. Vinod KPaul, Member, NITI AAYOG; Dr Dharmendra Singh Gangwar, IAS, Addl. Secy. & Fin Advisor Min of Health &Family Welfare; Mr. Lav Agarwal, IAS, Jt. Secy., Ministry of Health and Family Welfare; Dr.SoumyaSwaminathan, Chief Scientist, WHO, Lt Gen ( Dr) MadhuriKanitkar;Ms. VandanaGurnani, Addl. Secy. and Mission Director of the national Health Mission at theMinistry of Health and Family Welfare, Government of India; Mr. Frank Lievens ( Belgium),ISfTeH Executive Secretary (Switzerland) and Dr.Prof. Thais Russomano (UK),Space Physiology, Aviation Medicine, Telemedicine & Digital Health Co-Founder & CEO, InnovaSpace UKamongst others.

The presidential Oration was delivered by President Maj Gen (Dr) AK Singh (Retd.)and he spoke about his experience over the years in the Telehealth space in India.

The chief guest for the inauguration Dr. Vinod KPaul, Member, NITI AAYOG, spoke truly from his heart and gave a message of hope and spoke about the responsibility that had been bestowed on the medical fraternity for creating a tele-health ecosystem as a new enabler for providing affordable access to universal healthcare in India.

Chief Guest for Inauguration function of TELEMEDICON2020Dr. Vinod KPaul, Member, NITI AAYOG delivered his chief guest address. Dr Dharmendra Singh Gangwar, IAS, Addl. Secy. & Fin Advisor Min of Health & Family Welfare delivering the Keynote address. He inaugurated the Virtual Exhibition for TELEMEDICON2020 
Presidential Oration by Maj Gen (Dr) AK Singh (Retd.) Dr. B.N Gangadhara, Chairman, Ethics & Medical Registration Board, National Medical Commission gave his keynote address on ‘Emerging Ethical challenges in Digital Health’

Mr. Lav Agarwal, IAS, Jt. Secy., Ministry of Health and Family Welfare delivering his keynote address at the Valedictory Function on the Way Forward for Telehealth. He also released the Telemedicine Practice Guidelines FAQ’s for Medical Practitioners from TSI.

 

Synopsis of Presidential address

 

 

 

 

Maj Gen Dr. A K Singh (Retd.)
President

In his own words –

The year 2020 has been a very tough year for all of us but for Telemedicine Society of India it has been a year where the TSI has trained over 15,000 Doctors after the Telemedicine Practice guidelines were issued by the board of governors (MCI).

The training team led by Dr Sunil Shroff curated a very comprehensive training programme. What I have realised is that majority of TSI members are indifferent to the activities of the TSI. I appeal to the TSI members to be more proactive and become fellow members. The TSI requires more mature TSI members as executive committee.

In future Telemedicine will grow rapidly and we, the TSI, need to be very clear in what we advocate about teleconsultations. Documentation of Teleconsultations is of paramount importance. TSI needs to shift the HQs to the NCR and start a Telehealth education wing.

Please ensure positive participation in all TSI activities.

 

The New President Speaks

 

 

 

 

 

 

 

Col (Dr) AshviniGoel (Retd.)
President, Telemedicine Society of India

As I done the unenviable mantle of the President of Telemedicine Society of India, I cannot help but reflect upon the year gone by. It has indeed been a year that no one will forget in a hurry. Some notable events of the past year being; the TELEMEDICON 2019 organised at Indian Spinal Injuries Centre in New Delhi with the largest gathering of very senior government functionaries in any TSI conference so far; the proclamation of Govt support for ‘Regulatory Framework for the Practice of Telemedicine in India’; the hurried and intense work on the Draft Telemedicine Practice Guidelines by a small group of dedicated and sincere TSI members with legal background at behest of the Chairman Board of Governors MCI and Member NITI Aayog; the issuance of the “Telemedicine Practice Guidelines” for RMPs on 25th March 2020 quickly followed by similar guidelines for ASU practitioners by CCIM on 7th April and for Homeopathy practitioners by CCH on 10th April 2020; the quick and successful response by a committed group of TSI members in forming the Training Team and conducting ‘Online Basic Orientation Course on Telemedicine Practice Guidelines’, training a large number of doctors (RMPs) by curating content equalling global standards, mostly working ‘pro bono’; the havoc created by Covid Pandemic; the disruption of the daily life and acceptance of the ‘New Normal’; the ‘feeling of being in doldrums’ at the realization that we may have to forego TLELEMEDICON 2020 this year; the serendipitous decision by the Immediate Past President and the undersigned to approach a State Chapter of TSI (or a group of more than one) to organise the conference on a Virtual mode; TN Chapter taking up cudgels under the capable leadership of its President and the resulting stupendous success of the TELEMEDICON 2020.

The hurried melange of activities has left an indelible impression on my mind and possibly helped to shape my thoughts for the future. I wish to take this opportunity to share my thoughts with you all. As with all such endeavours, there is a great deal of subjectivity. Many of the thoughts and ideas are offshoots of observations over the past twenty years. If we attempt most, accomplish some and others do not see the light of the day; I think we would have done our job of doing a sincere effort of getting our Society on an even keel. Getting the process started and making it a self-sustaining process is what we must ensure.

In our consolidated effort to move forward as a society, there are a few housekeeping matters which require to be streamlined. A notable few being: manpower concerns within the society; financial avenues for sustaining the capacity building programs initiated by the society; partnering with other associations, industrial bodies as a matter of public outreach exercise; review of internal milieu, organisational restructuring. In order to achieve the foregoing, I intend to realize the following:

1.Implementing agile and decisive decision making: Implementing agile and decisive decision making within the Executive Committee and beyond the closed group, to ensure no new partnering initiative or moot point is side-lined: The entire world has now woken up to the benefits of Telemedicine technology after the advent of Covid pandemic. This has resulted in all and sundry jumping onto the Telehealth bandwagon with the majority of them being hard core profit oriented business entities well entrenched in cut-throat business and “for-profit” ethos. If we at TSI, want to have a place in this eco-system, we will have to follow a process of rationality in our thought process, well-researched and well-informed decisions and most importantly agile and decisive decision making.

2.Inclusive and participative governance of TSI activities: By office bearers, and other senior members who have been spearheading the cumulative efforts of the society over the years. TSI is now almost 800 members strong, and growing day by day in strength. I feel it is far too ambitious to think that an Executive Committee of 14 members comprising of COO, Immediate Past President, President, President Elect, Vice President, Secretary, Jt.Secy& Treasurer and the seven EC members; can do justice to all the decision making required to make TSI a globally recognized think-tank and promoter for Telehealth activities, especially when we are competing with organisations like ATA, HIMMS and other similar entities in the field of digital health. Hence, to be able to fulfil our obligations we need to reach out to all our members, especially the senior members, the TSI Margdarshaks to seek their views and recommendations in a process of participative governance. A number of committees have been constituted recently to enable this, and I exhort all TSI members to take this responsibility with all seriousness and in the right spirit to help steer TSI on the path of progress of being ‘Numero Uno’ in the field. I request that more and more members seek to be involved with the various committees that have been formed for ‘governance’ of TSI matters.

3.Growth and empowerment of Regional chapters: By supporting them financially, as well as extending institutional support, as and where required, to increase outreach, and make telemedicine available to the last mile. The Regional Chapters are the functional arms of The Society. The growth and empowerment of the Regional Chapters will go a long way towards progressing the agenda of The Society. I request all TSI members to explore avenues of growth within the spheres of influence of their Chapters. I promise that as President TSI, I will extend all support for all such activities.

4.Explore reasons for lack of involvement by TSI members in TSI activities: Remove any hurdles for involvement of TSI members in TSI activities, increase participation for inclusive growth of the society and its members. See para 3 above;

5.Increase membership: Increase membership both at individual and institutional levels; “each one, get one” is a strategy which could be adopted by us all to ensure that the opportunity which has been presented this year is not lost and we attempt to gainfully utilize this ‘God given’ opportunity to maximal benefit for The Society;

6.Revision of Bylaws: Revision of Bylaws is necessitated as the present are antiquated and must be aligned with the change in the overall ethos pertaining to the field of Telehealth, growing participation of the private sector, and other industry associations as well as NGOs seeking an alignment with TSI in augmenting the vision and activities of The Society;

7.Lateral linkages: In order to grow in this rapidly progressive field of Telehealth, TSI has to strike synergistic liaisons with other NGOs and industry majors who are functioning in this field. Lateral linkages with the industry and other agencies were forthcoming in plenty, however the various MOUs could not be finalised due to internal misgivings and apprehensions of some EC members. Our intention should be to streamline the internal processes for engaging in such partnerships to the betterment of The Society and to keep the momentum going;

8.Financially sustainable activities: Financially sustainable activities for the purposes of ensuring growth and smooth functioning of the society will go a long way towards fulfilling the aims and goals of The Society.

9.Training with Certification: Training with certification will have to be promoted to ach.ieve the goal set out by the Member, NITI AAYOG and in conformity with the Telemedicine Practice Guidelines for evangelizing telemedicine and accurate adoption of the Telemedicine Practice Guidelines by the community;

10.TSI website: Website of an organisation is its face that the visitors look at for the first time while enquiring about its activities, “first impressions are lasting impressions”. TSI website must be updated continuously to reflect the activities of the society, as well as to keep the community abreast with the latest updates from around the world;

11.TSI eMagazine/Journal: TSI eMagazine/Journal has to be rolled out on a defined, periodic basis, with high quality scientific content, demonstrating the commitment of the society to the cause of telemedicine;

12.Liaison with Govt functionaries: Sustained liaison with the concerned Govt functionaries, both at Centre and State level, in furthering the regulatory and policy work in the domain and practice of telemedicine;

13.Relocation of TSI HQ: Relocation of TSI HQ to NCR to facilitate convenience in conversations with the centre;

14.Development of Telehealth Standards and benchmarking capabilities: Development of Telehealth Standards, alongside government agencies, private bodies, and other designate agencies in collaborative efforts. Also, developing bench marking capabilities for Telehealth apps and platforms, by engaging with the industry and by advising and consulting within the society, leveraging the cumulative experience of the members from different walks of professional life;

15.Restructuring TSI as a corporate body: Restructuring TSI on lines of ATA/HIMSS ( Healthcare Information and Management Systems Society), which work in close contact with the Government, private players and take pride in operating as corporate bodies.

As a way forward, I invite participation of one and all, in the smooth functioning, promotion and activities of Our Society. Stay Safe, Stay Healthy.

