Newsletter – Page 3 – Telemedicine Society of India

Tele-Health-Newsletter March 2023

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

What is New?

TSI has recently opened its 12th chapter in Haryana, marking another milestone in its growth and expansion.

ChatGPT, an AI language model, has been generating buzz this year with its impressive capabilities. It has been used in this issue to create fascinating AI-related news and articles that are worth checking out for anyone interested in this exciting field.

Furthermore, in this issue, Dr. Vikrant Mittal has contributed an article about the progress of tele-psychiatry in the country. This is an interesting read for anyone interested in mental health and technology.

Last but not least, our past presidents, Dr. B,S. Ratta and Mr. L. Satyamurthy, attended the American Telemedicine Congress, the biggest event in the field. They have compiled all the highlights of the event, so be sure to read and benefit from their insights.

Finally, we would like to wish everyone a Happy Easter!

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

Haryana State Chapter – Telemedicine Society Of India(TSI) Inaugurated at Amrita Hospital, Faridabad

Shruti Saxena
DGM – PR & Communications (North), Amrita Hospital, Faridabad

The newly formed Haryana State Chapter— Telemedicine Society of India (TSI) was inaugurated at Amrita Hospital, Faridabad. Swami Nijamritananda Puri, Administrative Director, Amrita Hospital, Faridabad, lighted the lamp and inaugurated the project.

Delivering the inaugural speech, he said, “Ours is a country where most people do not have access to proper medical care. Though there are several reasons, one of the main reasons is the geographical factor. Launching the Haryana Chapter will help transcend the obstacles and help people denied advanced medical assistance.”

Telemedicine facilitates communication between a doctor and a patient in a remote location with the support of the latest technology. Artificial Intelligence (AI) and Machine Learning support an accurate diagnosis. It includes phone calls, video chats, emails, text messages, and even drone delivery of medicines. Telemedicine is often called telehealth, digital medicine, e-health, or m-health (mobile health). The Haryana Chapter aims to connect patients who need medical help with in-house technical teams using telemedicine and clinics on wheel units.

Dr. Prem Nair, Group Medical Director, Amrita Hospitals & Vice-President National Telemedicine Society of India, said during disasters when all modes of communication are down, satellites establish connectivity with patients within the time described as the golden hour. When the tsunami struck, it was possible to provide healthcare to people in Lakshadweep and Andaman & Nicobar Islands through telemedicine. “This was one of the important milestones for us in telemedicine,” he said, adding, “We have also been successful in mobile telemedicine. We have been able to provide teleconsultation and teleeducation through mobile telemedicine units. We look forward to working with the Telemedicine Society of India and start connecting with local healthcare facilities to support some of the far-flung areas in Northern India substantially.”

Prof Meenu Singh, President of National Telemedicine Society & Director of AIIMS, Rishikesh said, “The government of Haryana started telemedicine Delhi-NCR and Chandigarh many years ago. It is 25 since telemedicine services began in Haryana when Prof. BD Gupta introduced it in 1997. In 2005, the Prime Minister of India started telemedicine along with ISRO and the Department of Education and Technology. It is gratifying to see Amrita collaborating with ISRO and other agencies.”

Stressing the need to bridge the healthcare digital divide, Dr. Puneet Dhar, President, Haryana Telemedicine Chapter said, “About 1.3 billion people in the country fall in the spectrum of the healthcare digital divide. Healthcare infrastructure development is vital to the country’s development, and telemedicine can help. The increasing penetration of smartphones, mobile connectivity, and the internet makes it a game changer. Amrita has been a pioneer in exploring this. During natural disasters, our telemedicine van goes around providing treatment. It proved to be crucial when Covid-19 struck,” he said. He also pointed out the case of start-ups providing online consultation, remote patient monitoring systems, and online pharmacy services that use drones and assist in palliative care.

Unlike the developed world economies, healthcare infrastructure and distribution of the medical fraternity are not uniform in India. A robust, uniform referral system is lacking to directly refer sick patients suffering from specific diseases in remote areas, where tertiary/quaternary is missing. The absence of hospitals/centers/institutes with state- of- art facilities for their treatment further jeopardizes the survival of these sick patients.

The chapter in Haryana is the first step towards making high-quality healthcare accessible to all our citizens. It will help ensure a future where healthcare is no longer a privilege but a fundamental right of every citizen of India. The Chapter is dedicated to hand-hold government/semi-government/private healthcare stakeholders to improve healthcare quality at all levels in Northern India and the rest of the country.

However, some challenges come in implementing telemedicine services in India. The lack of infrastructure, limited internet connectivity, and the shortage of healthcare professionals trained to use telemedicine technologies are some of the challenges that need to be addressed. Hospitals and other conventional healthcare institutions can be crucial in expanding telemedicine services in India. They can provide the necessary infrastructure and technical expertise needed to support telemedicine services. They can also provide the required training for healthcare professionals to use telemedicine technologies effectively.

The TSI’s Haryana Chapter will collaborate with all medical colleges/institutions to provide an in-training for future doctors. It is the 16th state chapter of TSI in India. They will also team up with various stakeholders for quality improvement in all aspects of healthcare- preventive, primary, secondary, and tertiary levels. It is of utmost importance for achieving Millennium Development Goals.

Dr. Kamal Bijlani, Director of E-Learning Research Labs (AERL), is the secretary, and Dr. Tarana Gupta is the treasurer of the Haryana Chapter. Currently, the Society has 45 members.

Dr. Murthy Remilla, Secretary, TSI spoke at the event. Dr. Arti Pawaria, Senior Consultant & Clinical Lead, Department of Paediatric Hepatology, Gastroenterology & Liver Transplantation, Amrita Hospital, Faridabad, Dr. Ashutosh Sharma, Medical Superintendent, Amrita Hospital, and Dr. (Col) B.K. Mishra, Principal, Amrita School of Medicine, Faridabad, graced the occasion.

Meet ChatGPT: Your Intelligent Companion for Endless Conversations!”

Dr. Sunil Shroff
President, Tamil Nadu Telemedicine Society of India | Consultant Urologist & Transplant Surgeon

ChatGPT is an artificial intelligence language model that is designed to interact with us humans through text-based conversations. It uses a machine learning algorithm to generate responses to questions or statements, and its responses are based on the patterns and information it has learned from large amounts of text data.

To put it simply, ChatGPT is like having a conversation with a very knowledgeable and intelligent computer program. It can understand and respond to a wide range of topics, from basic questions about the weather or current events to more complex discussions about science, technology, and philosophy.

ChatGPT is not a physical entity, but rather a software program that operates in the cloud. It is accessible through various chat platforms, such as messaging apps or websites, and can be used by anyone with an internet connection.

Overall, ChatGPT is a powerful tool that can provide information, support, and entertainment to people around the world, and its capabilities continue to improve as its machine learning algorithm evolves and learns from more data.

The impact of ChatGPT on content writing is likely to be significant. With the ability to generate high-quality, human-like responses to text-based conversations, For example, ChatGPT can be used to generate blog posts, news articles, and product descriptions, and can even be used to create entire websites or e-books. However, it’s important to note that ChatGPT is not perfect and still has limitations. While it can generate text that sounds natural and coherent, it can also produce responses that are irrelevant or even nonsensical. Therefore, it’s likely that human writers will still be needed to edit and refine the content generated by ChatGPT.

Furthermore, ChatGPT is not a replacement for human creativity and originality. While it can generate text based on existing patterns and information, it cannot create entirely new ideas or concepts. Therefore, human writers who are able to think critically and creatively will still be valuable in the content writing industry.

Overall, while ChatGPT has the potential to disrupt the content writing industry, it is likely to complement rather than replace human writers. By automating many of the repetitive and time-consuming tasks associated with content creation, ChatGPT can free up human writers to focus on higher-level tasks, such as brainstorming new ideas, developing creative concepts, and refining the quality of the content.

Privacy in Healthcare: Changing Times and Systems

Ms. Bagmisikha Puhan
Associate Partner, TMT Law Practice

In the wake of the recent breach which has been suffered by a leading pharmaceutical company, Sun Pharmaceutical Industries, owing to a ransomware attack – it has become apparent how a sensitive sector like the healthcare does not have enough safeguards in place in terms of data privacy. Fortunately, as a listen entity and in view of the CERT-In Directions notified last year, there was a modicum of an obligation placed squarely on the company to make these disclosures.

However, it is not a sector which can be left fraught with risks, which make the individuals – who could be patients, recipients of transplants, clinical trial participants, surrogates, and several such other individuals, become subject to a harrowing experience at the hands of a person who intends to abuse their data. It is to this end that in addition to the existing policy and standard frameworks which apply to the healthcare framework, only with persuasive value – there be the introduction of an umbrella privacy framework which applies to all and sundry as a mandate.

It has been oft the case that the end user, to whom the information pertains to, either rely on IT, e-commerce, consumer protection laws to somehow build a case for preserving and enforcing their own right to privacy – which is now a fundamental right, in the stead of being presented with a forum which is marked with the dedicated objective of enforcing their rights.

We have already witnessed the turmoil that is being faced by the e-pharmacies in wake of the recent court order, which was covered under the earlier newsletter; it is only imperative now that the draft drugs and cosmetics legislation which came into circulation last year be considered for further discussion and deliberation, to also look at the digital health ecosystem, privacy of the stakeholders anew.

While, as per the regulatory filings Sun was able to clarify that “we proactively isolated our network and initiated the recovery process.” It also went on to clarify that the incident did not impact the company’s core systems and operations. It is important to note that while Sun was able to contain it to impacted assets and not let the core systems suffer, imagine a healthcare organization suffering from a breach with their Health Information Systems being impacted, it will expose entire medical/ health histories of patients to the perpetrators.

Recently, ICMR issued the Ethical Guidelines for Application of Artificial Intelligence in Biomedical Research and Healthcare focusing on all stakeholders, including innovators, developers, technologists, researchers, healthcare professional, Ethics Committees (ECs), Institutions, sponsors, and funding agencies involved in research related to artificial intelligence in biomedical research and healthcare. The preface to the guidelines state that the central goal for AI and ML systems should be to make the platforms available for the benefit of the largest section of common people with safety and highest precision possible. This will also press further the need to have a robust privacy framework. We shall discuss finer details of these Guidelines in the next newsletter.

Telepsychiatry in India: Brief Review

Dr. Vikrant Mittal MBBS, MD (Psychiatry)
Chief Medical Officer, Oasis Lifecare LLC

Background
Disruptor is a commonly used phrase in international IT & business settings. It specially came into vogue with technology disrupting how business was being done for decades. Similar disruption happened during coronavirus disease (COVID – 19) pandemic in the field of telemedicine in India. Some initial data and perception suggest that depression and anxiety increased in general population after Covid-19. Associated with data from a previous study that reported shortage of psychiatrist in India – only 2 psychiatrists for a population of 10 lakh (1). This has brought increased focus on psychiatry. And this is one of the opportunities where telepsychiatry can help bridge the gap in care and achieve more.

History
Similar to other branches telepsychiatry was also growing as the need arose and with technological advances in cameras, connectivity infrastructure and audio technology. Earliest use of telepsychiatry has been mentioned as a 1961 article on two-way television in group therapy (2). Over the years, telepsychiatry has been studied in different settings – child and adolescent population, adult forensic and correctional psychiatry and in geriatric populations throughout the world. It has shown to be highly effective and improved sustained care even in Schizophrenia and other psychotic disorder patient population (3). Indian data also suggests telepsychiatry is more economical than the present practice of in-person clinical care (4). It is also acceptable and feasible to the general population (5).

Progress
In India, one of the first implementation project was during the devastating 2004 Tsunami calamity mainly in Coastal districts of Tamil Naidu. This was done by an NGO SCARF (The Schizophrenia Research Foundation) (6). They provided psychological support services and training to volunteers.

Over the years mainly various government organizations have led in developing telepsychiatry guidelines for both synchronous and nonsynchronous models. Some of the successful models highlighted by Naskar S et al (2017) are STEP model by SCARF, PGIMER, Ganiyari model and ATP in different states (7).

In reaction to Covid 19 and to utilize virtual medical practice The Telemedicine practice guidelines were released in March 2020 (8). Following it in May 2020 Medical Council of India released the Telemedicine practice guidelines, The Indian Psychiatric Society (IPS) and Telemedicine Society of India (TSI) in collaboration with the National Institute of Mental Health and Neurosciences (NIMHANS) released Telepsychiatry operational guidelines (9). Guidelines outline scope, definitions, norms, protocols, and framework to implement telemedicine services. These guidelines are to help better understand the administrative and legal concerns present in practicing telemedicine. Other highlights of the guidelines are that both synchronous and asynchronous communication modes could be utilized to deliver service. Psychiatrists would be able to consult patients across the country leading to better and equitable access to all parts of the country. The guidelines offer legal protection to all the stakeholders and a higher likelihood of maintaining patient records. The inclusion of research and training in the guidelines would provide the necessary scope to evaluate the telepsychiatry practice (10).