TELEMEDICON2020 Stats

The registration fee for delegates was a meagre token amount to get their valuable commitment to attend and enjoy the 3 days of virtual technical feast.

The registration was slow to start but gradually towards the end touched 1126

Delegates – 923
Speakers, Chairpersons and Moderators – 203
Overall – 1126

Further breakup showed that the registrations included:

TSI member Registration – 220
Doctors – 586
Students 154

We had a small participation from the industry with about a dozen sponsors who were provided with a stall in the Virtual Exhibition hall.

The scope of the conference enlarged as the dates got closer. Finally we had almost 24 hours  of conference time that were spent in three concurrent sessions on day two and three, making it almost 52 hours of deliberations on Telehealth. There were 18CME’s, Symposiums and Workshops including a Hackathon.

All the sessions have been video-recorded and we hope to make it available to all the members. 

Claim Credit Hours for Attendance to TELEMEDICON 2020

The doctors who attended and submitted their medical registration numbers of council would be able to claim four credit hours from the Maharashtra Medical Council. Though the time was short but this  was made possible due to the efforts of Dr. B.S. Ratta, Co-Chairman  of the meeting. This made  TELEMEDICON 2020 truly an academic meet.

TELEMEDICON2020 – A Summary of the Event

 

 

 

 

 

 

Bagmisikha Puhan
Executive Member, TSI

TELEMEDICON2020 was a new  experience in this new normal. To encapsulate 52 hours of deliberations of the virtual meet would be impossible. However we would like to highlight few key takeaways from the event as this difficult year 2020 comes to close.

1.With the introduction of the legal framework, the trust in the ecosystem has been supplemented,and has fostered faith in the practitioners, patients, and the other valuable stakeholders in the ecosystem, in terms of care delivery.

2.In terms of rural health vis a vis telemedicine, reaching the last mile would require greater public-private participation; it is felt that increased interactions between the practitioner and the patients will increase the faith restored by the patients in the infrastructure. The government’s plans are laudable through its various projects to reach the last mile to deliver health to the masses using telehealth, however there are likely to be huge implementation challenges.

3.There is apprehension in the minds of the practitioners, in terms of the incumbency to comply with data privacy and protection laws.

4.Integration of the patient’s health / medical records in a centralized system would enable the practitioners to access documents from secure servers without having to concern themselves with storing the same onto their local servers and exposing themselves to additional risk.Furthermore, lack of clarity in respect of the retention timelines may lead to potential lapses on part of the data fiduciary / custodian with respect to data storage principles.

5.Training and capacity building exercises will have to be amplified, to bring the practitioners up to speed with the advanced technology, as well as the regulatory norms which they must adhere to in terms of delivery healthcare via means of information and communications technology (ICT).

6. In the face of the ongoing pandemic of Covid-19, the practicing physicians (from across several clinical specialties) have had to attend to a diverse spectrum of ailments via telemedicine consults; in doing so, they feel, the lists of medicines which are referred to within the TPG are limited and restrict the physician from managing the patient effectively / desirably. While the potential for abuse of medication/ drugs is relevant, the restrictions on drugs which can be prescribed over a telemedicine consult, undermines the very purpose of digital health, which is to widen the outreach, and serve the underserved.

7.There were deliberations with respect to the benefits of telemedicine, in reaching out to the vulnerable population in augmenting the mental health care infrastructure. The mental health practitioners have realized the benefits of telemedicine, which allows women, elderly, and home-bound citizenry to reach out to them for consultations. TPG has given the necessary fillip to the home-bound citizenry to access mental health professionals, without having to worry about their privacy, or their prowess to access such services, as and when necessary.

8.Deliberations were also made with respect to the minor/ children/ adolescent population, who are benefiting from access to mental health practitioners from across the vast geographical spectrum, without exposing themselves to the undue / unwarranted / unsupported physical visit to the practitioner/s.

9.The specialists have also witnessed a boost to their consultancy services and have been able to engage with the treating physicians, who may be situated in a poorly accessible demographic landscape (Tier-3 cities, remote areas).

 10.Several practitioners have also brought to the fore, the challenge in spending a longer time in ‘raw data-entry’, especially the ones who are not conversant with the technology at hand. This leads to delay and extends the average discussion/ consultation time with the patient, adding to the already disparate physician-to-patient ratio in the country.

.11.A solution-oriented approach, leading to introduction of homogenous/ interoperable systems would be preferred.

12.Greater involvement of ancillary workers in supporting the physicians, patients, and other stakeholders in the ecosystem, is the need of the hour.

13.Practo in collaboration with TSI released a position paper, emphasizing on the gaps in the system and the overbearing positive implications of the new regulations. The paper highlights the associated statistics and the key levers in the ecosystem.

To surmise, during the conference, while the above factors were discussed, the participating delegates and faculty have expressed their gratitude to the government in enabling the ecosystem to flourish by way of the introduction and successful implementation of TPG.

The participation from dignitaries situated outside the country, brought to the fore, that as a society we have along way to go in terms of imbibing the practice of telemedicine in our daily lives. There is a pressing need to build the confidence in the patients to favor the practice and adoption of telemedicine, which is critical tosupport the lifestyle medicine practice, moving us from illness to wellness. Also, with the necessary capacity building and structured trainings, the practitioners will be able to become better aware of the telemedicine related laws and be more confident in their use of ICT in healthcare. A study presented by a French practitioner, showed that the numbers featuring the willingness to imbibe telemedicine practice have only risen since the country first introduced the legal framework over a decade ago. For India, while the geography and the demography pose challenges, there is also an invaluable opportunity presented by the onset of the pandemic, which is changing the perspective of the larger population, and reassuring faith in ICT for delivery of services.

This document only lends a very brief, high-level insight to the lengthy and engaging discussions during the conference; however, it brings to the fore the pressing needs, and the positive feedback since the release of TPG, and the continued practice of telemedicine through decades. We expect the healthcare fraternity to adopt ICT and augment their practices, as well as the patients to feel safer in interacting with their physicianstranscending physical barriers.

TELEMEDICON2020 – Free Papers and their Winners  

There were 34 free papers submitted of which 27 were presented.  There were thirteen podium and fourteenposters presentations.

Six Podium papers were selected as winners for best papers and will be issued certificates and cash award

These were as follows:

PODIUM WINNERS

1.Dr Sarang Patil, MUHS Nashik
Tele-pulmonology a ray of hope in elderly COPD patients

2.Moaz Hamid, Western Sussex Hospital, UK
Mobile Health Apps: Using the Five-Factor Model of Personality as a predictor of the preference for gamified features and their usage characteristics

3.Govinda Narke, Free Asthma Clinic Hadpsar Pune
Use of telemedicine for asthma control and follow up consultation during COVID pandemic

4.Akhila Kosuru, Deputy General Manager, Apollo Tele Health Services, Hyderabad
Perception of doctor for prescribing drugs in teleconsultation

5.Ms Jinchu Paul, NIMHANS, Bangalore
Effectiveness of the addition of virtual NIMHANS ECHO tele-mentoring model for skilled capacity building in providing quality care in alcohol use disorders in DMHP districts

6.Dr Avinash T,, Kidwai Memorial Institute of Oncology, Bangalore
Roadmap to paediatric oncology palliative care services through Telemedicine.POSTER PRESENTATION WINNERS

First

Aditi Kini, HCG Hospital
Feasibility of Tele-rehabilitation of swallow and communication & Functions–

Second

Zeenat Fatima, AIIMS, Bhopal
Feasibility and acceptability of Teleconsultation through  video mode for diabetes at a tertiary care centre in India

Third 

Vijayalakshmi Poreddi, NIMHANS Bengaluru
-Nursing Interns perceptions of Telenursing Implications

 

TELEMEDICON2020 Feedback

 

TELEMEDICON2020 – ‘Picture that Said It All’

TELEMEDCION2020 was attended by at least four speakers who were suffering from active COVID19 infections.  COVID infection did not deter them from participating in this virtual meet. In fact Mr. Harish Manian, CEO of MGM Healthcare, Chennai spoke from his hospital bed about the Hospital Perspective for Tele-health Insurance.

Mr. Harish Manian, CEO of MGM Healthcare, Chennai spoke from his Hospital Bed

The next issue in Jan 2021 would carry the Part- 2 of TELEMEDICON2020  and cover the highlights of the various sessions


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.

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
Design – Sankara Nethralaya
Technical Partner- www.medindia.net

 

e-Newsletter Nov 2020

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

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.

TELEMEDICON 2020
www.telemedicon2020.com

This will be the 16th International conference of the Telemedicine Society of India. The meeting will be in a virtual web mode in keeping with the current new normal.

The TN chapter along with four other state chapters (Delhi-NCR, Rajasthan, Maharashtra and Karnataka) have taken up the responsibility to conduct TELEMEDICON 2020 from 18th to 20th Dec 2020.

Telehealth in India has grown exponentially in a very short time after the notification of the Telemedicine Practice Guidelines by the Govt. of India. In keeping with the above the theme of the conference has been aptly adopted as ‘Telehealth – From the Fringes to the Mainstream’

The conference will have 2.5 hours of morning and another 2.5 hours of evening deliberations with 4 hours of virtual exhibition and sponsored webinars in the afternoon from our potential sponsors.

Medicall – an established medical exhibition company for the last 20 years has agreed to take up the responsibility for handling our virtual exhibition.

The registration amount for the three days web-conference is very nominal.

TELEMEDICON 2020 will connect healthcare professionals, policy makers, industrialists, health insurance providers, online pharmacy chains, nurses, students, and various stakeholders from the field of Telemedicine and Health Informatics, over one common platform and bring to the fore the pain points, as well as the possible solutions, that could resolve existing issues.

Association with entities

Telemedicine Society of India invites you to participate at various levels –

  • Industry sponsor of the conference with its various benefits to showcase the brand and products.
  • Knowledge partner, whereby, an organisation can add value in terms of policy development and organise webinars keeping the above program in mind with mutual agreement.
  • Affiliate partner, whereby, the partnership adds value in terms of providing services such as hosting of the conference on a platform, hosting the website, creating design, sending mailers, helping with sponsorship or any other way to help the conference. TSI will share the logo and acknowledge such partnerships.

Planned Themes

1. Transforming Telehealth Training for Registered Medical Practitioners in India

a. Format of Training
b. Current Experience with Training
c. Virtual and augmented reality
d. The way forward

2. Legal & Ethical Aspects – The Grey Areas

a. TPG – what needs to be changed?
b. Data Protection Act and Health
c. Good Practices – learnings from abroad

3. Challenges in Health Data Integration – National and State

4. 5G and Telehealth – the Larger Impact

5. AI, Block chain and Telehealth

6. Wearables and impact on Tele-health

7. Remote Monitoring – How to cut costs and Improving Patient care

8. History of Telemedicine

a. India
b. International

9. Standards

10. Health Apps in India

11. COVID-19 and impetus to Telehealth

12. Wellness & Telehealth

13. STEMI project in Cardiology

14. ECHO global project

15. Health Insurance and Telehealth

16. Online pharmacies – Getting it Right for Telehealth in India

17. How can Rural Health care be Transformed Using Telemedicine?

18. Planned Workshops & Parallel Tracks

a. How to set up a Telehealth consultation Platform – DIY
b. Taking care of Security issues in Telehealth
c. Setting up Payment Gateway
d. Standards – software and Hardware
e. Teleopthalmology – Joint meeting with WHO group & ITU
f. International Telehealth Societies – working together and sharing of good practice documents
g. Tele- health Initiatives by central & State Govt in India – Examples of Excellence

Dr. Sunil Shroff
Organizing Secretary
President, TN – Telemedicine Society of India


Telemedicine pRoject for screENing Diabetes and its complications in rural Tamil Nadu (TREND) project

Dr. V. MOHAN, MD,FRCP, Ph.D, D.Sc, FNA,FACE, FTWAS, MACP, FRCE
Chairman, Dr. Mohan’s Diabetes Specialities Centre and
President, Madras Diabetes Research Foundation, Chennai.

Awareness, diagnosis, regular checkups and other ways of preventing as well as treating NCDs especially diabetes, are very low among the rural sector. Hence, to study the status of diabetes and associated complications in rural Tamil Nadu, the Madras Diabetes Research Foundation (MDRF), Chennai and the University of Dundee, UK have taken up a joint research collaboration to screen 15,000 people in 25 shortlisted villages in Kancheepuram and Chengalpet districts of Tamil Nadu. The program called as the TREND (Telemedicine pRoject for screENing Diabetes and its complications in rural Tamil Nadu) project focuses on finding the burden due to diabetes and its complications in rural Tamil Nadu and providing novel solutions for its management. This project is funded by the National Institute for Health Research (NIHR) of the Department of Health, UK to take up the INdia-Scotland PartnershIp for pRecision mEdicine in Diabetes (INSPIRED) project. The TREND project is part of the overall INSPIRED program. Through the TREND project, we aim to address the challenges with innovative use of technology that will enable even remote areas gain access to quality medical diagnosis and care.

Early and timely screening for diabetes and pre-diabetes, prevalence of hypertension and obesity, screening diabetic complications in eye using retinal images, foot and kidney as well as assessing diabetes control among individuals etc. are being carried out through this project. We are utilizing telemedicine technology in the chosen villages to screen for diabetes related complications. A fully equipped mobile telemedicine van fitted with all equipment necessary for screening for diabetes and its complications has been set up. The infrastructure in the telemedicine van includes an inexpensive mydriatic Remidio “fundus on Phone” apparatus, computerized electrocardiography (ECG), Doppler and biothesiometry. The telemedicine van also includes facilities for blood sampling. So far, nearly 10,000 individuals aged =18 years have been screened for diabetes and other metabolic NCDs.


Tele Counselling Solutions From Sankara Nethralaya
S. Chandra Mouli
Chief Information & Technology Officer,
Sankara Nethralaya, Chennai.

 

INDIAN TELE HEALTH MARKET TRENDS : MARCH – JUL 2020

  • 50 MILLION INDIANS ACCESSED HEALTHCARE ONLINE
  • 700% GROWTH IN TELE OPHTHALMOLOGY
  • 80% EXPERIENCED IT FIRST TIME
  • 44% WERE FROM NON-METRO CITIES
  • 67% DROP IN PERSON DOCTOR VISITS

The pandemic outbreak was a perfect storm warranting fast tracking innovation in health tech.and its adoption at a rapid pace never thought of before with the providers and its participants.

Sankara Nethralaya being a pioneer in the country in adoption of Technology through its adoption of specialty EMR and Hospital Management systems fast tracked its adoption of its Innovative Tele counselling solutions to its Patients as its COVID response. Social distancing, concerns on Hygiene warranted disruption to the OPD at large and forced Medical fraternity to adopt newer ways to engage with Patients and also provide services on demand.

In view of the early lock down SN realized that it needs to reach out to all its patients who were operated upon and provide counselling. We realized the need for an autonomous, smart and self aware system that

  • Need to manage appointments for the patients with their respective doctors with whom they consulted
  • Provide the doctors with relevant clinical information for decision making
  • Capture Action plan and update the EMR
  • Provides a frictionless compute & highly automated with the least manual intervention in view of remote working and servicing.

Solution & approaches

Key objectives – Provide patient delight and actionable insight to Consultants through smart solutions.

Key design principles

  • Zero UI concept – Familiar Email interface, smart texts leveraging SMS, proven APPS for patient engagement, Web based solutions and Voice based services
  • Simplicity in design
  • Focus on superior user experience

Development approaches

  • Agile / Extreme programing
  • Remote working & usage of collaborative tools & technologies
  • Working code as a measure of progress
  • Incremental build – over 90+ enhancements and feedback were factored as changes
  • Continuous release of working code
  • Integration with proven cloud solutions for reuse
  • EMR integration & leveraging existing applications
  • Secure coding practices IT Infra, Cyber security & Cloud
  • Leveraging existing highly resilient data center
  • Multi cloud and best in class on demand services like voice telephony, messaging and email
  • Disaster recovery on private cloud
  • Secure infrastructure and continuous monitoring for performance
  • Monitoring for any cyber attacks and ensuring high availability
  • Leveraging IT Help desk for proactive support

Technology used

  • Microsoft based Techstack
  • MS SQL2016
  • .net 4.5 framework
  • Cloud telephony & voice basedservices
  • MESSAGINGServices
  • Emailintegration
  • Secure hostedsolutions
  • API based integration into coreservices
  • Analytics

Outcome

Over 10,000 SN patients were provided tele counselling services leveraging the platform since April 2020.
98%ofthepatientswereextremelysatisfiedandprovidedravingfeedbackonthequalityofservices. Dissatisfied patients or negative or feedback were followed up and continuous enhancement to servicesmade.

Lessonslearnt

Keep communicating Every resource isimportant
Distribute work and manage stress & also risk
Progress is important. Working code is the best test of success. Manage surprises & have a plan B for every contingency Leverage proven tools
Incremental innovation – no big bang approaches.
Continuous feedback and go the extra mile to provide patient and user delight Train and educate users and reduce adoption risks.


Transmission of ECG over Telephone Lines – 1905
(History and Evolution of Telemedicine – 3rd 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).

On March 22nd 1905 Willem Einthoven, a Dutch professor of physiology recoded the first tele-cardiogram. He utilized a telephone cable to transmit the signal from the hospital to his laboratory 1.5 km to record the ECG. He was the first to introduce the Latin term ‘tele’ as a prefix to indicate remote delivery of medical service. The term he used for this was “telecardiogramme.” The original ECG Machine weighed 270 kilograms required five people to operate and the patient had to immerse their legs and hand in saline water. It also required cooling for the powerful electromagnets.

Einthoven graduated in medicine from the University of Utrecht and served as professor of physiology at the University of Leiden from 1886 until his death. It was in 1903 he first invented a galvanometer that was used to measure the changes of electrical potential caused by contractions of the heart muscle and to record them graphically and he coined the term electrocardiogram for this process. Apparently his hospital did not allow him to use the ECG machine in its premises and he hence transmitted the ECG over the telephone line and recorded it in his lab. He received Nobel Prize for this important invention of ECG in 1924.

In current age of so many technical advances with so many tools to evaluate and treat the heart we can still refer to Einthoven’s remarks in 1920s when he said – “An instrument takes its true value not so much from the work it might possibly do but from the work it really does” and “Truth is all that matters, what you or I may think is inconsequential.”

Ref –
1. https://en.wikipedia.org/wiki/Willem_Einthoven
2. https://journals.viamedica.pl/cardiology_journal/article/view/21712/17316

(Next Issue – Radio & Marine Telemedicine)


Telemedicine – News from India & Abroad

India

Artificial Intelligence Smartphone Tool Could Diagnose Strokes Within Minutes
Novel tool can diagnose stroke with the accuracy of an emergency room clinician from interaction with a smartphone, reports a new study. The tool can diagnose a stroke based on abnormalities in a patient’s speech ability and facial muscular movements within minutes from an interaction with a smartphone….. Read More


Novel Wearable Sensor Help ALS Patients Communicate
New wearable sensor was developed by MIT researchers to help those living with amyotrophic lateral sclerosis (ALS) communicate. The findings of the study are published in the journal Nature Biomedical Engineering. ….. Read More


Virtual Reality Helps Patients Address Eating Disorders
Virtual Reality (VR) technology can significantly impact the validity of remote health appointments for those with eating disorders. Through a process known as Virtual Reality Exposure Therapy (VRET) ….. Read More


Novel Chili-shaped Device may Reveal Just How Hot That Pepper is
Novel chili pepper-shaped device containing a paper-based electrochemical sensor can be connected to a smartphone to know how much capsaicin is in hot pepper, reports a new study. The findings of the study are published in the journal ACS Applied Nano Materials.….. Read More


International

Abboud Chaballout Is Using AI to Revolutionize the Healthcare System
Abboud is an entrepreneur and thought leader in the field of health and medicine. He earned his law degree from the University of California Berkeley School of Law, one of the most prestigious institutions and one of the top ten universities for law studies….. Read More


United Airlines Rolls Out Digital Health Passport
(CBS DETROIT) – United Airlines is testing out digital health passports. The digital health dossier houses Covid-19 tests results for passengers. Travelers can take coronavirus tests up to 72 hours pre-flight and then input their results on what’s called the common-pass app.. Read More


India & EU explore possibilities of enhanced cooperation
In a statement, the MEA said that leaders explored the possibilities which can help to strengthen India-EU strategic partnership in the post-COVID-19 world. In the meeting, decisions which were taken at the 15th India-EU Summit held in July 2020 were also reviewed….. Read More


Scientists Develop First Smartphone App That can Detect Ear Infections in Children
University of Washington researchers have created a new smartphone app that can detect ear infections in children. The app detects fluid behind the eardrum by simply using a piece of paper and a smartphone’s microphone and speaker..….. 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.