Conclusion
At present there is an estimated huge gap ranging from 75% to 93% (11). Telepsychiatry services provided by both private and public providers would help bridge this gap. Guidelines provide a working framework that will help smooth implementation of programs, easy accessibility of services to all. Guidelines should be updated periodically with inputs from all stakeholders. This would be prudent given the ever-evolving technology, types of stakeholders and patient needs.

References:

Mohandas E. Roadmap to Indian psychiatry. Indian J Psychiatry 2009;51:173-9.
Wittson CL, Affleck DC. Two-way television in group therapy. Mental Hospitals Magazine. 1961 Nov: 22-23.
Dwyer TF. Telepsychiatry: Psychiatric consultation by interactive television. Am J Psychiatry 1973;130:865-9.
Moirangthen S et al. Telepsychiatry as an economically better model for reaching the unreached: A retrospective report from South India. Indian J Psychol Med 2017;39:271-75.
Das S et al. Tele-psychiatric after care clinic for the continuity of care: A pilot study from an academic hospital. Asian J Psychiatry 2020;48:101886.
Thara R, John S, Rao K. Telepsychiatry in Chennai, India: The SCARF experience. Behav Sci Law 2008;26:315-22.
Naskar S et al. Telepsychiatry in India – Where do we stand? A comparative review between global and Indian telepsychiatry programs. Indian J Psychol Med 2017;39:223-42.
Board of Governors in supersession of the Medical Council of India. Telemedicine practice guidelines. 1st ed. India BOD-MCI. India, 2020.
Math SB, Manjunatha N, Kumar CN, et al. Telepsychiatry Operational Guidelines-2020. Bengaluru: NIMHANS.ISBN No: 978-81-945815-29.
Dinakaran D et al. Telemedicine practice guidelines and telepsychiatry operational guidelines, India – Commentary. Indian J Psychol Med. 2020;42(5S):1s-3s.
Gururaj G et al. National Mental Health Survey of India, 2015-16. Prevalence, patterns and outcomes. 2017. Ministry of Health and family Welfare, Government of India.

Conflict of Interest:
Author is partner at USI Health LLP which owns Telepsych website and App.

Glimpses of American Telemedicine Association 2023 Conference, San Antonio, Texas

Satyamurthy Lakkavalli and Bhagwant Singh Ratta
Suquino Telehealth India

Mr. L Satyamurthy and Dr. B S Ratta, our two Past Presidents attended ATA 2023 at San Antonio on 4th, 5th & 6th March 2023.

Brief Report:

It was a Teletreat for us to attend and present our Paper. There were over 300 Speakers & 2000 Attendees, spread out by Sessions on Tele Business, Clinical Opportunities, Policy, Research, Technology apart from Special Interest Group (SIG) Meeting, Book Signing by Authors, CEO Spotlight, Deep Dive, Express Theatre talks, Fire side chats, Keynotes, Panel Discussions, Patient Spotlight, Research Oral & Poster Presentations & Workshops.
A.I, Remote monitoring, Building and sustaining Tele Networks, Transforming care for rural populations were the highlights.
Every delegate, exhibitor was on an APP and he or she could prepare their own planner, see exhibitors & sponsors, including Scientific Program.
S.I.G Meetings were held on Telemental health, Ocular Telehealth, Govt relations, Acute & Critical Care Digital transformation, Remote monitory home & community telehealth, Home testing ATA Global Health Collaborative etc.
Telehealth, Innovators challenge was another highlight along with the startup conclave.
The exhibitors (Over 200) were par excellent and each stall was designed elegantly – The Keynotes, Panel Discussions in the mornings with over 2000 seating capacity and Breakfast/Lunch area were all in one huge hall with exhibitors and one could easily do 10,000 steps a day in that arena. There were over 4 break away groups for rest of the day. The Startup Zone was vibrant and their stalls were classic.
All in all it has left an indelible memory to be cherished. The overall program, arrangements, interactions, networking & fun is value for money and strongly recommend our young enthusiasts to take the lead and represent India.
Social Program – Casino Night & Welcome reception on Day 1 was a fun filled evening followed by a Paid Dinner on the 2nd night and the last day was by the river in the Hard Rock Café
With live music where everyone let them loose and enjoyed.

Telemedicine – News from India & Abroad

AI system can predict cardiovascular risk more accurately than humans

Researchers at the University of Oxford developed an AI system that uses machine learning to predict a person’s risk of developing heart disease and stroke. The AI system was able to produce a personalized risk score for each patient using medical data such as blood tests and lifestyle factors. In a study of over 400,000 patients, the AI system was able to predict cardiovascular risk more accurately than traditional methods used by doctors. The study was published in the journal, The Lancet Digital Health. https://www.thelancet.com

AI system detects early signs of Alzheimer’s disease

Scientists at University College London developed an AI system that can detect early signs of Alzheimer’s disease in brain scans. The AI system uses machine learning to analyze brain scans and identify subtle changes in the brain’s structure that are associated with Alzheimer’s disease. In a study of over 500 patients, the AI system was able to accurately predict which patients would develop Alzheimer’s disease up to six years before symptoms appeared. The study was published in the journal, Radiology. https://pubs.rsna.org

AI technology helps diagnose rare genetic disorders

Researchers at the Children’s Hospital of Philadelphia developed an AI system that can help diagnose rare genetic disorders by analyzing patients’ medical records and DNA sequencing data. The AI system uses machine learning to identify patterns in the data that are associated with specific genetic disorders. In a study of over 1,000 patients, the AI system was able to accurately diagnose rare genetic disorders in a fraction of the time it would take for a team of human doctors to review the same data. The study was published in the journal, Science Translational Medicine. https://stm.sciencemag.org

AI system improves accuracy of breast cancer diagnosis

Scientists at Google Health developed an AI system that can improve the accuracy of breast cancer diagnosis by analyzing mammogram images. The AI system uses machine learning to identify subtle changes in breast tissue that are associated with breast cancer. In a study of over 76,000 mammograms, the AI system was able to reduce the number of false positives and false negatives, which could help improve the accuracy of breast cancer screening. The study was published in the journal, Nature. https://www.nature.com

AI technology helps predict ICU mortality rates

Researchers at the University of Chicago developed an AI system that can predict the mortality rate of patients in intensive care units (ICUs). The AI system uses machine learning to analyze patient data such as vital signs and laboratory results to produce a personalized risk score for each patient. In a study of over 46,000 patients, the AI system was able to predict ICU mortality rates more accurately than traditional methods used by doctors. The study was published in the journal, Critical Care. https://ccforum.biomedcentral.com

Telemedicine Practice Guidelines – A Foundation Course for RMPs by TSI Faculty

To know more about the Telemedicine Foundation Course click on the link below:
https://tsitn.org/tpg-course/

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

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

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

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

Tele-Health-Newsletter February 2023

Click Here to Download PDF Version

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

What is New?

Since its inception during the COVID period, the e-sanjeevani app has performed 100 million teleconsultations, the prime minister revealed in his Mann Ki Baat programme. This is unquestionably a world record for the most free teleconsultations ever conducted. We’ll wait for a publication to learn more about its accomplishments and difficulties. The clinicians may learn a lot and contribute to the ecosystem’s general expansion.

TN-TSI chapter and KCG College of Technology successfully hosted a CME on telemedicine for engineering students this month. The programme was warmly accepted, and we intend to run more programs in the future. One of our members displayed the mobile lab that provides lab results instantly.

The recent decision from the Gujarat High Court regarding e-pharmacies is covered by our legal expert Bagmisikha. Even though there is uncertainty regarding their legality, e-pharmacies have expanded. There are unlikely to be any quick fixes to resolve issues related to their status.

We are getting ready for the next TELEMEDICON in Goa. Registration is open so do register.

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

Faculty Empowerment Program on Telemedicine and Health Care Research

Dr. Thulasi Bai
Professor, KCG College of Technology

Faculty Empowerment Program (FEP) on Telemedicine and Health Care Research was organised by KCG College of Technology in association with Telemedicine society of India-TN Chapter (TSI-TN) on 18th February 2023 at Mirza Seminar Theatre. Dr.Thulasi Bai, Professor, Department of ECE coordinated the over all program.

The inauguration started with prayer song at 9.15 AM. The workshop was inaugurated through traditional lighting of Kuthuvillakku by the dignitaries of TSI-TN and KCG College of Technology. Dr. Kavitha Balamurugan, Head, ECE department welcomed the gathering. Dr. Sunil Shroff, Senior Consultant – Urologist, Madras Medical Mission and President – TSI, TN Chapter gave the presidential address. In his speech, he explained the importance of Telemedicine.

Dr. T. Senthil CEO, Welcare Health Systems, Honorary Secretary, TSI-TN briefed about the activities of the TSI-TN and telemedicine in general. Dr. Srinath Yeswanth, Co-Founder, Curehealth Systems, LLP explained his experience with Telemedicine. Dr. Sheila John, Head of Teleophthalmology & E-Learning, Sankara Nethralaya, TSI-TN talked various initiatives taken in the hospital for screening the patients in rural areas through telemedicine.

After the inauguration the following speakers delivered their speech to assure the participants the best experience about the Telemedicine.

The Faculty Empowerment Program was attended by around 150 participants (Students and faculty) which includes external participants, Faculty of Electronics and Communication Engineering, Students of ECE, IT, AI&DS and Mechatronics department. Tele-Pathology van was brought to the campus and the participants had a chance to explore the facilities which was the highlight of the program.

The participants were given certificates and the FEP received good feedback from them. The workshop came to an end by 2.30 PM.

The organising team thank Management of KCG college of Technology and Principal for hosting the FEP and TSI-TN for arranging the eminent speakers for the sessions.

**Dr. Sunil Shroff, Senior Consultant – Urologist, Madras Medical Mission, Chennai & President – TSI, TN Chapter giving his speech**

**Dr. T. Senthil, Director & CEO – Welcare Health Systems, &**
**Hon’ry Secy – TSI, TN chapter delivering inspiring speech**

**Mr. P. Ravindran, IT Consultant, Arvind Eye Care Systems giving his talk on Tele-ophthalmology**

**Dr. Srinath Yeswanth, Co-Founder, Curehealth Systems, LLP during his session**

**Dr. Thulasi Bai thanking the speakers and gathering**

DCGI issues notice to e-pharmacies for online sale of drugs without a license

Bagmisikha Puhan
Associate Partner, TMT Law Practice

Siddhant Gupta
Associate, TMT Law Practice

The Drug Controller General of India served show cause notices to prominent e – pharmacies earlier this month, for their continued violation of the provisions of the Drugs and Cosmetics Act, 1940 (DC Act). The show cause notice has relied upon the 2018 order of the Hon’ble High Court of Delhi in the matter of Dr. Zaheer Ahmed v. Union of India and Ors., whereby e-pharmacies were injuncted from the online sale of medicines without a due and proper license and were directed to ensure that the same is prohibited forthwith. The DCGI’ action is driven by the complaint forwarded by the All-India Organization of Chemists and Druggists (AIOCD) to multiple government agencies, including the Prime Minister’s Office (PMO), citing blatant abuse and violation of applicable law, and a rise in spurious drugs distribution.

It is interesting to note that while DCGI had forwarded the captioned order for compliance and action by the state drug controllers in 2019, there were no similar actions contemplated in the last 3 years, during the COVID-19 pandemic. E – pharmacies were instrumental in the past years for last mile healthcare delivery, where a considerable size of the demographics was stationed at home and accessibility to efficient and reliable healthcare services was a challenge. In fact, on March 26, 2020, during the lockdown, the Central Government realized that the retail sale of drugs to the doorstep of consumers is essential to meet the requirements of emergency arising out of pandemic COVID-19 and in the public interest, and accordingly notified the prescriptions for regulation of sale and distribution of drugs for their delivery to the consumers.

In addition to the same, the Telemedicine Practice Medicines, 2020 had sought to regularize and regulate the practice of telemedicine and provided nominal guidance to RMPs for their online consultation conduct and provided for necessary compliances to safeguard patient interest. This also provisioned for what happens when the RMP needs to communicate the prescription to a pharmacy, this was also provided within the same. It did seem like there was not just a mere acceptance of this position, but also growing awareness of consumer comfort which was being sought to be achieved by way of this arrangement between online pharmacies, and end users.

With an objective to regulate this market proposition, the amendments which were proposed to the existing regulatory framework by way of introduction of the draft Drugs, Medical Devices and Cosmetics Bill, 2022, which further indicated towards issuance of specific licensing guidelines for e-pharmacies to regulate the online sale of drugs and cosmetics. Furthermore, the draft National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations, 2022 sought to provide extensive guidance on the online conduct of RMPs, thereby reiterating the government’s intention to rely on digital technology to promote medical accessibility.

Indeed, the Ayushman Bharat Digital Mission (ABDM), the brainchild of the NITI Aayog and Ministry of Health and Family Welfare, further seeks to provide for a federated health information architecture, which will seek to further interoperability, accessibility and portability of health records across public and private healthcare institutions.

The DCGI action could set the Indian pharmaceutical industry on the backfoot again, after spirited efforts have been made by the regulators and industry stakeholders alike, to realign their operations to incorporate a digital component, and provide healthcare services to patients who are bed-ridden, or reliant upon their caregivers, in terms of finding access to the most primitive modes of care delivery. Adoption of technology, specifically the internet, allows for the ecosystem to increase accessibility and affordability of the services which are presented to the end users, bringing healthcare delivery to the last mile. We must afford e-pharmacies similar leeway, and provide them with the necessary guidance and regulation to streamline their operations, and allow the demographic to leverage the countless advantages of such service providers.

What appears to be a disconnect is the fact that the online pharmacies did not necessarily always rely on the large brick-and-mortar pharmacy chains which exist, but turned towards their own warehouses, stores in bringing this service to the last mile. The representation which made its way to the top, seems to be motivated by the lack of opportunities for the existing set-ups, where digital consultation, has paved way for the end users to find consultation, health check-up and drugs/ medicines, all at one point of care on the internet, as opposed to having to visit a doctor in a facility, and then going to another place for seeking their prescription drugs.

A show cause notice seeking information could be the starting point for regulation, however, this should not be considered to be an opportunity to undo the entire online ecosystem which has been created for the benefit of the masses.

Satellite to Block Chain – A new paradigm in Covid care delivery through Telemedicine under India’s Health care Mission “Ayushman Bharat“

Satyamurthy Lakkavalli and Bhagwant Singh Ratta
Suquino Telehealth India

Introduction

“Ayushman Bharat” meaning blessings of longevity for Indians, is a national flagship mission which is a federally funded government health care delivery system launched in the year 2018. It is an umbrella of two major healthcare initiatives namely:

National Health protection scheme (NHPS): This scheme is envisaged to be applicable for over 100 million poor and vulnerable families for providing up to $ 7,000 (USD) per family annually for secondary and tertiary care hospitalization. Benefits of the scheme are portable across the country with cashless benefits from any public or private empanelled hospitals across the country.

Health and Wellness centres (HWC): Under this scheme a whopping $170 million (USD) is allocated for establishment of 1,50,000 HWCs centres to provide comprehensive health care, covering non-communicable diseases and maternal/child healthcare services at primary level.

Ayushman Bharath and Telehealth:

The Telemedicine Program conceptualization, formulation and implementation in India was primarily spearheaded by the Indian Space Research Organization (ISRO) in the year 2001 under Space Technology applications for societal benefits. ISRO marshalled the diverse stakeholders across the country namely the Doctors, Specialist Hospitals, State Governments, Health Administrators, Technologists and Industry into a common platform for ushering Telemedicine service for rural, semi-rural and urban population.

The important factor of providing satellite connectivity without any charge by ISRO was the major boon for many of the rural district and specialty hospitals.

During the period 2002-2010 India had one of the largest Satcom based Telemedicine network by ISRO with 400 Remote/ rural/ district hospitals and 200 Village resource centres in most of 25 States of the country connected to 50 Specialty hospitals/Medical college hospital located in major cities/towns in the country including 20 Mobile units covering the various medical specialties.

More than Million Teleconsultation took place with several lifesaving instances during that period.

This commendable effort by ISRO demonstrated a beneficial change in reaching out to the rural population of India culminating in a federal government recognizing Telemedicine as an important application under National Health Mission (NHM)of the country.

Ayushman Bharat Digital Mission (ABDM)

ABDM scheme launched in 2018 got a fillip to stitch the silos in Indian health care system. Blockchain technology was thought of since it has the potential to revamp the currently existing processes to unlock new sources of efficiency and value, as was seen and evidenced in the pharmaceutical supply chain, verification and approval of fertiliser subsidies, verification of university certificates and transfer of land records in the country.

The ABDM envisages to register every next provider of healthcare in the country on the portal as the first vertical with all the healthcare facilities in government/ private sector including corporate hospitals and diagnostic Labs registered as second vertical. The third vertical being the population registry with every citizen having healthcare ID called ABHA no (Ayushman Bharat Health Account). The last being the software, hardware, medical devices, health IT companies being registered to provide the service for primary care through Wellness clinics and secondary/tertiary care through hospitals across the nation. With the advent of IT solutions like IoT-driven (Internet of Things) intelligent medical devices, personal healthcare apps for Telemedicine, AI for clinical decision making, online pharmacies for convenience and price comparisons, to name a few, have helped fuel the growth of Indian healthcare.

Creating a unique EMR under ABDM

One of the potential solutions that is often missing from the discussion is a portable or intra-operational Electronic Medical Record (EMR). In India, EMRs are primarily a platform to generate billing for the patient as there is low penetration of package pricing (an agreed-to and published price for a defined procedure) and thus most patients pay a-la-carte for the services they consume (doctor’s time, drugs, radiology reports, procedure, etc.). In this scenario there are no incentives to contain costs or stop unnecessary services from being performed and/or billed, as hospitals generate revenues by providing additional diagnostic tests which may not always be clinically appropriate. In addition to the billing aspect of an EMR, an EMR should also provide an electronically formatted patient file which provides a medical history and ensuing patient notes which are written by the doctor, nurse or allied health professional, results of lab tests and radiology imaging reports, as well as pharmacy orders.

It is not just in India, but in high income economies like the U.S, most of the EMRs cannot easily transfer data from one hospital to another. Why this is important, especially for poorer patients availing services as part of the Ayshman Bharath scheme? Many of these targeted patients need to travel for life saving care from rural India to a Tier I or Tier II city for surgery and rehabilitation, yet their private health information does not easily travel with them in an organized manner that would ensure timely and smooth transition for admission at a surgery centre and subsequently the post-surgery follow-up phase.

Block chain and EMR

Blockchain technology adopted has the potential to facilitate a national EMR system and provide the backbone for building a robust and centralized EMR system. Uploading and storing EMR data on a blockchain application could ensure that all stakeholders would benefit from EMR data without disturbing the integrity of the data and the privacy of confidential patient information. A blockchain EMR could store patient data and provide a unique file identification number to each patient, akin to an Indian Aadhar card number (UID) or U.S. Social Security card number, but the file can only be unlocked by a confidential code that is generated by the EMR blockchain system and the access code is known only to the patient. Additionally, since blockchain is a peer-to-peer technology, all users have a copy of the data in the database and unauthorized changes to the data can be flagged and deleted automatically in each user’s database, thus further ensuring data integrity.

Some of the benefits of using a blockchain EMR system could include:

Continuum of care resulting in better outcomes
Tax payers and Government could track the successful service for greater transparency and understanding as to how services are being utilized and paid for.
Insurance companies/trusts could more easily identify payment fraud and automatically disburse payments directly to a hospital’s bank account which is also one of the Government’s objectives (cashless, pre-authorized payment for services rendered)

Block chain adopted for Covid care

Covid brought unprecedented challenges in every walk of life due to which a big shift taking place in the healthcare industry. Government of India responded well by bringing in The Telemedicine Practice Guidelines on the very next day of the National lockdown on 25th March 2020. This opened the Pandora’s box for teleconsultations on Government and private platforms.

With the success of Blockchain technology in various Government sponsored program in India such as Aadhar, the world’s largest unified ID based system (1.2 billion biometrics and as more than 25 million authentications per day) and others like Unified Payments Interface (UPI) 1.3 billion transactions in Dec 2019, e Sign, Digi locker, Goods and Services Tax Network; Ayushman Bharat Digital Health mission (ABDM) with ABHA app, unified health interface and sandbox integration using block chain technology permits online search of health services, teleconsultations, diagnostic tests etc for creation of longitudinal health record . This enables connecting the different silos in the healthcare system and giving equitable and ubiquitous access to healthcare there by drastically reduce out of pocket expenses for the beneficiaries.

Conclusion
ABDM has already taken off and about 240 million e Cards have been issued to beneficiaries with approximate 8 million hospital admissions. It is envisaged that more than 80 per cent of India’s 1.35 billion population will be in the ABHA registry in the foreseeable future. 144787 healthcare facilities have already been registered. ABDM has built in security at different stages to prevent fraud in any chain. This enormous effort of integrating all the stake holders is enormous job by the federal government and hope for a successful fruition of this mega programme benefiting the major population of India in the near future.

Bibliography:

National Health Authority of India
Ministry of Health and Family Welfare, Govt of India
Ministry of Electronics and Information Technology, Govt of India
Digital India
The National Portal of India
Centre for Development of Advanced Computing, Govt of India

Disclaimer: The complete work related to Ayushman Bharath, Covid care and adaptation of block chain is being carried out by the different Ministries and Departments of Govt of India under the advice of NITI Aayog, the Think tank of the Indian Government. The authors have only done the research study from the data available and do not claim any credit or responsibility on the success of this mega project.

Development of a Digital Platform: A Perspective To Advance Space Telepharmacy

Marlise A dos Santos, Juliana Herbert, Ilaria Cinelli, Jose Antonio L Burmann, Vinicius V Soares, Thais Russomano

Abstract:

Goal : Lessons learned from decades of human spaceflight have helped advance the delivery of healthcare in rural and remote areas of the globe. Inclusion of the public in spaceflights is not yet accompanied by technology capable of monitoring their physical and mental health, managing clinical conditions, and rapidly identifying medical emergencies. Tele-pharmacy is a practice prioritizing pharmaco-therapeutic guidance and monitoring to help improve patient quality of life, and can potentially expand the field of space medicine. We seek to advance pharmaceutical care through tele-pharmacy by developing a digital platform.

Objective: This study focuses on the development of a digital platform for tele-assistance and pharmaceutical teleconsulting services that builds on lessons learned in delivering space medicine.

Methods: The platform contains evidence-based information on various drugs grouped by medical specialty, and also records and saves patient appointments. It has specific service protocols for service standardization, including artificial intelligence, to allow agility in services and escalation. All data is protected by privacy and professional ethics guidelines.

Results: The tele-pharmacy platform is ready and currently undergoing testing for ground applications through validation studies in hospitals or medical clinics.

Conclusions: Although developed for use on Earth, this tele-pharmacy platform provides a good example of how terrestrial healthcare knowledge and technology can be transferred to space missions. Read More

Telemedicine – News from India & Abroad

Transforming India’s Healthcare: Digitize Health Records

The gap between healthcare delivery and digitization is narrowing daily. Global health systems have continued to evolve, especially in the area of information technology (IT) penetration. In India, where 1.6 million people die due to poor quality health care, more stakeholders in the health sector are increasingly searching for solutions to address quality . …Readmore

Can Artificial Intelligence Detect COVID-19 by Listening to Cough Sounds?

Cough sounds do not help Artificial Intelligence (AI) technology to predict COVID-19 better, reports a new study.The AI classifiers trained on audio recordings cannot accurately predict whether someone has COVID-19 by analyzing the sound of their coughs, according to the study led by the UK’s Alan Turing Institute…..Readmore

Life-saver: Apple Watch Saves Wearer’s Life From Fatal Internal Bleeding

our watch can be a life-saver.Apple Watch saved the wearer’s life, by alerting him about a racing pulse following a nap, which led to a diagnosis of severe internal bleeding. Apple Watch can Now Detect Heart Blockage in Real Time Can Apple Watch detect heart problems? Yes, an Apple watch can now help in detecting undiagnosed heart blockage. …Readmore

Can Robots Help Children with Learning Disabilities Stay Focused?

Social robots can assist children with learning disabilities, reports a new study.Engineering researchers at the University of Waterloo are successfully using a robot to help keep children with learning disabilities focused on their work. ….Readmore

Click here to Become a Member of Telemedicine Society of India

Telemedicine Practice Guidelines – A Foundation Course for RMPs by TSI Faculty

To know more about the Telemedicine Foundation Course click on the link below:
https://tsitn.org/tpg-course/

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

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

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

Tele-Health-Newsletter January 2023

Click Here to Download PDF Version

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

What is New?