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
Design – Sankara Nethralaya
Technical Partner- www.medindia.net

 

e-Newsletter Oct 2020

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

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.

 

Vision Centres

 

Dr. Kim Ramasamy
Aravind Eye Hospitals, Madurai

With over a billion people living with blindness or visual impairment due to preventable or treatable conditions, universal coverage for eye care is still a largely unmet need. This is especially because those who need care are in remote and rural locations where service delivery is a challenge.

Primary eye care remains a challenge especially because it has been difficult to provide comprehensive care for all the conditions encountered at the primary level. However, with the arrival of broadband internet, this has become a possibility. Vision Centres or primary eye care centres now provide comprehensive and complete eye care to the rural population.

Most notably, Aravind Eye Hospitals and LV Prasad Eye Institute in India have a large network of rural vision centres. This model is now being rapidly replicated by national and state governments.

Comprehensive care: Patients who visit the vision centre receive a comprehensive eye examination by an allied ophthalmic personnel or vision technician. The technician captures the findings in a cloud-basedelectronic medical record – including any images of the eye. These records are accessed by an ophthalmologist at a secondary or tertiary eye care facility. The patient is able to have a teleconsultation immediately with the ophthalmologist, who gives the final treatment advice and prescription. The technician prints out the prescription and gives it to the patient along with counselling about the treatment.

Complete care:It is important that patients are able to act upon the doctors advice. So as to complete the loop,it is important that affordable spectacles and ocular drugs are made available at the vision centres itself for the patients. If the patient needs to be referred for higher levels of care, clear instructions and counselling needs to be given to ensure that patients act upon the referral.

Coverage:Each vision centre serves a rural population of 70,000-100,000. An estimated 30% of this population would need some form of eye care. Evidence shows that over four years 82% of those in need have been seen at the vision centres! This coverage is not only true at the level of gross patient numbers – but also for individual eye conditions too.

Vision centres, being closer to the community have a unique advantage to ensure treatment of chronic conditions are truly effective. Given that they are local to the patient, they are more accessible for regular follow up visits and can ensure patients stay on-track for their treatment. Aravind Eye Hospitals have ensured that patients with chronic conditions can procure medication and a patient registry helps to longitudinally monitor these patients over time.

The model has been successfully replicated and scaled up by other governments and NGOs in different parts of the Indian Subcontinent:

  • Aravind assisted the state government of Tripura to set up 40 vision centres across the hilly state of Tripura where access to health care is a major issue.
  • Aravind is also working with other state governments in India to replicate this model: so far, 10 centres have been set up in Chhattisgarh and 32 in Tamil Nadu, as pilot initiatives.
  • Aravind has helped the Government of Bangladesh set up 50 vision centres, with another 40 in the immediate pipeline. The commitment is to set up a total of 400 vision centres across the country.

A senior ophthalmologist at the State Blindness Control Society of Tripura observes how the tertiary government hospital at the capital city used to receive several patients with minor eye ailments. This not only meant that critical resources of the hospital were being used for minor treatment but also meant a great financial burden on the patients who travelled so far. But now, a much larger number of such patients are seen locally at the vision centres and only those with more complex eye conditions show up at the tertiary facility.

What does it take to set up a successful vision centre network?

  • Patient centric workflows
  • Comprehensive eye examination
  • One-stop services (eyeglasses, ocular drugs etc. should be made available)
  • Staff trained to provide high quality, patient centric care
  • Telemedicine consultation
  • Affiliation with a referral hospital
  • Strong monitoring system to ensure quality of care (patient feedback surveys)
  • Staff engagement, motivation and continuous education

Tele-ICU: Distance is not a real barrier for Critical Care

 

Dr. N. Ramakrishnan AB (Int Med), AB (Crit Care), AB (Sleep Med), AB (Obesity Med), MMM, FACP, FCCP, FCCM, FAASM, FISDA, FICCM
Founder & Managing Director, Chennai Critical Care Consultants & TACT Academy for Clinical Training Director, Nithra Institute of Sleep Sciences

 

 

 

What is TeleICU?

  • Tele-ICU or Tele-Critical Care is a customized solution for hospitals using technology to bridge experienced Critical Care Specialists (Intensivists) and nurses to monitor and support care for patients in the Intensive Care Unit (ICU). The Intensivists and nurses operate from a centralized monitoring center

What are the various models of care?

  • Remote monitoring is referred as ‘continuous’ when care is provided proactively round the clock usually from a centralized monitoring center (often referred to as ‘Command Center”).
  • Alternatively, ‘episodic’ care could be provided reactively ‘on-demand’ when the ICUs requiring support could request services as needed. With increasing use of smartphones and tablets, this model has been facilitated by specialized Tele-ICU applications (apps).
  • Tele-ICU rounds have been helpful in assisting ICUs. In this model the Intensivists remotely connects with the Doctor at the user end and is available to facilitate and discuss about patients and assist with care plans. Focused rounds for Nutrition support, implementing antibiotic stewardship are also an option with this model

 What are the advantages?

  • It is currently not feasible to staff every ICU with qualified Intensivists as they are far and few and mostly concentrated in tertiary care centers in larger cities. Tele-Critical care helps to reach specialized services anywhere, anytime.
  • Remote monitoring services have consistently shown to improve implementation of evidence based best practices
  • Monitoring by specialists has shown to improve outcome such as reduction of length of stay, implementing care bundles and reducing infections and also reducing mortality rate.
  • Hospitals have noticed that there is an increased retention of patients who would have otherwise been transferred out.

ICU care is complex – How can it be provided remotely?

  • Critical care involves several interventions by a multidisciplinary team. Most of these are ‘cognitive’ while some involve bedside procedures.
  • It is important to understand that the remote ICU model complements and does not replace the bedside team. The input from the bedside team is crucial for the remote Intensivist to provide input.
  • Specialist team of Intensivists, Physician assistants, Respiratory Therapists, Critical Care Nurses, Clinical Nutritionist & Pharmacist can remotely offer several cognitive inputs that could greatly benefit patient care. They need to closely interact with the bedside team to implement these decisions and also for any procedures that may be required.

Are TeleICU services available in India?

Chennai has been a leader in healthcare in our country and has several firsts to its credit. The first TeleICU anywhere outside the USA was a collaborative effort by Chennai Critical Care Services. We partnered with Advanced ICU Care, USA and started providing Tele-ICU for hospitals in America from 2010.

  • The fact that the first successful remote monitoring services in India were for ICUs in USA clearly confirms that distance is not the real barrier. We continue to provide these services successfully for over 10 years now.
  • Proactive continuous monitoring services in India were provided by us (InTeleICU™) and providers including Critinext. With the new telehealth policy of Ministry of Health, there is a scope for modified services particularly in a reactive episodic model to extend the outreach of specialized services.
  • We refer the readers to our recent article calling for an urgent action on Tele-ICU services published in Indian Journal of Critical Care Medicine cited below:

Ramakrishnan N, Vijayaraghavan BKT, Venkataraman R. Breaking Barriers to Reach Farther: A Call for Urgent Action on Tele-ICU Services. Indian J Crit Care Med 2020;24(6): 393–397.


Blockchain Use and Opportunity in Healthcare

 

Tory Cenaj, Founder, Partners in Digital Health, Publisher, BHTY

According to a 2018 a SERMO survey, physicians across all specialties lack awareness for  blockchain technology impacting healthcare providers and payers at institutions and clinical settings around the US.

  • 47% of physicians polled have not heard of blockchain
  • 25% indicated blockchain is ready to enter healthcare
  • 28% reported blockchain was not ready to enter healthcare

In 2020, an American Medical Association (AMA) Survey reported:

  • Physicians weighed in on emerging technologies such as blockchain and augmented intelligence (AI), which is often called artificial intelligence. While 46% of physicians are familiar with the blockchain technology, 0% are using it.

Before we explore the potential applications for blockchain, let’s first provide a top line definition for it. Blockchain is a shared distributed digital ledger technology (network platform), that securely facilitates interoperable data management and provides any original source of ownership, that can potentially transform healthcare. The technology is currently utilized in pilots and scaled ecosystems in healthcare around the wordto optimize business processes, lower costs, improve patient outcomes and enable better use of data interoperability.

Unlike traditional centralized databases, data on a blockchain can be distributed across multiple databases and computers (also known as ‘nodes’) so that everyone has the same version(or “ledger) of a process or transaction. ‘Blocks’ of data are linked together by a hash (a digital signature of random letters and numbers) that form a ‘chain’ of data containing a complete history of the performed transaction that cannot be changed – only added to, so it is considered “tamper resistant.” Data is secured through cryptography (advanced encryption) for participants can trust the ‘blocks’ of data posted are authenticated and verifiable. These features result in decentralized data systems that are not controlled by a central authority that are usually vulnerable to breaches or points for failure. Blocks represent a single source of information all participants agree to as true, resulting in higher levels of trust by participants.

Applications and Studies

Blockchains offer the option to be permissioned/private or consortium networks, not open to the public but used by a group of participants to limit the participation and access to shared data, or they can be public blockchains.

The technology as an appropriate network sharing platform electronic health records to reduce errors and increase interoperability while preserving data privacy. It also enables analysis and payments for claims or contracts between provider, health system(s) and patients. Most physicians aren’t aware of the efficient, error free utilization the technology provides – particularly since the onset of the Covid-19 pandemic has highlighted deficiencies in the marketplace.  To learn more, view articles below:

Blockchain technology can significantly reduce the cost and speed of clinical trials. This includes a shared data ledger, security of data,  patient recruitment and retention, interoperability between all devices used, efficient and validated clinical and patient data management and analysis, increased data integrity, and payment portals – all while reducing human error and increasing security. See the article below for more details.

Pharmaceutical supplies also include multidisciplinary stakeholders including manufacturers, wholesalers, packagers, logistics, regulators, hospitals, pharmacies and patients across countries creating a global ecosystem.Consider drug fraud, mismanagement, quality and safety. Blockchain resolves many supply chain challenges and provides cost efficiencies and faster turnaround. Tracking and tracing becomes seamless in a modernized system. Consider the publications below describing methodologies and pilots in more detail. We already find blockchain utilized in other industries.

Many breakthrough articles have been published in Blockchain in Healthcare Today (BHTY), the world’s first open access peer reviewed journal that amplifies and disseminates distributed ledger technology research and innovations in the healthcare sector. We encourage authors to submit manuscripts and join the ecosystem. The journal is published on a continuous basis with a world-class peer-review board and registers original research article provenance on the blockchain. The journal is indexed in Science OpenUnpaywall, Google Scholar and the PKP Indexes.