This New Year’s first issue carries very interesting perspectives from different health domains from mental health to how our health will cope in a microgravity environment of space travel. Dr. Smriti Joshi leads the tele-psychology group and has published a paper entitled “Are you ready for the shift?” From In person therapy to telepsychotherapy” in Indian journal of clinical psychology. We congratulate her for her recognition in this field and for being awarded Ethics in tech leader award for 2022.

Practical application of telehealth in saving lives among stroke patients especially in remote locations in Uttarakhand state is covered by Dr. Meenu Singh our president of the society.

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

Telemedicine Workshop for Trauma & Stroke

Dr. Meenu Singh
Executive Director, AIIMS Rishikesh
President, TSI

Head injury is a major cause of mortality and disability in the working population, resulting in more than 200,000 deaths in India every year. The survivors of head injury become dependent on their family members for months to years, resulting in major financial implications for the family. The department of Neurosurgery organized a two-day CME on 20-21 January 2023 for management and triaging of head injury patients. This CME was attended by 18 medical officers from 10 different districts of Uttarakhand state, 10 neurosurgery residents, 20 nurses and 20 BSc nursing students.

There was a dedicated session on telemedicine on 21 January 2023. In this session, Dr Amit Aggarwal, Assistant Professor, Department of Telemedicine from PGIMER Chandigarh discussed ‘Telemedicine Practice Guidelines’. In this lecture, medical officers were explained how to utilize telemedicine, precautions to be taken while using telemedicine and about the need to take informed consent from the patient and their family. This was followed by the talk by Professor Padma Srivastava, Chief, Neurosciences Center, AIIMS Delhi. In her talk, she shared her experience with telemedicine in management of stroke at the grassroot level in the states of Himachal Pradesh, Haryana and Punjab. Prof Padma led multiple state-level projects in these states, very similar to the ones that is being planned by the team led by Dr Nishant Goyal and Dr Jitender Chaturvedi in Uttarakhand. Time is of important in both stroke and head injury and telemedicine can be utilized in preventing loss of crucial transport time. In her talk, Prof Padma explained that they initially trained medical officers in identifying stroke and differentiating ischemic from hemorrhagic stroke on plain CT scans. They were trained regarding managing ischemic stroke with intravenous thrombolysis. Neurologists at AIIMS, Delhi and IGMC, Shimla were available via telemedicine to provide support to these doctors. They protocol was to discuss the clinical condition of the patient and evaluate the CT scans via telemedicine.

This was followed by the talk by Dr Nishant Goyal, Additional Professor, Department of Neurosurgery at AIIMS, Rishikesh. In his talk, Dr Nishant explained what information should be provided by the medical officers to the neurosurgery team at AIIMS Rishikesh while communicating via telemedicine. With the use of telemedicine, medical officers across the state would thus be in touch with Neurosurgery team at AIIMS Rishikesh and would receive support in providing initial treatment and triaging these patients. This will help in preventing unnecessary transfer of many head injury patients, who will be managed and triaged by the medical officers at grass-root level, close to patient’s residence. The same network will be used in following up the patients of head injury, discharged from AIIMS Rishikesh. After this, the medical officers were taken to the telemedicine facility at AIIMS Rishikesh, where they were introduced to e-Sanjeevani, a telemedicine web-portal, developed by the Government of India.

Global Recognition received for Safe Delivery of Tele mental health services following legal and ethical Standards

Dr. Smriti Joshi MBPsS
M.phil Clinical Psychology
Chief Psychologist & Member board of Directors, Wysa

The WHO estimates that about over 450 million people globally suffer from mental health disorders. It was suggested way back in 1996 that by the year 2020, our world would be reeling under increased health burden due to mental disorders (Murray and Lopez 1996). No one had imagined back then that a pandemic would strike the entire globe leading to not just physical health crisis but also trigger a Tsunami of mental health concerns. The existing gaps in seeking mental health care arising from shortage of mental health professionals, concentration of most mental health professionals in urban areas, stigma around seeking mental health care and loss of access to physical health care facilities due to social isolation guidelines worsened access to mental health care in India and globally.

Telepsychology services existed even before the pandemic but the pandemic forced both service providers and service users realise the power of digital health modalities to access health care services, especially for mental health care. Some countries were better prepared for their health care providers to make this shift from delivering onsite or in person health care services to delivering mental health services via online modalities. These countries already had good practices and standards of care documented and established around how to offer mental health care services at scale, in a legal and ethically safe way, yet this sudden and forced transition was not easy for anyone. Just around the same time, there was a steep increase in demand for remote mental health services not just to bridge the gap that was triggered due to the pandemic but also to provide mental health support at scale to people across the mental health spectrum. Digital mental health innovations saw a rise like never before and a large variety of digital mental health products and services came into being. Mental health professionals were being hired not just to offer therapy but to assist or take lead with ideating, creating products and service platforms that could meet and bridge the demand-supply gap as well as offer innovative ways to assess and manage mental health concerns at a population level and be able to triage if needed. These are new exciting support unities and psychology students and mental health professionals want to feel more prepared to offer these services but also want to learn to do this in a legal and ethically safe way.

When I had made this professional decision to move into telemental health space about 10 years ago, it was my training at the telemental health institute that had given me the confidence to make this transition, to design products and services that were well grounded with evidence based research and using best practices. There’s a clear need for capacity building and training and guidance for mental health professionals aspiring to enter mental health domain in tech space and for other mental health professionals as well to stay updated with this rapidly evolving space. I volunteered as an expert in this field, to help draft the first set of guidelines for offering telepsychology services and conducted webinars and virtual trainings for the psychologist fraternity in India and South east Asia to assist them with this transition from in person services to offering services using online modalities. Also as a lead for ethics in tech team at therapistsintec a not for profit organisation that came into being during the pandemic promoting the development of ethical digital mental health leaders through authentic connections, upskilling, mentoring, training, and inclusion, I along with my co lead Dr. Erika Torres conducted a survey to assess the need-gap analysis being experienced by mental health professionals aspiring to offer services in this space. The survey results indicated the immense need (30.8%) to learn about how to deliver clinical services/interventions via telehealth in an ethical way. About 23% of members expressed that they wanted to know more about legal and ethical issues that a provider/organisation can face when providing their services via online modalities and another 23% expressed their need to learn more about ethics of using ML and AI in mental health or for mental health service delivery.

These results found support in a recent research paper titled ” Ethics in Telehealth: Comparison between Guidelines and Practice-based Experience” , where key findings from their work indicate that there exists a gap in what practitioners or service providers would find helpful as guidelines and the actual content of existing telehealth /tele mental health guidelines globally. It was observed that existing guidelines are more focused on the structural aspects of telehealth whereas the clinician or practitioner focus on behavioural challenges and implications of using telehealth in specific contexts seems to be not addressed.There is a need to identify and collate Practitioner perspectives and create sources for practice based evidence to develop a better or more helpful set of guidelines that address our questions or need to know ethical implications of delivering services via various modalities, with people from different cultural backgrounds , how social determinants are impacting client’s access to these services , what are the challenges of integrating ML and AI in actual service delivery mechanisms and its implications on outcomes. This survey has led to taking more informed steps for “therapistsintech” members and the larger mental health fraternity to support, train and provide mentorship to aspiring members so they can feel more confident and unleash their full potential. I also shared these results and my vision around bridging the gap that exists between published legal & ethical guidelines and challenges clinicians experience while trying to implement these in their practice at the 8th Annual eMHIC Congress and have been invited to contribute to the position statement on ethics in digital mental health being drafted by a special interest group at eMHIC. These efforts were really appreciated by Therapists in Tech community and I was awarded Ethics in tech leader award for 2022.

A Journey Into Space

Prof Thais Russomano, MD, MSc, PhD
InnovaSpace UK (http://InnovaSpace.org)

Future space missions aim to further the capabilities of space travel by aiming to fly farther and for longer than ever before. The National Aeronautics and Space Administration (NASA) and a number of private space firms (such as Blue Origin, SpaceX, and Virgin Galactic) have already begun the process of getting ready for long-distance, long-duration space exploration. They currently have plans to explore inner solar planets (such as Mars) by the 2030s. Space travel has emerged as a potential new, exciting frontier of commerce, hospitality, medical, and technology in the upcoming years thanks to the development of space tourism. However what are the implications of space travel on our health.

The presence of gravity on Earth has had an integral effect on the development of life over billions of years and has shaped the anatomy and physiology of human beings. Exposure to microgravity has been shown to affect the whole body, causing numerous changes, such as a reduction in heart size and blood volume, disturbances of the neurological system, decreases in bone and muscle mass, and impairment of the immune function. These physiological changes can lead to undesirable health consequences and to operational difficulties, especially in emergency situations.

The paper entitled Human Health During Space Travel: State-of-the-Art Review is an open access article that presents aspects related to the medical selection of astronauts and examines the physiological and psychological reactions of body and mind to the hostile environment of space. We categorized the extraterrestrial environment into exogenous (like space radiation and microgravity) and endogenous (like altering the human circadian rhythm and mental health due to confinement, isolation, immobility, and lack of social interaction) processes and their various effects on human health. In order to enable new paradigms for space health, we analysed potential health risks connected with space flight and how they might be mitigated, as well as how to employ developing artificial intelligence (AI) technologies to further future space health research.

Space is undoubtedly humankind’s final frontier. Fasten your seatbelt, click on the link and enjoy your free journey into space and read how it can affect your health!
https://www.mdpi.com/2073-4409/12/1/40

Virtual healthcare in the new normal

Dr. Nitin Upadhyay
Associate Professor, IT Systems & Analytics, Chairperson MBA, Program Director Executive Program in Digital Finance and Banking, Indian Institute of Management Jammu

The use of information communication and technology (ICT) in public administration systems and service delivery has become increasingly crucial in today’s world as governments around the globe invest in upgrading their ICT infrastructures. One of the most promising applications of ICT in public service delivery is telemedicine, which allows patients and doctors to connect remotely, eliminating the barriers of time and distance and reducing healthcare costs. India, in particular, faces a shortage of doctors and nurses, resulting in a significant gap in healthcare services. To address this issue, the Indian government has implemented regulations, policies, and solutions to strengthen telemedicine services.

The National Telemedicine Service – eSanjeevani was launched in 2019 as a doctor-to-doctor telemedicine platform, operationalizing the Ayushman Bharat health insurance scheme. Amidst pandemic, the Indian Ministry of Health and Family Welfare (MoHFW) expanded the capabilities of eSanjeevani, a telemedicine platform, to provide patients with remote access to medical consultations. This e-government healthcare service allows patients to receive medical treatment from the safety of their homes, instead of in-person visits. This new approach to virtual consultations is a revolutionary way for patients to communicate with healthcare professionals and receive medical services.

However, the successful implementation of these services depends on the willingness of healthcare consumers to adopt telemedicine. Our research aimed to understand users’ attitudes and behavioral intentions towards adopting e-government telemedicine services. The research extended the unified model of e-government adoption (UMEGA) by considering factors such as perceived severity, self-efficacy, and political trust.

The study’s findings revealed the significant impact of “facilitating conditions” on both effort expectancy and behavior intention in regards to the adoption of e-government telemedicine systems (EGTMS) such as eSanjeevani. To accomplish this, the government must invest in the development and provision of a favorable ICT ecosystem that supports the implementation and delivery of EGTMS. This includes designing, procuring, and developing a viable technology infrastructure and ICT tools, as well as ensuring the availability of affordable data packages, uninterrupted power supply, internet connectivity, and access. Furthermore, the government can take steps to reduce the learning curve for individuals using the system, such as providing helpdesks and individual training sessions.

Users’ perceptions of risk can have a major impact on their attitudes and decisions to adopt e-government telemedicine systems (EGTMS). In the virtual environment in which e-government services operate, users may encounter various uncertainties and have concerns related to financial, psychological, performance, and security risks. To address these concerns, it is crucial for the government and administrative entities to design and implement robust and secure systems that can help users overcome these risks. Additionally, providing users with training on the proper use of information can help to alleviate any uncertainties they may have.

Telemedicine services such as eSanjeevani can serve as a medium for preventive health behavior, rather than just a medium for consultation services. Therefore, it is important for the government to strategize and roll out appropriate health communication and health literacy programs to mobilize the public and motivate healthcare consumers and professionals to use EGTMS. Overall, the study suggests that government and administrative entities should focus on building a facilitating environment, developing positive attitudes, addressing perceived risks and promoting self-efficacy for increasing adoption of EGTMS.