The journal hosts the annual ConVerg2Xelerate (ConV2X) conference. Registration is open for the November 10 and 11 symposium with the theme “US -World Health Transformation.” Attendance is free. For more information click here. 

 


India leads the world in Telehealth Cross-Sector Partnerships

 

Dr. William B. Eimicke is Professor of Practice and Director of the Picker Center for Executive Education at the School of International and Public Affairs at Columbia University. He retired from the FDNY as Deputy Commissioner for Strategic Planning and Performance Management and served as New York State Housing “czar” under Governor Mario M. Cuomo.  He is also the co-author of Management Fundamentals (2020) and Social Value Investing (2018), both published by Columbia University Press

 Adam Stepan  is the Director of the Picker Center Digital Education Group, and Adjunct Professor at the Picker Center. Adam oversees creation of online class materials and audiovisual case studies for the global EMPA program and works with SIPA faculty on the research and creation of audiovisual case studies.

In 2014, my colleague Adam Stepan and I began a project to develop original video and written case studies for a new hybrid MPA at the School of International and Public Affairs (SIPA) at Columbia University. We focused on innovations in providing essential public services such as police, fire, education, sustainable agriculture and health care. After considerable research, our innovation in health care focused on telemedicine and electronic record-sharing identified India as being at the cutting edge of that innovation.

Our team then made several trips to India to meet with Dr. K. Ganapathy, film what was going on at Apollo Hospitals, look at the history of telemedicine and its future and then make what is now a widely used case film and written case study ( https://vimeo.com/200378894 ), comparing India to less advanced efforts in the United States and Brazil. The case study was presented and discussed at a major conference here at SIPA, appropriately simulcast to other experts across the global.

As we continued our research, we observed a series of emerging public-private partnershipsin India. By 2018, another colleague, Howard W. Buffett and I published what is now a very well-known book—Social Value Investing (https://www.sipa.columbia.edu/svi) which features an array of cross-sector partnerships called Digital India that developed from the earlier foundation by a  wide array of public and community partners.This this spring and summer, telemedicine emerged as one of the most effective tools in fighting the COVID-19 virus in the United States and now in India and other countries across the world.

For example, in New York City telehealth insurance claims have accounted for approximately 13% of patient activity compared to 0.15% only a year earlier, according to one monitoring organization. Another survey in April found 50% of responding patients said they were using telemedicine, many for the first time. Among doctors, 85% reported using telemedicine, compared to 25% at the end of 2019. A major heath care service provider, New York-Presbyterian reported that its telemedicine service use during the pandemic reached 70,000 cases per month and is continuing to rise steadily.

In India, Modi government sees Common Service Centres  as a cornerstone of Digital India, as they provide access points to every corner of India to the increasing number of services and assistance the government hopes will create a much more inclusive society that will improve the quality of life for India’s very large population of poor families and individuals. Many organizations seethe program as an opportunity to do good while simultaneously attracting new customers and perfecting a new way of delivering medical services.

While the potential is great, this initiative is complex and expensive with a relatively high risk of failure. Indian telemedicine continues to face ongoing technical challenges: unreliable electrical supply, inadequate Internet bandwidth, video distortions, and software malfunctions. Even so telemedicine examinations provide reliable diagnoses for 80 percent of patients. Telemedicine examinations are generally videotaped (with permission of the patient), providing the physician with an opportunity to review, or “see” the patient again several times, to make sure the initial diagnosis was correct and that no important information was missed.

In the United States, major providers face challenges as well such as getting thousands of physicians, behavioral health specialists and office staff onto a telehealth platform and training them on how to use it. Also, many low-income patients had insufficient data plans and/or limited internet-connected devices. In some cases, this requires a regular phone call rather than a video chat. From a reimbursement perspective, health care providers are working to figure out how to incentivize the use of telehealth services while still covering their operating costs overall.

These partnerships of public and private organizations are providing potentially world-class health care for patients in urban and rural areas and even serving those with little or no income. Telehealth creates the opportunity to attract new patients, more easily offering virtual second opinions, more effectively treating addictions, improving management of chronic conditions and enhancing the lifestyle choices for doctors. In this COVID-19 pandemic, the telemedicine model developed in India helped hospitals in the United States and many other countries manage the burden on hospital emergency rooms, diagnosis and provide medicine to vulnerable patients unable or unwilling to leave their homes and ultimately help control the spread of the virus. Through the effort and expertise and hard, sustained work by several groups starting two decades ago,thousands of dedicated doctors, nurses and health care workers in India and the Indian government and its civil servants are now leading the way to a more affordable and accessible health care system for all. 


Telephone call for Tele-Consultation
(History and Evolution of Telemedicine – 2nd 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)

 

 

 

For doctors ‘Tele-consultations’ is nothing new. It started soon after the telephone was invented by Alexander Bell in 1876.Little do people know that the first call that Mr. Bell made was for medical help or for an emergency of sorts. Mr. Bell  called his assistant Thomas Watson and said:

“Mr. Watson, come here, I want you.”

What had happened was that the sulphuric acid from the wet battery which was powering the telephone transmitter had spilled on clothes of Bell. And after the very first conversation on the telephone for medical help, Watson quickly appeared to administer the first aid.This first call on the telephone for medical help from Mr.Bell, was almost prophetic and 140 later, the mobile phones are now being considered to be the preferred device that will help provide universal and affordable healthcare to the people of the world.

Just two years after the invention of the telephone two letters to the editor appeared in the famous medical  journalLancet on 9 February1878, The first, from “A.B.M.” of Hornsey suggesting that the telephone could improve medical diagnosis and that it might be specially useful in “demonstrating and studying the sound produced by a muscleduring contact, the negative contraction, etc.” This way of listening-auscultation in medical terminology-could be done, according to A.B.M., by applying the electrodes (presumably of the telephone transmitter) directly to the muscle.

And on Nov’1879 another piece in Lancet spoke of Practice by telephone and its use that could bring down the visits to doctors clinics in the future.The commonest consultation on the telephone over the years perhaps has been – ‘Doctor I have a headache, what can I do.’

Next issue: Read about Willem Einthoven and how ECG was transmitted over telephone lines.


 

Telemedicine – News from India & Abroad

India

Apple Watch Saves Man’s Life

In India, the electrocardiogram (ECG) feature on Apple Watch has saved the life of a 61-year-old Indore resident. Apple CEO Tim Cook wished him fast recovery post-surgery.R. Rajhans, a retired pharma professional who uses an Apple Watch Series 5 …Read More


Younger and female doctors adopted telemedicine more during Covid in India, study says

More of the younger and female doctors adopted telemedicine or online consultations as a practice in India compared to male and older doctors in the June-July period this year, reveals a new study.A joint study by India-based healthcare research organisation Strategic Marketing Solutions & Research Centre (SMSRC) l…… Read More


India’s Telemedicine Service Completes 5 Lakh Consultations

eSanjeevani, India’s new telemedicine platform, has recorded five lakh teleconsultations. The last one lakh consultations were completed in a record time of 17 days.As a digital modality of healthcare services delivery ….. Read More


Telehealth Trains Parents to Improve Behavior Skills of Autism Kids

during the coronavirus pandemic or in other instances when in-person instruction is not possible, according to a Rutgers researcher.The study, which was published in The Journal of Applied Behavioral Analysis, broadens the treatment options for parents of children with autism who lack access to in-person training as they do now …. Read More


Demand for Telemedicine to Rise Post Covid-19: Survey

A survey on growth in telemedicine consultation in India since Covid shows that digital adoption of medicinal services grew three times during this period. According to the survey, conducted by DrOnA Health in collaboration with Mankind Pharma, 60% of respondents reported high satisfaction with telemedicine consultation…. Read More


DIVOC Health Set To Launch 20 New Telemedicine Laboratories In India By 2021.

India, October 2020: With a mission to create the most advanced digital diagnostic laboratory network enabling the connected world and to provide telemedicine and instant care, DIVOC Health launched its first, one-of-a-kind, technologically advanced DIVOC Laboratories in New Delhi in August 2020… Read More


International

New Tool Allows Easy, Effective Disease Tracking

New study used the novel IDseq tool to confirm and sequence the whole genome of the country’s first case of COVID-19. The findings of the study are published in the journal GigaScience.This tool can distinguish pathogens before there is an available complete genome sequence…Read More


Telehealth Services: A Post COVID-19 Reality?
The regular use of telehealth services for cancer patients was found to have long-lasting and unforeseen effects on the provision and quality of care, said an article published in JAMA Oncology, Trevor Royce, MD, MS, MPH, an assistant professor of radiation oncology at the University of North Carolina Lineberger Comprehensive Cancer Center and UNC School of Medicine. Read More


Morneau Shepell launches unified telemedicine solution to enhance Canadians’ total wellbeing

Morneau Shepell, Canada’s largest provider of wellbeing and mental health solutions, has expanded into the rapidly growing telemedicine market to provide the employees of Canadian clients and their families with easier, more convenient access to digital health care services. .Read More


StudyKIK Introduces Remote eConsent Technology Solution with Integrated Telemedicine Video Calling for Clinical Trials

StudyKIK, a full service patient recruitment & retention technology company headquartered in Irvine, CA announced today the release of their fully remote eConsent platform with Telemedicine Video Calling technology. Now, any sponsor who has provided their enrolling sites access to StudyKIK’s…… Read More


Health Recovery Solutions Announces Lineup of Telehealth Experts for October Vision to Virtual Conference
Health Recovery Solutions (HRS), a national provider of Telehealth and Remote Patient Monitoring (RPM) solutions, is excited to announce its incredible lineup of speakers for the upcoming Vision to Virtual conference. From October 15 to October 16, HRS will welcome telehealth experts from across the healthcare industry including those from health systems,… Read More


The “Global Next-Generation Surgical Robotics Market: Analysis and Forecast, 2020-2030” report has been added to ResearchAndMarkets.com’s offering.

The market size of next-generation surgical robotics was valued at $10.9 million in 2019. The global next-generation surgical robotics market is expected to grow at a robust rate. It is anticipated to reach $884.5 million in 2030 with a CAGR of 44.6% during the forecast period 2020-2030…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.

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
Design – Sankara Nethralaya
Technical Partner- www.medindia.net

 

e-Newsletter Sep 2020

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

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.

 

Message from Maj Gen (Retd.) A K Singh, President, TSI

It gives me great pleasure and satisfaction that the Tamil Nadu Chapter of Telemedicine Society of India’s first Newsletter is being launched. Last three months have been very busy and productive. The training team led by Dr Sunil Shroff has done a commendable job of providing par excellent training to over 3500+ doctors. The Armed Forces Medical Services led by Lt Gen Madhuri Kanitkar had two sessions, in one the DGAFMS attended. That was the crowning glory of the TSI. The volunteering effort of the editorial team headed by Dr Shiela John is worth appreciating.

A short piece by our executive committee member Ms. Bagamishika Puhan about these training program also is enclosed.

I thank all members of the TSI in contributing to the growth of Telemedicine. The margadarshaks ( Past Presidents) have been a guiding force.

Jai Hind.

Maj Gen (Retd.) A K Singh
President, TSI

Telemedicine in India: Personal Reminiscences from 1996

K. Ganapathy M.Ch (Neurosurgery) FACS FICS FAMS Ph.D is a Past President of the Telemedicine Society of India, Former Secretary & Past President Neurological Society of India, Past President, Indian Society for Stereotactic & Functional Neurosurgery, Formerly Adjunct Professor IIT Madras & Anna University, Madras & Emeritus Professor Tamilnadu Dr MGR Medical University. He is on the Board of Directors of Apollo Telemedicine Networking Foundation & Apollo Tele Health Services.

 

“Excellence is not a destination – it is a never ending journey” 

The beginnings

It all started on the night of Sep 16 1996, I had just finished delivering an institute lecture an IIT Kanpur. Just after the Q&A ended at 09:00PM, Prof. Srivathsan, HOD of Electrical Engineering Department insisted I have dinner with him. He introduced me to the word “Telemedicine” and persuaded me to prepare a project report from 11:00PM – 04:00AM. Then commenced a love affair, which over the next 24 years has taken its toll. My legally wedded wife is often relegated to No. 3. Initially, I was wedded to Neurosurgery and now it is Telehealth. Looking back the journey has always been exciting. Arduous, often frustrating,sniggers were common, comments included “Telemedicine Ha ha ha”- but that was the 20th century. In 1998, I even had the audacity to request the association of Rural Surgeons of India to embrace Telemedicine ( Fig 1). .Having started the first Stereotactic Radiosurgery unit in South Asia and as Secretary of the then 2200 strong Neurological Society of India, conventional wisdom dictated that I should continue to focus my skills and energy completely, on what I was trained for, namely neurosurgery .However deep down was a nagging feeling , “Was there not something else, which I could do, which could help more than a few thousand neurosurgical patients ” and then the story began . I took the road less travelled by and the rest – as they say is history !! In fact I embarked on making Geography History ! and distance meaningless.

The Aragonda Story
On March 24th 2000 Bill Clinton formally commissioned the world’s first VSAT enabled village hospital at Aragonda in Andhra Pradesh . In the first 2 years two hundred fifty echocardiograms were done there, telementored from Chennai by Dr Premshekar a pediatric cardiologist. Unfortunately we were all so inundated with clinical work that no papers were published, in what may have been a first of its kind initiative even globally. Every Tuesday morning, a tele–grand round took place with super specialists from the Department of Pediatrics at Apollo Hospitals, Chennai interacting with doctors in the village hospital.More than 200 tele grand rounds took place up to 2005. When Dr Vilvanathan Pediatrician who worked in this village hospital left it was not continued. Again this herculean effort was never documented.

Formation of ATNF
In 2001 Apollo Telemedicine Networking Foundation was formally established as a not for profit Section 25 company . Taking modern healthcare to remote areas using technology was the mission of ATNF . In between my neurosurgical commitments I spent time and effort to help a skeleton staff of four full time employees to achieve , what in 2001 appeared preposterous – remote consultation !! Every opportunity to put a then hardly existent Indian telemedicine on the world map was utilised. I took part in the first intercontinental live multipoint telemedicine symposium on June 19 2001. Bill Gates was also a speaker .Though today it looks juvenile, it was thrilling to talk to people across the globe from Chennai. I could not resist starting with “ Good morning, good afternoon, good evening and good night ladies and gentlemen!!” Then started teleconferences with, Japan, USA, Saudi Arabia, Hong Kong. 19 years ago for a hospital to embark on video conferencing to conduct clinical meetings was certainly not the norm. Over the next 20years more than 230 regional, national, and international videoconferences in different medical specialties have taken place.

2002

Feb 15 2002 was a red-letter day for the growth of Telemedicine in India. The tension which India went through when Chandraayan 2 was to land on the moon , was experienced by me and my team when we enabled the first VSAT teleconsultation to be witnessed by the Chairman of ISRO. ISRO has publicly acknowledged that their foray into Telemedicine was influenced by that demonstration. Such was my enthusiasm then, that the Vice Chancellor of Anna University even agreed to let me address principals of 600 engineering colleges of Tamilnadu to start telemedicine units. Needless to say only four responded and that too for a short time.Telemedicine for Armed Forces -It has been my privilege to have persuaded the Indian Army to set up telemedicine units in the southern and central commands as early as 2002 with the assistance of Lt Gen Anoop Jamwal who retired as Adjutant General. Unfortunately we were too far ahead of the time and the commissioned Telemedicine units became non functional . In 2017 Telemedicine in the Armed Forces was rte established.

2003

The first formal University accredited 4 week certificate course on Telehealth technology was started with Anna University. Over the next 3 years 150 candidates in 6 batches were trained. Unfortunately due to lack of employment opportunities the course was discontinued. At about this time the Ministry of External Affairs Govt of India produced a documentary India 2.0 where Apollo telemedicine was featured.Franchised Remote Telehealth Centres gradually increased in Tier II and Tier III cities mainly in North Eastern India . Port Blair, Andaman Islands and various other remote places followed. We had almost 30 centres then

2004-05

IIT Madras started working on telemedicine enabled indigenous peripheral medical devices, designed to transmit temperature, pulse rate, blood pressure, oxygen saturation, heart and lung sounds and a 12 lead ECG .We went to the villages, used kitchens in houses, got a 100 volunteers together and transmitted this clinical data to Apollo Main Hospital Chennai for doctors to evaluate. Several such testings and clinical feedbacks led to the birth of Remedi the first indigenous stand alone Telemedicine “ Black Box” . Due to a sickness at home I was unable to attend an international Critical Care Congress. Adversity was turned into Opportunity. I gave the talk from an ICU bedside . This had a great impact. Years later I had just landed in Chandigarh for the TSI annual conference. I was informed that my grand daughter was critical and admitted in the ICU at Bengaluru. I took the return flight. The next day I gave my scheduled talk on a mobile phone from the ICU. My younger colleague Aditi did a great job projecting the slides perfectly. This unscheduled virtual talk in 2008 was more effective than a normal talk.Telemedicine enabled Hospital on Wheels – In 2005 As part of the Distance Healthcare Advancement Project, along with Philips Medical Systems, ISRO, and the DHAN Foundation, a Hospital-on-Wheels (HoW) was made. The HoW would go to different villages and provide virtual teleconsults. Concentrating on the vehicle, its contents and satellite communication infrastructure. the low lying branches of trees and mud roads in villages was overlooked !! Subsequent VSAT receivers were made smaller and portable.Formation of TSI At the Telemedicine conference organized by ISRO at Bengaluru a few of us got together and decided to formalize the concept of TSI first mooted by Dr Saroj Mishra in 2001 at Lucknow. I became the first Treasurer ( and Joint Secretary) of TSI with the membership number of 001!!

2006- 2010

The next few years witnessed evangelisation of Telemedicine in India and overseas. Talks were given at Baghdad, Kosovo, Riyadh, USA and many other countries in the Middle East and Africa. Every opportunity was used to promote telemedicine. By this time, India has been placed on the world map in Telemedicine.Gradually VVIPs’ from other countries started to take notice of the work done here. The Prime Minister of Mauritius, the President of Nigeria and many, many other heads of states started visiting us to understand how we were making a difference. This resulted in setting up of telemedicine units in Lagos and Mauritius.Following visits from ministers from Uganda I received a “summons” from the First Lady of Uganda for a discussion to set up telemedicne units in Kampala. CII, FICCI and other organisations were pro actively contacted . Seminars, symposiums, workshops and conferences were conducted on a war footing throughout the length and breadth of India. Telemedicine became my second name. The audience were not convinced – ravings of another mad man ! . When The National Science Centre located at the National Science Museum New Delhi started a new gallery to showcase recent advances in science and technology a Telemedicine kiosk with facilities for live demos was set up. ATNF became a member of the Standards Committee on Telemedicine, the National Task Force on Telemedicine, the Working Group on Telemedicine of the Planning Commission, and the Working Group of the SARC Committee on Telemedicine.

International Conferences personally organised : In Nov 2007 the 3rd national conference of the TSI was held in conjunction with the 12th international conference of the International Society for Telemedicine and eHealth at Chennai. The conference was inaugurated by the Chief Minister of Tamilnadu. Over 300 Indian and 35 international delegates participated. In 2016 the ISfTeH conference was again held in Chennai along with the annual Conference of Transforming Health Care with IT Over 750 delegates participated. THCIT annual conference has been held regularly for the last decade.

mHealth – In August 2007 Ericsson requested me, to study for the first time in South Asia, the feasibility of remote clinical examinations through wireless connectivity. Special license was obtained to use 3G spectrum .We demonstrated that 12 lead ECG’s, blood pressure recordings, lung and heart sounds ,ultrasound studies and ECHO cardiograms could be transmitted wirelessly using 3G. For the trial demo availability of power for 10 hours in the outskirts of Madurai was organised. Backup generators with diesel for 4 hours as a standby was arranged. Due to an unexpected demise, staff of the Electricity Board left and there was no power !!. Getting additional diesel would take at least 4 hours. Diesel from two ambulances and a bus was removed and used. An example of how determination can solve any problem.This 3G trial was so successful that Ericcson requested us to showcase this in Bhutan and Bangla Desh. In July 2008 The Rockefeller Foundation organised a Making the eHealth Connection Conference at Bellagio Italy. I was invited for the 5 day brain storming session. The very term mHealth was conceptualised by mygroup.