Telemedicine holds enormous potential to revolutionize healthcare in India and other countries by reducing the gap in healthcare services. However, to ensure the success of telemedicine services, the government must invest in a favorable ICT ecosystem and address the attitudes and perceptions of healthcare consumers.

The details of the original published paper can be accessed through the following link
https://www.sciencedirect.com/science/article/pii/S0740624X22001368

Telemedicine – News from India & Abroad

New Technology and Old Books to Combat Insect-Borne Diseases Says Google

Google is developing a new technology to combat such diseases using decades-old datasets mined by Google Books as insect-borne diseases are affecting the lives of hundreds of millions of people every year. …Readmore

Artificial Intelligence Tool to Predict Lung Cancer Risk

Sybil, the artificial intelligence (AI) tool developed by researchers precisely predicts lung cancer risk for people with or without a significant smoking history. Results are published in the Journal of Clinical Oncology…..Readmore

On-The-Go Cardiac Imaging on Its Way!

Wearable ultrasound device that can assess both the structure and function of the human heart has been developed by engineers and physicians at the University of California San Diego and published in the journal Nature. …Readmore

Early Signs of Alzheimer’s Disease may be Detected With Artificial Intelligence (AI)

OpenAI’s GPT-3 program can identify clues from spontaneous speech that are 80% accurate in predicting the early stages of dementia as demonstrated by the research from Drexel University’s School of Biomedical Engineering, Science and Health Systems, published in the journal PLOS Digital Health ….Readmore

Click here to Become a Member of Telemedicine Society of India

Telemedicine Practice Guidelines – A Foundation Course for RMPs by TSI Faculty

To know more about the Telemedicine Foundation Course click on the link below:
https://tsitn.org/tpg-course/

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

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

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

Tele-health-Newsletter December 2022

Click Here to Download PDF Version

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

What is New?

A few notable developments that occurred in 2022 are likely to be helpful and have a big impact on telehealth practice. The first was the National Task Force’s submission of Version 2 of Telemedicine Practice Guidelines to the National Medical Commission. And the second – the public debate over the Personal Data Protection Bill and its final submission this month. After this, the bill is likely to be submitted to the parliament for approval. The future course of telehealth will be set by these two significant developments.

There has, however, been also another unsettling development, the expansion of surgical aggregators similar to those in the pharma feild. These aggregators are now offering commission for surgical referrals, which is very worrying trend (See the image). Corporate medicine in India has already resulted in ongoing ethical issues due to a practise known as referral kickbacks used by some of the country’s leading corporate hospitals and diagnostic centres, and now this – perhaps the mother of all kickbacks.

These kickbacks are against the laid ethical norms of NMC Professional Ethical Guidelines. TSI as a society can take a strong stand to condemn these practices before it catches fire and starts corrupting our ecosystem.

As the festivities and the year come to a close, our newsletter team wishes all the TSI members a very happy, peaceful and safe 2023.

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

Uttarakhand Chapter of Telemedicine Society of India, inaugurated at AIIMS, Rishikesh

Dr. Murthy Remilla
Secretary TSI

Telemedicine is the new normal for affordable access to best-in-class universal healthcare in a connected and comprehensive healthcare ecosystem linking even the most remote rural populations to District, State, National and International Centres of Healthcare Excellence.

The Telemedicine Society of India (TSI) inaugurated the Uttarakhand State Chapter of the Telemedicine Society of India during a programme organised at AIIMS Rishikesh on December 10,2022. Professor (Dr) Meenu Singh, President (TSI) and Dr.Murthy Remilla, Hony. Secretary (TSI), jointly launched the Uttarakhand (UK) State chapter of the telemedicine society of India.

Dr.Meenu Singh, is currently the executive director of AIIMS Rishikesh, She highlighted the telemedicine option as a significant advantage for hill states with difficult topographical conditions, such as Uttarakhand and Himachal Pradesh. Dr Meenu Singh stated that additional medical and nursing institutions around the nation would soon be linked to this facility. The Base Hospital, Kotdwar and Lal Bahadur National Academy of Administration (LBSNAA) in Mussoorie are currently linked to AIIMS Rishikesh’s telemedicine capability.

TSI Hony.Secretary Dr. Murthy Remilla described the technology-based telemedicine facility as beneficial for strengthening health facilities across the country. He explained that, with a telemedicine facility, the effort is to strengthen health facilities in every village.

Vice president of TSI Uttarakhand, Professor Shalini Rajaram; Dean Academics, Prof Jaya Chaturvedi; Secretary of TSI Uttarakhand State Chapter and HOD of Urology Department AIIMS Rishikesh, Dr Ankur Mittal and Dr Rajan Arora from Govt of UK also addressed the gathering.

The event was attended by the Medical Superintendent, Prof Sanjeev Kumar Mittal; the Additional Medical Superintendent, Prof Anshuman Darbari; the Principal of the College of Nursing, Dr Smriti Arora; Professor of Physiology, Dr Poorvi Kulshrestha, Professor Arup Kumar Mandal; Dr Yogesh Bahurupi, PPS Vineet Kumar, and a host of others. Representatives of various institutions across the country also participated in the programme online.

Digital Health Course Launched by IIM Raipur in collaboration with the Digital Health Academy

Dr. Rajendra Pratap Gupta
Programme Chair for the Post-Graduate Certificate Course in Digital Health

Why do we need a course in digital health

Broadly speaking using technology to deliver healthcare is Digital Health, and during COVID-19, all of us have used digital health in some form or the other. Healthcare is adopting technology faster than we can imagine. Online doctor appointments are now widespread, and using mobile apps for doctors’ consultations and management of chronic diseases is now a reality.

The software is now prescribed like a drug (SaaD), and software is now a medical device (SaMD); it is only that some have not used it while others have, and soon the number of people asking for digital therapeutics is going to increase. The age of treating patients with medicines alone is over, now, we would need technology for handling the new-age patient, and that’s why every doctor who is handling a patient will have to use digital health. The role of the doctor is becoming that of an infomediary. Technology is changing the relationship between the doctor and the patient.

The gap between what is happening and what is being taught is huge, and technology does not wait for anyone. Those who use digital health will replace those who don’t; hence, it is important to understand this digital health domain and be prepared so that when the opportunity knocks, people don’t miss it.

This course will help learners secure their organization’s future and medical practice. It will equip clinicians, paramedics, healthcare professionals, and managers to understand the digital health domain and the deployment of digital health tools. Also, now ABDM is incentivizing the adoption of electronic health records, every single provider will need people qualified in digital health to serve the patients under various government schemes and through the use of ABHA number. Also, newer technologies like the metaverse will impact health care. So, such a course will be a basic enabler for existence in the healthcare sector.

Why is this course online ?

Given that working professionals and doctors find it difficult to attend a college or a university to learn about digital health, we created this fully online course with the world’s best faculty teaching digital health from their years of experience in digital health. Also, for digital health, the course should be delivered digitally.

What did it take to build this course ?

The course was developed with over two years of research with the world’s top authorities on Digital Health. The course was designed in consultation with over 60 global leaders across the healthcare domain working in hospitals, the pharmaceutical industry, research & development, med-tech, information technology, regulators, and policymakers spread across the USA, U.K., E.U., South-East Asia, Africa, and after research in over 100 countries on the course’s need and content. The course is a unique blend of the world’s best faculty and use-cases in digital health.

This is the world’s first ‘Certified Digital Health Professional’ (CDHP) course blending the fields of health, technology, and management. The CDHP course has three levels; Basic, Advanced and Professional. This course aims to provide knowledge on theoretical, technological, management, and application aspects of digital health across the continuum of care. The faculty of CDHP™ are the actual practitioners of Digital Health & Management. They are global health technology leaders who have developed and delivered Digital Health. After this course, people will understand the digital health domain and how to deploy digital tools in day-to-day practice and gain a competitive advantage. The learners will get a theoretical, technological, management, and application-level understanding of key digital health tools.

What is the career perspective for those taking this course?

This Post Graduate Certificate Course in the field of Digital health offers people an opportunity to be a formally qualified and trained professional in digital health. This course can help build a career in:

Pharmaceutical Industry
Hospitals
Consulting & Advisory services
Chronic Disease Management
Medical Devices
Information Technology
Academics & Research
Digitalizing Medical/ Clinical Practice
Public Policy & Regulation
Digital Health Project Management
Marketing & Business Development for Organizations in Digital Health
Develop Digital Health Solutions
Insurance
Entrepreneurs in Digital Health

Who will award the certificate for this course?

The course certificate will be awarded by IIM Raipur & Digital Health Academy, and those successfully completing the course will become the executive alumni of IIM Raipur. Also, the Digital Health Academy will list the learners in the Certified Digital Health Professionals directory.

What is the international recognition for this course?

The course is endorsed by two of the most prominent bodies in Digital Health; International Society for Telemedicine & eHealth , Switzerland, and the European Connected Health Alliance

What are the eligibility criteria for enrolling in this course?

Graduation degree or its equivalent with work experience of minimum of two years . Clinicians and healthcare professionals, and managers can apply.

How many seats are being offered;

200 seats are available for the 2023 cohort.

What is the Fee structure?

For Indian Students: INR 3.6 Lacs plus applicable taxes
For Foreign Students: US$ 7,000
*The above fees include tuition Fees, Material / Notes & Alumni fees.
3 day Contact Program (Optional) at IIM Raipur.

Website for the course : https://web.iimraipur.edu.in/index.php/programmes/pgcpdh/pgcpdh-overview

NHA aims to promote adoption of Ayushman Bharat Digital Mission (ABDM) by offering incentives of up to Rs. 4 crores to hospitals, labs and digital health solution providers

The National Health Authority (NHA) has announced a Digital Health Incentive Scheme (DHIS) for the stakeholders of the digital health ecosystem. The scheme aims to give a further boost to digital health transactions in the country under the Ayushman Bharat Digital Mission (ABDM). The incentives under this scheme would be provided to hospitals and diagnostic labs and also to the providers of digital health solutions such as Hospital/ Health Management Information System (HMIS) and Laboratory Management Information System (LMIS).

Under the DHIS, the eligible health facilities and digital solutions companies shall be able to earn financial incentives of up to Rs. 4 crores based on the number of digital health records they create and link to ABHA (Ayushman Bharat Health Account). This incentive can be availed by the health facilities (hospitals and diagnostic labs) registered with ABDM’s Health Facility Registry (HFR) and fulfilling the eligibility criterion specified under the scheme.

Elaborating on the same, Dr. R. S. Sharma, CEO, NHA said – “We believe that this scheme will encourage more and more healthcare facilities and digital software companies to come forward and join ABDM for providing patient-centric healthcare. Through this financial incentive scheme, we’re encouraging the adoption of digital health. Further, we’re also including solution (HMIS/ LMIS) providers in the incentive scheme so that they handhold other health facilities to come on board and facilitate strengthening of the ecosystem. Incentives have played a catalytic role in driving early adoption of other citizen centric programs such as UPI, notification of TB cases, Janani Suraksha Yojana, etc.”

Important points under ABDM’s Digital Health Incentive Scheme are:

1.Incentives would be provided to the following entities:
a. Health Facilities having 10 or more beds
b. Laboratory/radiology diagnostics centres
c. Digital Solution Companies (entities providing ABDM enabled digital solutions)

2.The incentives shall be provided on the basis of the number of ABHA-linked transactions i.e. the digital health records created and linked to ABHA.

Healthcare Facility	Base Level Criteria	Incentives
Hospitals	50 Transactions per bed per month	Rs. 20 per additional transaction above the base level
Diagnostic facilities /Labs	500 Transactions per month	Rs. 15 per additional transaction above the base level

3.Digital Solution Companies (DSCs) will be given an incentive of 25% of the incentive amount received by the eligible health facilities using their digital solutions.

4.For the ABHA linked transactions done by facilities not eligible for direct incentives (Clinics/ Small Hospitals/ Health Lockers/ Teleconsultation Platforms etc.), an incentive would be provided to Digital Solution Companies.

Cost Incentives for Digital solution (HMIS and LMIS) Companies
For every Transaction by hospitals/labs using their software and receiving incentives under this policy	25% of the corresponding incentive amount received by the eligible facilities
For other Transactions (including by health lockers, Teleconsultation platforms, small clinics etc.), provided the transactions are more than 200 per month	Rs. 5 per Transaction

For public sector facilities, the incentives shall be added to the funds under Rogi Kalyan Samiti. The estimated initial financial outlay of the incentive scheme is Rs. 50 crores for a period of six months starting from 1st January 2023 onwards.

Further, public webinars would be organised by NHA starting from Dec 23, 2022 to provide detailed overview of the scheme. The schedule and link for the webinars will be available on the website https://abdm.gov.in/dhis. Full text of DHIS is available at: https://abdm.gov.in:8081/uploads/Digital_Health_Incentive_Scheme_550e710e09.pdf …Read More

Announcement

10th International Conference on Transforming Healthcare Using IT from 13th to 14th February 2023 at New Delhi

Telemedicine – News from India & Abroad

Google to Soon Translate Doctor’s Handwritten Prescription

Google to use artificial intelligence (AI) and machine learning (ML) model to identify and highlight medicines within difficult-to-read handwritten prescriptions.This will act as an assistive technology for digitizinghandwritten medical documents by augmenting the humans in the loop such as …Readmore

Artificial Intelligence may Predict Success of Botox Treatment in Dystonia Patients

With the help of artificial intelligence/AI technology, researchers have designed synthetic DNA that controls the cells’ protein production.How our genes are expressed is a process that is fundamental to the functionality of cells in all living organisms. Simply put, the genetic code in DNA is transcribed ….Readmore

Is Artificial Intelligence Better at Predicting Brain Metastasis Outcomes

An innovative artificial intelligence (AI) technique developed is found to be more effective than the human eye when it comes to predicting therapy outcomes in patients with brain metastases.The new research and technology could eventually lead to more tailored treatment plans and better health …Readmore

Virtual Reality Game Detects Attention Deficit Hyperactivity Disorder

Virtual reality games and machine learning approach were used by researchers to detect attention deficit hyperactivity disorder (ADHD).ADHD is a common attention disorder that affects around six percent of the world’s children. Despite decades of searching for objective markers, ADHD diagnosis ….Readmore

Looking towards the future of telehealth in Medicare, evidence is needed

Throughout the COVID-19 pandemic, telehealth services have played an essential role in maintaining and expanding Americans’ access to their health care. But what comes next to ensure that telehealth can work after the pandemic? What can we learn from those with “hands-on” experience with telehealth from the past two years? https://www.whitehouse.gov/ostp/news-updates/2022/11/10/looking-towards-the-future-of-telehealth-in-medicare-evidence-is-needed/

Click here to Become a Member of Telemedicine Society of India

Telemedicine Practice Guidelines – A Foundation Course for RMPs by TSI Faculty

To know more about the Telemedicine Foundation Course click on the link below:
https://tsitn.org/tpg-course/

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

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

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

Tele-health-Newsletter November 2022

Click Here to Download PDF Version

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

What is New?

The highlight of November 2022 has been the annual national conference at Kochi at Amrita Hospital and a report by Mr. Bijoy with pictures are presented. Kerala has been at the forefront of Telemedicine since the year 2002 and Amrita has an established department that has indeed helped its growth. In fact Amrita had also started a postgraduate course on the subject by Dr. Ajith Babu during the same time.

Last month there was another interesting telehealth event at Delhi organised by Dr. Rajenra Gupta, one of our TSI members. This was entitled – Global Digital Health Summit. There were apparently 1706 registrations but considering the COVID protocol they approved 750. There were 680+ participants from across the globe.

This month the Ministry of Electronics and Information Technology has invited feedback on the draft ‘Digital Personal Data Protection Bill, 2022.’ Our legal expert – Bagmisikha Puhan has sent her expert comments. Do go through the bill and send your feedback to the ministry. The link has been provided.

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

TELEMEDICON2022 at Kochi

M.G. Bijoy
Telemedicon Organizing Secretary,
Kochi

Highlights of 18th International Telemedicine Conference hosted by TSI Kerala Chapter in association with Amrita Hospital.

KOCHI: The three-day 18th international conference, ‘Telemedicon 2022’ of the Telemedicine Society of India with TSI Kerala Chapter, took place at Amrita Hospital in Kochi . Dr. Mohanan Kunnummal, Vice-Chancellor Kerala University of Health Sciences, inaugurated the conference. State IT Secretary Dr. Ratan Khelkar,IAS; Dr. Prem Nair; Group Medical Director, Amrita Hospitals, Chairman Telemedicon 2022 and TSI Kerala Chapter, Dr.P K Pradhan,President,TSI, M.G. Bijoy, Telemedicon Organizing Secretary, TSI Secretary,Dr. Murthy Ramila were among the dignitaries who spoke at the inaugural function. ISRO Chairman S. Somnath conveyed his best wishes through a video message.

Delivering the speech, Dr. Mohanan Kunnummal said that telemedicine has legal protection across the country, and with the shift to 5G, telemedicine will become popular. The advancement of technology and network connectivity will open up even better possibilities in telemedicine. He said that the days are coming when many modern technologies will have a decisive impact on telemedicine. Virtual reality and augmented reality will open up more opportunities for telemedicine. “The new technologies will help create the impression of getting tested sitting next to the patient,” he further added.

Dr. Prem Nair, Chairman of Telemedicon 2022, President of TSI Kerala Chapter, and Group Medical Director of Amrita Hospitals, delivered the introductory speech. He said telemedicine could help bring down the cost of health care. He also noted that 5G connectivity will strengthen the telemedicine system across the country, saving the time it takes to save the lives of critically ill patients and that telemedicine can be used effectively in situations where a wearable device is used.

“We are one of the early adopters of telemedicine in the state of Kerala. It primarily started as a programme to bridge the physical distance between care providers and patients, he said. Now we are making use of state-of-the-art technologies to expand telemedicine services. Our expertise, clinical care, technology research, and social commitment help us deliver technology-enabled care. “When we started our activity in Kerala in 2002, in association with ISRO, we aimed to provide early healthcare services at affordable cost. Today, after 17 years, we provide telemedicine services to 60 national and nine international centers,” he added.

ISRO Chairman S Somnath attended the conference virtually. He explained the steps taken by ISRO in the initial phase of telemedicine. He said that the growth and integration of technologies are very promising. Telemedicine will witness revolutionary changes as connectivity facilities further improve. Telemedicine connectivity can be strengthened, and the services can be expanded in rural areas with the spread of connectivity through satellites. He pointed out that there will be significant changes in healthcare services with the improvement of connectivity between patients and doctors through applications.

Kerala IT Secretary Ratan Kelkar said, “Startups, private entrepreneurs, and technology partners should come forward to promote telemedicine. He also mentioned that greater participation is essential for the sector’s growth as 5G has provided the best background.Also assured all the support for the digital health initiatives in Kerala”

Expert speakers from WHO presented the Telemedicine Guidelines released by WHO and also about advancements in AI.

Govt of India’s Telemedicine platform was detailed by E-Sanjeevani Man Dr.Sanjay Sood.

The Valedictory function was inaugurated by Mr. K.S. Srinivas IAS, Principal Secretary, Tourism. Mentioned about the possibilities of health tourism connecting Telemedicine.

Public Consultation on the draft ‘Digital Personal Data Protection Bill, 2022’

The Ministry of Electronics and Information Technology invites feedback on the draft ‘Digital Personal Data Protection Bill, 2022’.

Ministry of Electronics and Information Technology has been deliberating on various aspects of digital personal data and its protection, and has formulated a draft Bill, titled ‘The Digital Personal Data Protection Bill, 2022’.

The purpose of the draft Bill is to provide for the processing of digital personal data in a manner that recognizes both the right of individuals to protect their personal data and the need to process personal data for lawful purposes, and for matters connected therewith or incidental thereto.

The draft Bill employs plain and simple language to facilitate ease of understanding and is available on Ministry’s website at https://www.meity.gov.in/data-protection-framework, along with an Explanatory note that provides a brief overview of its provisions, which is available at https://www.meity.gov.in/data-protection-framework

The Digital Personal Data Protection Bill frames out the rights and duties of the citizen (Digital Nagrik) on one hand and the obligations to use collected data lawfully of the Data Fiduciary on the other hand.

The bill is based on the following principles around the Data Economy: The Bill will establish the comprehensive legal framework governing digital personal data protection in India. The Bill provides for the processing of digital personal data in a manner that recognizes the right of individuals to protect their personal data, societal rights and the need to process personal data for lawful purposes.

The Ministry has invited feedback from the public on the draft Bill. The submissions will not be disclosed and held in fiduciary capacity, to enable persons submitting feedback to provide the same freely. No public disclosure of the submissions will be made.

The feedback on the draft bill in a chapter wise manner may be submitted on https://innovateindia.mygov.in/digital-data-protection/ by 17 th December 2022.

Special Note About the Digital Personal Data Protection Bill, 2022

Bagmisikha Puhan
Associate Partner, TMT Law Practice

The Ministry of Electronics and Information Technology (MeitY) released the latest iteration of the data protection framework, christened as the Digital Personal Data Protection Bill, 2022 (Bill) for public consultation. At the outset, it appears that the Bill has sought to ease compliance requirements applicable upon start-ups, and has scrapped the erstwhile data localization requirements, which have been a consistent inclusion within the previous iterations issued by MeitY.

The preliminary relevant highlights of the Bill have been captured herein:

The objective of the Bill has been watered down, to remove protection of interest and security of State, and refocuses on the need to process digital personal data in a manner, which recognizes the right to privacy of individuals, who’s data is being processed by an entity.
The qualified title adding “Digital” seems to reflect the association of this Bill, with the slew of policies the Government intends to roll out to achieve a “Digital India”.
The Bill does not scope in non-personal data and has diluted the scope of what would constitute as harm, to an individual for the illegitimate processing of their data.
The definition does not address “loss of reputation”, “loss of employment”, “psychological manipulation”, and has been provided broad stroke indicators for what would constitute as harm under the Bill.
The Bill has extra-territorial application and extends to any businesses which process Indian user data in connection with any profiling of, or activity of offering goods or services to Indian users within the territory of India.
The Bill has rechristened the chapter on Grounds for Processing of Personal Data without Consent from the previous iteration to Deemed Consent, for optics and ease of understanding for the user.
Data fiduciaries are required to notify the Data Protection Board, to be constituted in accordance with this Bill, in the event of a personal data breach; this may create overlap in compliance obligations, as data fiduciaries are required to report personal data breaches to CERT-In as well.
The Bill permits for contractual arrangements with sub-processors as well; and has limited the scope of data principal rights from the previous iteration. The Bill does not provide for a right to be forgotten, right to data portability; this may be intended towards easing the compliance burden on start-ups, as it may necessitate massive technological overhaul to be able to offer such rights to the end users. The Bill further provides a right of grievance redressal to users, as well as a right to nominate an individual to exercise such rights, in the event of the death of the data principal.
Significant Data Fiduciaries, which will notified by the Government basis the volume of data processed, risks, shall be required to appoint a Data Protection Officer as well as an Independent Data Auditor, to review the organization’s compliance with the provisions of the Bill.
The Bill does not provide any references to compliances necessary to transfer data outside India. The Central Government has retained the power to notify such countries where cross border data transfers may be executed, upon an assessment of factors to be specified at a later stage by the Central Government.
The Bill permits entities to make a voluntary undertaking with respect to any compliance requirements, where a proceeding has been initiated before the Data Protection Board. A similar provision was included within the draft Telecommunications Bill, 2022; we surmise that such provisions are intended to reduce dispute resolution proceedings in front of the Board. An appeal against any order of the Board shall lie to the High Court.
The Bill caps the financial penalties for violation of the provisions of this Bill at 500 crore rupees. The Bill further provides for a penalty against a data principal, where the data principal has submitted a frivolous grievance with the Data Protection Board.

Global Digital Health Summit at Delhi

Global Digital Health Summit was held at Vigyan Bhavan, Delhi and was called an action summit. It led to important launches which will pave the way for ‘Digital Health for All by 2028.’ This is envisaged to be critical for the success of India’s journey in digital health. This summit witnessed the following launches:

Release of ‘Digital Health For All by 2028’- Declaration by Dr. Jitendra Singh, Hon’ble Union Minister of State, Prime Minister’s Office
Launch of the first Women’s Health Guideline with a holistic approach
‘Project Concern- 2028’ for taking Digital Health to pharmacies across India
Campaign on ‘Women for Digital Health’

Telemedicine – News from India & Abroad

Telehealth Program Helps Reduce Blood Pressure

After 12 weeks of a telehealth support program, with or without support from a dietitian, people with elevated blood pressure saw improvement.A research team led by Alexander Chang, M.D., Geisinger nephrologist enrolled two groups of patients with high blood …Readmore

Artificial Intelligence Tailors DNA For Drug Development

Artificial Intelligence Tool Predicts Decreased Blood Flow to the Heart

The artificial intelligence tool developed used computed tomography (CT) scans to spot patients at risk of reduced blood flow to the heart.Blockages of the coronary arteries typically occur due to the buildup of fatty plaques. This may restrict blood flow to the heart, causing chest pain, heart attacks …Readmore

Skin-like Electronics Help Monitor Health

A skin-like device developed by researchers does a personalized analysis of the tracked health data while minimizing the need for its wireless transmission. Worn routinely, future wearable electronics could potentially detect possible emerging health problems — such as heart disease, cancer…Readmore

Click here to Become a Member of Telemedicine Society of India

Telemedicine Practice Guidelines – A Foundation Course for RMPs by TSI Faculty

To know more about the Telemedicine Foundation Course click on the link below:
https://tsitn.org/tpg-course/

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

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

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

Tele-health-Newsletter October 2022

Click Here to Download PDF Version

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

What is New?