Global telehealth initiatives of Govt of India – The Ministry of External Affairs, Govt. of India initiated the Pan Africa e-Network project for teleconsultations in 2009. ATNF was a major player in this project .Unfortunately the project was not sustainable. Again to advise the government on the Central Asia e-Network Project. I visited Uzbekistan, Kazakhstan and Turkmenistan and submitted a project report. This also did not materialise.Formation of ATHS . With increasing activities it was realised that we needed a full time CEO to head a regular company rather than a full time Neurosurgeon involved in Telemedicine as a passion . This suggestion was accepted and in October 2010 Apollo Telehealth Services was formed. An excellent team under the leadership of Vikram Thaploo has made use of the rich heritage. Being future ready the outstanding team have managed to operationalise what were originally concepts. My wish list is becoming real . It is also true that “ nothing can stop an idea whose time has come”. Today ATHS has one of the largest Call Centres and is the oldest and largest multi speciality Telemedicine Network in South Asia.

2011

eHome Visits Belonging to the BC era ( Before Computers, Before Christ & Before Covid are the same !!) I was keen on reviving house visits which were in vogue in the early seventies. Electronic house visits were initiated with a laptop/ dongle carrying attender connecting from the uninitiated patient’s home.Interestingly this simple innovation got the best poster award at the World Health summit at Washington in May 2011

2012

World’s largest number of Teleconsults from a HoW – In a first of its kind initiative, 527 patients in 13 different specialities were connected simultaneously to six tertiary Apollo hospitals, in different parts of India from a HoW at a mega health camp held at Ajmer in Northern India on 11th and 12th February 2012.Remote clinical evaluation was followed by ePrescriptions. Subsequently similar telecamps were held in different parts of Tamilnadu in southern India.

2014

Patient empowerment in rural India by promoting eHealth Literacy -Deploying multi point Videoconferencing, a knowledge empowerment programme, at the internet enabled Village Resource Centers of the MS Swaminathan Research Foundation, in rural Tamilnadu was started in 2014 . 115 talks have been given in Tamil so far attended on 25,000 occasions from 18 villages.

2015 ONWARDS

Virtual visits to ICU I-SEE-U® was a state of the art solution developed to enable virtual visits to ICU patients, from anywhere in the world, by authorised consultants, friends and relatives. The remotely enabled networked camera in the individual ICU cubicle can also focus on various monitors. The product got an award at an international conference at Singapore. Due to subsequent regulatory and privacy issues it was discontinued.

International Educational Activities : Columbia University , Wharton School of Business, the London School of Economics, Harvard Business school, Ross School of Business, Atlanta state University, Indian school of Business are some of the international organisations who have used Apollo Telemedicine as study material .Software An in house, custom built software “Medentegra” which in addition, to a user friendly EMR (facilitating uploading of images, investigations etc.) has inbuilt video conferencing capabilities started being used regularly.

eICU : eICU’s where smaller ICU’s are connected to highly trained experienced intensivists in larger ICU’s are now a reality. One of the largest such networks operates from Apollo Hospitals Hyderabad where 15 ICU’s are connected. 600 plus teleICU consults in subspecialoitries have already been given.

Public Private Partnerships – a few illustrations

a) Himachal Pradesh . The first Telehealth PPP project in India commenced 5 years ago . Over 18,500 teleconsultations were given at a height of 14,500 ft. The world’s first 24/7 Tele emergency Services has seen about 1300 patients. Today we have four different Telemedicine Centres in Himachal Pradesh

b) Over 1 million teleconsultations have been provided under the Mukhyamantri Arogya Kendram (e-UPHC)- project covering 182 Centres from October 2016.

c) Jharkhand Digital Dispensaries programme In the first 15 months alone 328,648 patients have attended these Digital Dispensaries

d) Uttar Pradesh Telemedicine programme in the first one year 141,793 patients visited 114 Government Community Health Centres

e) Uttar Pradesh Teleradiology PPP program – Systematic implementation of operational activities, beginning from site development and installation of IT equipment to training of human resource and trial testing for assessing functional status of Centres has led to commissioning of 127 teleradiology centres in rural UP – a mammoth undertaking by any standards. On an average 360 images are reported daily with a turn around time within 4 hours

f) Tele ophthalmology A major project is being carried out in 115 existing Community Health Centres / Vision Centres run by the Department of Health and Family Welfare, Government of Andhra Pradesh in 13 districts. Through this Mukhyamantri e-Eye Kendram or MeEK project 1,5 million patients have been screened in 2 years. 355,000 fundus examinations were done remotely by 30 Opthalmologists from Chennai .

g) National Thermal Power Corporation . Located in rural Assam 30 km from the China Border this Telemedicine enabled center has made a major difference.

2019

Extra-terrestrial Telemedicine . The ultimate in Remote Health Care would be to assist in providing health care to India’s first Vyomanauts in Outer Space . After editing a special supplement on “ Extra Terrestrial Neurosciences” for Neurology India and presenting the only medical paper at the Human Spaceflight Programme organised by ISRO, I have even offered my services !! 2020 Academic contributions – The crusade for popularizing telemedicine has included the presentation of more than 400 papers in regional, national and international meetings in India and 105 overseas . Over 180 articles have been published, on Telehealth including 45 in peer-reviewed journals and chapters in textbooks

Conclusion:

The journey has been exhilarating . I have no regrets for taking the road less travelled by. Encomiums and accolades received on reaching the destination is only ephemeral. The greatest danger for most of us, is not that our aim is too high and we miss it, but that it is too low and we reach it. The TSI should not believe in following high standards. We should set them. We no longer should strive to achieve world class. The world should strive to achieve India class. Looking back, the growth of telehealth during the last 20 years has been rather slow – many of us are in a hurry, impatient, wanting to get things done yesterday !!. The first decade was spent in evangelising the product, developing the product and generally creating awareness . For a product to excite the masses it must elicit customer delight and cater to the consumer. A major stumbling block retarding the take off of telemedicine is WiiiFM ( What is in it For Me). Every member of the telehealth ecosystem needs to get a RoI ( Return on Investment) not necessarily monetarily alone. In the third decade of telehealth business models are mandatory. Revenue generation is a must for sustenance. Philanthropy and corporate social responsibility can initiate an activity not maintain it.

Epilogue: Not in my wildest imagination would I have ever expected the slow incremental annual growth to radically transform into an explosion. A strand of RNA has become the Global CTO ( Chief Transforming Officer) for Telehealth. Contactless Health care will be the new normal.Distance will become meaningless. Geography will become History!. Recognition of Telemedicine by Insurance companies augurs well. Formal recognition of importance of Telemedicine by the Govt of India and state governments will make all the difference, I once gain thank the TSI for bringing out a Newsletter . Hopefully the newsletter will bring our ever expanding family closer .

Fig 1 Earliest communication for starting Telemedicine

Fig 2 Inauguration of world’s first VSAT enabled village hospital for Telemedicine March 24th 2000 @Aragonda, Andhra Pradesh

 

Tele-Ophthalmology – in a COVID world – Opportunities and Challenges
Dr. T. Senthil, MBBS DO FICO. Founder and CEO Welcare Health Systems Pvt ltd – Honorary Secretory, Telemedicine Society of India Tamil Nadu Chapter. Dr. Senthil is an Ophthalmologist and Healthcare Entrepreneur, He established Welcare Health Systems in 2014 which has grown to become Indias Largest Teleophthalmology Company. He can be reached at senthil@welcaretelemed.com.

COVID 19 has brought in a drastic change in adoption of Teleophthalmology among Ophthalmologists in India. Since patients were not able to reach hospitals, and social distancing became the norm, hospitals in Corporate, Govt and Non-Profit sector started looking for Teleophthalmology Solutions to reach out to their patients. In Ophthalmology Telemedicine was used primarily in three scenarios. 1) Screening for Diseases such as Diabetic Retinopathy, Retinopathy of Prematurity etc. 2) Diagnostic Consultations. 3) For Long term follow ups of patients.

Screening for Diseases through Teleophthalmology has been the most successful of the above three models. There are many successful Screening projects in Teleophthalmology world over which has reached out to millions of patients. However, Challenges faced by Screening model providers are cost of the Technology such as fundus cameras, Internet connectivity, Paying capacity of patients etc.

The Diagnostic Consultation approach started getting traction during the COVID lockdown, since patients were not able to reach hospitals- they wanted to connect to Ophthalmologists from their homes. There was a huge spike in Teleconsultations during the initial lockdown periods. Hospitals and Clinics started teleconsultation services to reach patients. Many platform companies were able to generate patients to Ophthalmologists for consultation. The teleconsultation slowly started decreasing as Hospitals / clinics opened.

Challenges in Ophthalmic Teleconsultation
a) Ophthalmology diagnosis includes a few basic tests such as Examination of Eye on a Slit Lamp, Fundus Examination, Refractory error examination etc which cannot be done in the patients’ homes since the equipment’s are not available for these tests.
b) The willingness of Patients to pay for a online consultation was very poor.
c) The Ophthalmologists also have a lot of apprehension on missing Diagnosis using a Teleconsultation mode.

The most effective model during the COVID time for Ophthalmology was for follow up of patients such as Postoperative patients where advise was given on Medication changes, or Tele triage wherein patients were seen online and decision was taken if they have to come to Hospital or can be advised online, or even if they come to hospital which specialist they had to see and so on.

For Teleophthalmology to Succeed
1) Low cost Diagnostic Devices such a Fundus Cameras and ROP cameras to be available in the market.
2) At Home Screening devices for Intra Ocular Pressure Measurements, Refraction and Visual acuity Measurements, Fundus / Anterior Segment Imaging to be innovated and made available.
3) Medico Legal Clarity and Data Protection Clarity to be brought in so that Doctors will be more comfortable in doing Teleconsultations.

Mobile Teleopthalmology

Dr. Sheila John, Consultant Ophthalmologist, Head of Teleophthalmology and E-Learning, Sankara Nethralaya, Chennai.

Mobile Tele-ophthalmology is evolving into an integral clinical tool in the Indian health care system. In a developing country like India, the ophthalmologist-patient ratio stands at a dismal 1:10,000. What makes this wide gap between demand and availability of eye care even more critical is its inequitable spread, 70% of the nation’s citizens live in rural areas while 70% of its eye care professionals live in urban areas.

Mobile Tele-ophthalmology BUS may potentially provide health services to underserve and remote rural populations who otherwise may not have access to specialized eyecare. Eye screenings are conducted within the community, often in schools, community halls, and places of workship.Bringing the facility directly to the patients allows health professionals to diagnose and prevent vision threatening diseases such as diabetic retinopathy, glaucoma, age-related macular degeneration and others By detecting causative blinding disease early on mobile, teleophthalmology allows for timely referral to appropriate experts and consequently, earlier treatment. However, on-site screenings may utilize the state of art equipment including an automated refractor, slit lamp with Applanation tonometer, Non-mydriatic retinal camera and others. An ophthalmologist is available in person at the hospital to do teleconsultations with the patient and develop an assessment and treatment plan for the screened patients. The ‘Mobile Refraction Van ‘accompanies the teleophthalmology van to the villages, addresses the refractive error, and dispense spectacles to rural people at campsite.