Next month comes the annual meeting at Kochi and preparations are in full swing. This will hopefully be a good face to face meeting with some online components. The program is still not out there but we are sure it will be a very engaging program.

This month we see the inauguration of Telemedicine Society of India’s J&K chapter. Wish the chapter all the very best.

October has been a quiet month for telehealth with all the other festivities. The highlight of this issue is the work of our member Indiritta Indiritta Singh Dmello with a NGO called ‘Hospital Guide Foundation’ that works for upliftment of healthcare in remote locations.

The COVID menace is not yet gone but we are learning how to live with the virus, do take your precautions when you travel for the conference.

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

Hospital Guide Foundation – Working in Villages to Uplift Healthcare

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)

Inspired by Gandhiji’s quote “The future of India lies in its villages” Hospital Guide Foundation (HGF) has been working towards strengthening India’s villages with a focus on rural health.

With the concentration of Doctors in the Urban areas and more than two-thirds of Indians living in villages, there is a huge shortage of Doctors in the rural areas. (A shortfall of 79.9% specialists) https://main.mohfw.gov.in/newshighlights-90

The major disease burden in India resides in Non-Communicable Diseases (NCDs) such as Heart and Lung diseases, Stroke, Cancer & Diabetes. Nearly 5.8 million people in India die due to NCDs making it a leading cause of deaths. The majority of premature NCD deaths are preventable. NCDs cause considerable loss in potentially productive years of life and hence inflicting a burden on the socio-economic development of India (Ref –https://www.wbhealth.gov.in/NCD/)

Hospital Guide Foundation (HGF) ensures comprehensive Quality Healthcare is accessible in the rural areas with a focus on Non-Communicable Diseases free of cost. It works with an effort to have a sustainable impact supported by Corporate Social Responsibility and is currently working in Western Uttar Pradesh, impacting masses of people annually and hoping to hit a million by 2025, by expanding to the entire state and then the entire country.

For effective last mile connectivity, HGF works with the Pradhans of the villages with a two-pronged strategy of spreading awareness followed by action. It uses Telemedicine as an enabler to address the gap where there is a lack of sufficient Doctors in the rural areas. To have a sustainable and successful Telemedicine program, HGF deploys a holistic approach with seamless processes and optimal technology hence achieving better results. It ensures tests, medicines, counseling is given (about the process, disease & treatment), right expectations are set, ensures compliance (tests, medicines & life style) and pro-active follow ups. Multiple touch points are managed seamlessly between patients, nurses, Doctors and telemedicine specialists for enabling a great healthcare experience against a harsh backdrop of poor infrastructure be it roads, electricity or internet. Hence optimal technology is deployed for a superior Doctor-Patient experience as the quality of communication has a direct impact on the diagnosis, prognosis and treatment.

Regular Health camps are conducted to drive awareness and reach the masses. Post the health camps, patients are linked to HGF’s telemedicine program to ensure continuum of care.

HGF’s focus on quality processes and alliances with the best institutes such as AIIMS, National Heart Institute, Sita Ram Bhartia Institute of Research & Sciences, Dr Dang’s Path lab has ensured that the best care is provided.

Being the most stringent form of an NGO (licensed by the Govt of India, Company U/S 8 for charitable purposes) only reinforces the core values it stands for – Ethics, Competence and Compassion. It has been featured by many prominent media houses like Economic Times, India Today, Hindu and internationally covered by BMJ Innovations (British Medical Journal). The Advisory Board comprises of stalwarts like Dr. M.C. Misra, Ex Director with AIIMS (appointed on HGF’s Advisory Board on approval of the Union Health Ministry while he was the Director) handholding HGF through all its processes to ensure quality delivery. The Director of HGF, Indiritta is an Oxford Graduate with a PG Diploma in Medical Law & Ethics from the National Law School, Bangalore, who works relentlessly towards achieving HGF’s dream of a Stronger Healthier Rural India.

A case study of HGF’s work featured in a top Medical Journal and a success letter from the Government of Uttar Pradesh is a testament to the quality of work being done on the ground. However, the truest and most rewarding testament is from the patients itself!

Curtain raiser Webinar for TELEMEDICON 2022

“Strengthening Health Systems through Sustainable Telemedicine and Digital Health”
in Association with Telemedicine Society of India Kerala Chapter, Amrita Hospitals & Journo Med
26 October, Wednesday, 8:30 PM

A curtain raiser webinar for TELEMEDICON 2022 was conducted at Amrita Hospitals with Telemedicine Society of India Kerala Chapter, on 26 October.

The theme was “Strengthening Health Systems through Sustainable Telemedicine and Digital Health”

With the significant increase in technological usage at all levels, Telemedicine and Medical Informatics are expected to grow at a considerable pace in the upcoming years, which enhances the growth of the MedTech space. . The significance of Telemedicon 2022 is to discuss the future of Telemedicine which holds immense potential in the healthcare sector. The pandemic catalyzed the pace and the growth dimension in the field of Telemedicine and digital health.

Topics Discussed

How Remote Patient Monitoring is Changing the Healthcare Services
How to Implement Telemedicine in Daily Practice

Expert Speakers

Dr. Rajesh Pai, Chief Operating Officer, BMH Gimcare Hospital, Kannur
Dr. Uma Shankar, Principal, Padmashree School of Public Health Bangalore, Managing Director – Med.Bot

Telemedicine Society of India (TSI) Maharashtra Chapter Organizes Annual Conference Mahatelemedicon 2022

The Maharashtra Chapter of TSI recently Organized Mahatelemedicon 2022-on 17 Sep 2022 in association with DY Patil Medical College and Research Centre (DYPMCH-Pimpri).

The conference was well attended and had unique highlights.

Two credit points were awarded to participants by Maharashtra Medical Council.
There was a poster and an essay competition on the theme My Idea of Telemedicine
A Product Theatre on connected care devices was presented by Dr SV Kulkarni.

The conference was inaugurated by Dr Yashraj Patil Trustee and Treasurer DYPMCH-Pimpri Plenary Oration was by Dr Ganapathy on the topic- DIGITAL HEALTH IN 2030 : A PEEP INTO THE FUTURE.

Keynote addresses were given by Vimal Wakhlu and Dr Gaur Sundar. They spoke on AI in health care and Ayushman Bharat Digital Mission respectively.
Dr Bagmishika Puhan gave an excellent presentation on medicolegal aspects of telemedicine.
Dr Suchitra Mankar -current President of TSI-MH conducted a quiz on Telemedicine Guidelines in which there was very good audience participation.

The entire chapter worked and contributed to the success of the conference.
Notably, Constant guidance and mentorship was provided by Dr BS Ratta.
Dr JS Bhawalkar (Dean DYPMCH) provided immense support in venue and infrastructure.
Dr SV Kulkarni-President elect and Dr Prachee Sathe provided excellent liaison and sponsorship.
Dr Suchitra Mankar (President) and Dr Prashant Kulkarni (Organizing Secretary) planned and executed the entire conference efficiently and effectively.

TSI MH has been very active and dynamic in 2022. Besides Mahatelemedicon, an annual conference by a State Chapter, they have hosted many events like Telemedicine Quiz for all doctors of Pimpri Chinchwad and for Indian association of Occupational Health; Teleophthalmology Conference; Tele physiotherapy conference to name a few.

Lamp Lighting Ceremony

Dr Ratta felicitation the poster winner

**The Chairpersons, The Org Secretary and the MC-Dr Sayali Shinde enjoying the moment**

AI assisted model to predict bone repair outcomes for various fracture-treatment methods

AI-based simulation model can potentially help a surgeon choose the right implant or technique before a fracture-treatment surgery.
Developed at Indian Institute of Technology Guwahati.

Researchers have developed Artificial Intelligence (AI) model to predict the healing of thigh bone fractures after surgery. The model developed by Dr. Souptick Chanda, Assistant Professor, Department of Biosciences and Bioengineering, IIT Guwahati, and his team can be used to assess the healing outcomes of different fracture fixation strategies so that an optimum strategy can be chosen for the patient depending on their personal physiologies and fracture type. Using such precision models can reduce the healing time, lighten the economic burden and pain for patients who need thigh fracture treatment.

The results of this research have recently been published in the open-source journal, PLoS One, in a paper co-authored by Dr. Souptick Chanda and his research scholar, Mr. Pratik Nag.

Speaking about the research, Dr. Souptick Chanda, Assistant Professor, Department of Biosciences and Bioengineering, IIT Guwahati, said, “AI has tremendous potential when it comes to understanding and predicting complex biological phenomena and hence, can play a big role in health sciences applications.”

The research team have used a combination of Finite Element Analysis and the AI tool, Fuzzy Logic to understand the healing process of fracture after various treatment methods. Various bone-growth parameters were used along with a rule-based simulation scheme for this purpose. The study further examined the influence of different screw fixation mechanisms to compare the fracture healing efficacies of each process. The predictions of healing made by the model agreed well with experimental observations, pointing to its reliability.

IIT Guwahati’s AI-based simulation model can potentially help a surgeon choose the right implant or technique before a fracture-treatment surgery. In addition to various biological and patient-specific parameters, the model can also account for different clinical phenomena, such as smoking, diabetes, etc. The model can also be adapted for veterinary fractures which are, physiologically and in various aspects, similar to those occurring in human patients.

The researchers plan to develop a software/app based on the algorithm that can be used in hospitals and other healthcare institutions as part of their fracture treatment protocols. The team is presently collaborating with Dr. Bhaskar Borgohain and his team of orthopaedists from the North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences Hospital, Shillong, for animal studies to validate and fine-tune certain parameters.

Research done by IIT Guwahati researchers is useful because the incidences of thigh-bone and hip fractures have increased significantly due to the increasing geriatric population in the world. An estimated 2 lakh hip fractures occur every year in India alone, most of which require hospitalisation and trauma care. Treatment for hip fractures traditionally includes bone plates and rods to bridge the fracture site and promote bone healing. Fracture treatment methods are intuitively chosen by surgeons based on their experience, and there is no way of predicting the efficacy and success of the treatment method chosen. The research from IIT Guwahati will help increase the accuracy rate in decision-making in orthopaedics, thereby reducing the cost and disease burden associated with fracture recovery.

IIT Guwahati is working progressively in the field of medical technology and related fields. With the recent installation of Supercomputer facility PARAM KAMRUPA at the Institute, Artificial Intelligence, Data Science, and Deep Learning, among others, and their applications in the inter-disciplinary areas of health sciences, weather prediction and nanotechnology have got a major boost.

Telemedicine – News from India & Abroad

LifeHub+ App Links Patients, Doctors With Fitbit?

LifeHub+ app launched by telecom company StarHub links patients to their doctors with Fitbit data for better healthcare management.The LifeHub+ app provides two different ‘ConnectedCare’ plans to the patients– $9.99 monthly plan and $99.99 annual plan…Readmore

Are Smartwatch Health Apps Smart Enough?

Philadelphia, October 12, 2022 – Extended cardiac monitoring in patients and the use of implantable cardiovascular electronic devices can increase detection of atrial fibrillation (AF), but the devices have limitations including short battery life and lack of immediate feedback. Can new smartphone to…Readmore

Artificial Intelligence Helps Find Similar Cases, Diagnose Rare Diseases

A deep learning algorithm known as SISH (Self-Supervised Image search for Histology) teaches itself to learn features which can then be used to find similar cases in large pathology image repositories.The new machine learning tool acts like a search engine for pathology images and has many potential ….Readmore

Facemask can Detect Viral Exposure Within 10 Minutes?