As an institution committed to its founding principle of cost free service with a personal touch to those who cannot afford to pay, Sankara Nethralaya realized right from the time of its inception that for every single indigent patient who visited its centers seeking cost free eye care there were two such patients outside needing such care. It also realized that patients in rural areas may not avail eye care dispensed at a base hospital in the city owing to several socio-economic factors and the only way to dispense preventive and curative eye care to this segment would be through outreach programs. ‘Mobile Teleophthalmology’ holds great potential to improve the quality, access and affordability in eye care especially for patients in rural areas by reducing the need for travel and providing virtual access to a super-specialist right at their doorstep.

Best practices!

Indiritta Singh Dmello, Director, Hospital Guide Foundation (An Oxford graduate in Politics, Philosophy & Economics with a PG Diploma in Medical Law & Ethics-National Law School, Bangalore)

“The developed India will not be a nation of cities. It will be a network of prosperous villages empowered by telemedicine, tele-education & e-commerce”-Dr. A.P.J. Abdul Kalam.

It is paradoxical that even though India has emerged as a hub for medical tourism, we are unable make healthcare accessible and affordable to the masses in India. As per the WHO statistics, India is far below the recommended Doctor Patient Ratio (recommended ratio 1:1000 & India1:1700). Further compounding the problem is that only 26% of these Doctors are present for 70 percent of the population in rural areas.

This is where Telemedicine plays a pivotal role in addressing this gap. Telemedicine is a tool that makes healthcare accessible and cost effective by engaging the Doctors and patients remotely through an integrated technology platform. This platform could be as basic as a simple Audio Visual with a software for patient details or as advanced as integrated diagnostic equipment, remote monitoring of Intensive Care Unit Patients or even remotely conducting a surgery.

Hospital Guide Foundation (HGF) has been running a Telemedicine project with the Govt of Uttar Pradesh in the rural area of Western UP, supported by the Doctors of National Heart Institute & Sita Ram Bhartia Institute of Research & Technology at New Delhi. While it is a Telemedicine project, the objective is to provide comprehensive healthcare with Telemedicine being an enabler. At HGF the following key factors were observed for making a Telemedicine project successful.

Holistic Approach: Telemedicine delivers significant advantages for the patients only with a complete treatment and support mechanism – ensuring tests & medicines, setting right expectations, counseling (about the process, disease & treatment), driving awareness, ensuring compliance with (tests, medicines & life style) and pro-active follow ups, which helps gain patient confidence & cooperation therefore delivering much better results.

 Seemless process: Multiple touch points have to be managed seamlessly between patients, nurses,Doctors and telemedicine specialists for enabling a great healthcare experience. This makes it even more challenging in rural areas where we grapple with basic problems like electricity. Coordination to perfection is key for a sustainable telemedicine project, specially when the Doctor’s limited time should be well spent on communicating with patients rather than waiting for them.

 Optimal technology: is also essential for a superior Doctor & patient experience. For eg the quality of internet bandwidth, audio visual can affect the dialogue between patients and Doctors who are trying to communicate remotely on sensitive health issues. The quality of communication will have a direct impact on the diagnosis, prognosis and treatment.

 Quality diagnostics: Similarly, well calibrated high tech diagnostics is essential for the patients to get the right diagnosis, prognosis and treatment.

With the onset of the Pandemic COVID 19, Telemedicine has gained the much needed impetus that it has been yearning for. As it has become an important enabler in Healthcare delivery, not only for reasons of accessibility, affordability but for reasons of safety. In a country where there are several Telemedicine projects running in silos, it is important to continuously share best practices , for which Telemedicine Society of India (TSI) is a great platform & this newsletter a great initiative. With the astute leadership of TSI, I have no doubt that Telemedicine will be on a trajectory it so deserves!

Train to Practice Telemedicine Guidelines

Ms. Bagamishika Puhan, Advocate, Legal Advisor and EC Member, Telemedicine Society of India, Member, Indian Society for Clinical Research.

On April 04, 2020, after a tumultuous yet short ride, a group of TSI members came together to unfurl the Train to Practice project. This was the culmination of an informal mandate received from a benefactor to train and educate as many registered medical practitioners (RMPs) about the nuances of the Telemedicine Practice Guidelines (TPG) in particular and telemedicine in general.

The Society pioneered work in the field of telemedicine over the past many years, and now, is at the helm of inculcating the best practices in the field and has been successful in training over 3500+ RMPs directly under the project, and about 15000+ RMPs through the volunteers.

In this exercise, the focus has been to ensure that the participants take away an acute understanding of the legal aspects of telemedicine (TPGand allied laws), how to marry the legal concepts to their clinical practice, and also a basic understanding of how and when to triage a patient by means of telemedicine. As we continued with the project, we added another module which lends a helping hand to the practitioners who want to get started right after the discussion, with their own kit of telemedicine.

The project has witnessed roaring applause from various factions including the much revered Armed Forces Medical Services for the volunteering efforts and the dynamism of the project and the team. We have also sought support from entities who believe in this social and evolving practice of telemedicine. As the awareness amongst the user increases, we will continue to ensure that safety is not compromised, and we will continue to impart the necessary education concerning safe and convenient practices around telemedicine.

We welcome participation of volunteers to train, to learn, and to contribute to this endeavor of the Society in any manner and capacity that they wish to associate with the Society. Learn more at https://tsi.org.in/learn

 

History and Evolution of Telemedicine – Samuel Morse and Telegraph
Dr. Sunil Shroff, President, Tamil Nadu Telemedicine Society of India, Consultant Urologist & Transplant Surgeon.

History and Evolution of Telemedicine – Samuel Morse and Telegraph (First of Ten important milestones). “The Past supplies the key to the Present and Future“ ~ Ancient Historian. The history of telemedicine is the history of evolution of distance communication. If it was not for the legacy laid down by many of the scientists, telemedicine may have never evolved as it has done currently.The start of this was the invention of the public telegraph system set up by Samuel Morse. Why did Samuel who had developed a reputation as a portrait painter go on to invent the telegraph system?

This is an interesting piece in the history of communication. Apparently he was hired to paint a portrait of a famous person and travelled out of his town. Back at home his wife fell ill and died of heart attack and it took Samuel days to reach back home and when he did return the wife’s funeral had already taken place.He was so upset with this episode in his life that he left his art career and started looking at ways to establish a way to communicate information at a distance. His pursuit lead him to become interested in the telegraph system.

He went on to invent a single-wire telegraph system and the first Intercity public telegraph services were set up between Washington and Baltimore in 1844. In almost all the wars that followed the telegraph was used by the military to order medical supplies, transmit list of casualty and it is probable that some use of the telegraph in its early decades involved medical consultations.He was also the co-developer of Morse code that helped the commercial use of telegraphy. One of such codes was the internationally recognized distress signal SOS. The SOS letters were chosen because they are easy to transmit in Morse code: “S” is three dots, and “O” is three dashes.

 

Telemedicine – News from India & Abroad

India

500% rise in healthcare teleconsultation in India, 80% are first-time users: Report
Besides COVID-19 related symptoms, some of the other most-discussed queries included back pain, eye health and mental health issues. Online consultation for healthcare has increased by 500 per cent between March 1 to May 31, 2020…… Read More


Digital Care: The Way Forward for Management of Chronic Conditions
The use of digital care in driving positive health outcomes, especially for chronic patients, it is possible because of the availability of remote monitoring and virtual care tools backed by the spread of affordable smartphones and data consumption, it’s the next major emerging disruption in India after e-commerce, fin-tech ….. Read More


Telemedicine is the roadmap to improve medical Care in rural areas : Ayush Mishra
According to the Medical Council of India the doctor to patient ratio in India may be as low as 1:2000 if not lower. This is a serious challenge to the health of Indians and is compounded by the fact that most doctors practice in larger cities where opportunities are greatest …. Read More


Today technology can make physicians available to patients: Sunil Wadhwani
Artificial intelligence really can have dramatic impact on how we address healthcare in India, how we can become the leading country in the developing world, on how AI is being applied to improve healthcare…. Read More


Telemedicine Guidelines Released in India Notified and Gazetted
The Government of India Notified and gazetted the Telemedicine Guidelines that were released on 25th March 2020. What it means is that this framework is here to stay even after the current COVID-19 pandemic recedes. While 25th March was a historic day when the guidelines were released by the BOARD OF GOVERNORS – In super session of the Medical Council of India under NitiAayog, 14th of May the guidelines have officially been notified and gazetted. Read More


International

Telehealth Services: A Post COVID-19 Reality?
The regular use of telehealth services for cancer patients was found to have long-lasting and unforeseen effects on the provision and quality of care, said an article published in JAMA Oncology, Trevor Royce, MD, MS, MPH, an assistant professor of radiation oncology at the University of North Carolina Lineberger Comprehensive Cancer Center and UNC School of Medicine. Read More


Heart Failure Assessment Via Telemedicine
The jugular venous pressure is an indicator of fluid retention and build-up of pressure inside the heart. Being able to check jugular venous pressure using telemedicine, virtually, will help doctors assess heart failure patients remotely by just using the camera on a smartphone. Read More


Digital Health Unplugged: August news team debrief
During the Covid-19 pandemic primary care was forced to go digital-first to avoid unnecessary face-to-face consultations in a bid to control the virus, but now lockdown restrictions are easing are those services here to stay? Speaking at a Royal College of Physicians event in the UK on the future of healthcare post-Covid, Hancock said teleconsultations would allow the NHS to provide a “much better” service. Read More


Telemedicine Market- Growth Insight, Rising Demand, Share and Healthy CAGR in the Upcoming Forecast 2024
BY NEWS@RESEARCHNESTER.COM ON AUGUST 11, 2020
Global Telemedicine Market is growing immensely due to its growing application; Tele-cardiology, Tele-radiology, Tele- dermatology, Tele-gynecology etc. At 19%, Tele-dermatology had the highest share in the global applications market in 2015 and is expected to lead in next five years followed by Tele-cardiology. The report titled, “Global Telemedicine Market 2024”, projects the global Telemedicine market to grow at a CAGR of 14.8% during the forecasted period of 2017-2024 according to our research report. Read More

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