Scientists have created a face mask that can detect common respiratory viruses, including influenza and the coronavirus, in the air in droplets or aerosols. The highly sensitive mask, presented September 19 in the journal Matter, can alert the wearers via their mobile devices within 10 minutes if …Readmore

Click here to Become a Member of Telemedicine Society of India

Telemedicine Practice Guidelines – A Foundation Course for RMPs by TSI Faculty

To know more about the Telemedicine Foundation Course click on the link below:
https://tsitn.org/tpg-course/

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

Submission may be sent to – tsigrouptn@gmail.com
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Editor in Chief – Dr. Sunil Shroff
Editors – Dr. Senthil Tamilarasan & Dr. Sheila John
Technical Partner- https://www.medindia.net

Tele-health-Newsletter September 2022

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Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

What is New?

The Personal Data Privacy act has been long overdue in India. It was introduced in the parliament in December 2021, to regulate personal and non-personal data jointly but was withdrawn in August 2022. The government has now put out the draft of the telecommunication bill that was put out recently for public comments (https://dot.gov.in/relatedlinks/indian-telecommunication-bill-2022). Comments may be sent on the email ID : naveen.kumar71@gov.in Last date of sending the comments will be 20th October 2022. This bill will influence the provisions in the data privacy act too.

The existing regulatory framework for the telecommunication sector is based on the Indian Telegraph Act, 1885. With advent of new technologies such as 4G and 5G, Internet of Things, Industry 4.0, M2M Communications, Mobile Edge Computing, AI and many more, the technologies are creating newer opportunities for India’s socio-economic growth. Therefore, India needs a legal framework attuned to the realities of the 21st century.

The draft bill covers conventional phone calls, text messages broadband connections and over-the-top applications, including WhatsApp defined as telecommunication services.

The worrying aspect is that the bill seeks the regulatory powers to control and management of, or suspending the operation of services without putting a review mechanism in place. The explanatory note to the bill says – “The Bill provides an enabling framework for the Central Government to address any situations of public emergency, public safety, or national security concerns. These provisions provide for the time-bound limited suspension of transmission of messages, or of provision of telecommunication networks or services while ensuring the rights of the citizens of India,”

The Supreme Court in January 2020 had said that such shutdowns should be temporary and periodically reviewed. No review mechanism has been mentioned in the draft bill and this will invite criticism. Such provisions will have a bearing on the Data Privacy Act too. The Sept Newsletter covers an updated information on Data Privacy Act from Ms. Bagmissikha Puhan.

It is now just another 6 weeks to the national conference of TELEMIDICON2022 at Kochi. Do register in large numbers to make this national event a success.

Wish all our members a Happy festivities during Navaratri.

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

Digital India Act and Pending Legislations

Bagmisikha Puhan
Associate Partner, TMT Law Practice

Siddhant Gupta
Associate, TMT Law Practice

The Data Protection Bill, 2021, introduced in December 2021, to regulate personal and non-personal data jointly, was withdrawn in August 2022, in view of the increased regulatory compliance upon start-ups, and persistent opposition from stakeholders on provisions of data localization, data transfer, and LEA access to such datasets [including anonymized data]. The absence of a comprehensive data privacy legislation compels stakeholders to rely upon sectoral guidelines, which while enforceable, may become more onerous, for want of a common thread across all sectors. It is expected that the Information Technology Act, will also undergo a complete overhaul, pending legislation with respect to data privacy . The intention of legislature is to create a future-proof, comprehensive regulatory landscape for the regulation of digital activities, the government has proposed to issue a set of legislations, to usher a comprehensive framework for information technology law and regulation.

The legislators propose to introduce the Digital India Act (DIA), to address the convergence in technologies, services, and devices in the digital ecosystem. The DIA is expected to govern aspects of regulation of intermediaries, over-the-top (OTT) platforms, and provide for guidelines around women and child safety on the internet. While the DIA is expected to be tabled in the winter session of the Parliament, the privacy legislation may be introduced only during the budget session.

Presently, the regulation of over-the-top platforms is not contemplated under any enforceable statute; DIA is likely to provide for a definitive classification for OTT services, and provide guidelines for developing appropriate self-regulatory methods, providing guidelines around classification of content, age verification mechanisms and other issues.

DIA is further expected to account for new age technologies, such as artificial intelligence, internet of things, blockchain, and address regulatory concerns. Keeping in mind the business friendly outlook of the regulators towards digital space, it is expected that there would be an evaluative criteria to determine the level of compliance for entities. With the existing telemedicine practice guidelines referencing the usage of AI, ML, and big data to the advantage of the platforms, as well as the practitioners, a little more clarity will drive the functionality of platforms in the digital health sector, better. Interestingly, the telecom regulator is also considering revisions around use of this technology in the telecom sector, which will be also something that the digital health world will rely upon.

It is expected that DIA will harmonize the legislations, regulations, amendments released within the last couple of years, with respect to social media platforms, digital services, and blockchain related business undertakings. Towards such end, the government had released a draft Non-Personal Data Governance Framework in 2021, for consultation, to enable controlled access to non-personal data for “sovereign, public good purposes”.

It is expected that the DIA shall provision for such controlled access to NPD, per the granularity criteria of DIA, to provide access to such aggregated data sets to public, private entities, for their intended use. It is pertinent to note that IRCTC had sought to capitalize on the passenger sets available and had introduced a tender for hiring consultants in order to formulate a passenger data monetization plan. For example, businesses may have access to estimated footfalls in a particular location based on ticketing volumes bound for the location through IRCTC’s monetized data. The scope of work was to be limited to sharing aggregated data and anonymous data for sharing with private and government companies; however, in absence of a dedicated central data privacy legislation, the tender has been temporarily put under review.

1. https://indianexpress.com/article/opinion/columns/why-we-need-to-build-a-framework-for-global-digital-governance-8160848/;
2. https://www.moneycontrol.com/news/business/drafting-of-new-data-protection-bill-almost-complete-as-centre-to-introduce-it-in-parliament-by-budget-session-ashwini-vaishnaw-9197031.html

TSI Mid-Term Conference – Proceeding and Recommendation Thereof

Mr. Farooq Ahmad Wani M. Tech.
Superintending Engineer, Electronics & Communication / Information Technology (E&C/IT),
Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar | State Nodal Officer (Telemedicine), Jammu & Kashmir

Department of Electronic Communication & IT at Sher-i-Kashmir Institute of Medical Sciences or SKIMS conducted the first TSI Mid-Term Conference 2022 in Jammu and Kashmir under the Aegis of Telemedicine Society of India on 25TH – 26TH AUGUST, 2022.

The Chief Guest of the Conference was Shri Rajeev Rai Bhatnagar, Advisor to Hon’ble Lieutenant Governor J&K and the Guest of Honour was Shri Bhupinder Kumar (IAS) Administrative Secretary, H& M E Department, J&K. The event was attended by faculty SKIMS, faculty from other Institutions, Administrative staff and students along with the national TSI executive members.

This event in Srinagar holds special significance as it is the first of a kind conference in this UT and this could give great impetus to the ongoing rolling out of ABDM in the UT.

As far as Telemedicine in J&K is considered, the Government of Jammu and Kashmir and The Indian Space Research Organisation (ISRO), both have contributed immensely to creating this facility at SKIMS along with 12 other Medical Colleges/District & Sub District Hospitals with SKIMS Telemedicine Centre as its hub.

Theme
The theme of the event had been carefully chosen – “Telemedicine in Special Conditions & Special Geographies” as we expected that the conference became a platform for discussing the role of Information Communication Technologies (ICT) in bridging the gap between the patient and the doctor in the terrains like J&K.

The theme was apt for the UT as it is a disaster-prone area and has the occurrence of earthquakes and floods, and turmoil prone. It also has extreme winter, making many of its parts inaccessible during winter periods. This is particularly true for Ladakh, Gurez, and Zanskar areas and some parts of the Jammu region which include Padar and Wud Vun, that remain cut off for more than six months in a year.

Telemedicine has the potential to play a bridging role in overcoming these challenges. Telemedicine also finds its use in places where large populations occasionally/periodically gather at a point in time, where the provision of medical care becomes the need of the hour; for example, the Government of J&K practices telemedicine during the Amarnath Yatra.

The Chief Guest along with the guest of honour inaugurated the two-day mid-term conference in presence of various other dignitaries.

Key Messages from the Dignitaries

Shri Rajiv Rai Bhatnagar who was the chief guest on the occasion in his address complimented SKIMS for pioneering services in Telemedicine. He said there needs to be more focus on telemedicine services in UT J&K attributing vast expansion in the medical area. He also said that critical services need to be accessible in remote places and access to masses to various services in telemedicine needs to be prioritized. He hoped that today’s event will provide us with better inputs and ideas to further improve upon the better patient care services.
Mr. Bhupinder, IAS, Secretary Health and Medical Education Govt. of J&K who was the guest of honour on the occasion said UT J&K has many inaccessible areas and has made a lot of strides to adopt digital services and the general public has been provided satisfactory services like comprehensive call centres, mobile ambulances in remote areas. He further said IT solutions including hospital management system are revolutionizing the functioning of hospitals. He underlined that user-friendly technology can be significant in the use of telemedicine services and emphasized training/capacity building of practitioners and said a lot more needs to be done to popularize telemedicine services to benefit the common man. He also highlighted various services being provided under the Ayushman Bharat Initiative in UT J&K including Ayushman Bharat Pradhan Mantri Jan Arogya Yojana. He said times like COVID made the adoption of technology much easier and brought greater work efficiency and the use of various applications generating sufficient data helps strategize policies for the future to come.
Director SKIMS Prof. Parvaiz A. Koul complemented the organizing team and thanked the Telemedicine Society of India for choosing SKIMS for the event and said that SKIMS is the only public hospital with a well-established Telemedicine Centre and said the department of Electronics and Communication/IT needs to be commended for their excellent work. He further said SKIMS recently digitized important service areas including patient registration, payment system, and report access which has been well received by the public and has facilitated patient care services here at SKIMS.
Prof. Tariq Gojwari, Dean Medical Faculty and organizing chairman, while speaking on the occasion gave a detailed account of Telemedicine services at SKIMS and said SKIMS is the only tertiary care centre with well networked digital platform which has so far benefitted the huge number of patients.
Prof. Prasanta Kumar Pradhan, President of the Telemedicine Society of India who joined online while addressing the audience said that it is the first mid-term conference organized by the Telemedicine Society of India in J&K. He emphasized the use of digital technology in health services. India has adopted digital technology which has been a game changer and has brought greater accountability and accessibility to health care services, he added.
Dr Murthy Remilla LN, Hon. Secretary TSI, welcomed the dignitaries and the guests. At the outset he, complemented the Director SKIMS for allowing the conference at such short notice. He urged, not to see the quantity but quality of the conference which is at par with any national level conference, that too at such short notice. He further said that this meeting is the only such conference outside the headquarters of TSI, and will act as a precursor to the Annual Conference of TSI at J&K in future. He congratulated the team and appreciated the efforts of organizers, dignitaries, guests and SKIMS administration. Regarding Telemedicine at J&K, he emphasized the need for champions for utilizing the Telemedicine system and leaders making the people make use of the system by the convergence of technology for the implementation of Telemedicine and take forward this technology state-wide. He concluded by advising the audience to leave with good memories and utilize Telemedicine to provide good services to patients.
Er. Farooq Ahmed Wani, organizing secretary of the event welcomed the guests and thanked Rajiv Rai Bhatnagar and other dignitaries for attending the event. He gave a detailed account of the activities of the Telemedicine Society of India vis a vis Telemedicine services at SKIMS. He said Telemedicine Centre at SKIMS is an essential link in providing the best health care services state-wide and has served as the nerve centre of the JK Telemedicine network, particularly in various disaster situations like the 2005 Earthquake, 2014 Floods and the 2019 Covid 19 Pandemic. He thanked Director SKIMS for supporting and facilitating the event.
Mr Vimal Vakhloo former president of TSI also spoke on the occasion and Er. Parvaiz A Bhat co-organizing chairman and Chief Engineer SKIMS were also present at the event.

PROGRAMME
The event had a total of 10 sessions of one hour each, spanned over 2 days (5 each day) where each session had 3 slots for presentation or panel discussion. Day first had the first 2 sessions merged and the inauguration session in the afternoon and the day second had a valedictory function at the end. The following is the list of topics for each session.

Besides the usual scientific programme the event focussed on newer emerging digital technologies which are influencing telehealth, strategy besides showcasing the ABDM initiatives.

In the last two decades, the domain has progressed a lot and is still expanding like Artificial Intelligence, Machine learning, imaging informatics, 5G network, cloud, blockchain etc. having potential in healthcare and professional education.

OUTPUT
As evident from the discourse of this conference, the future holds enormous opportunities in the usage of these technologies which are becoming simpler and less expensive day by day and many of them are patient-centric applications in home settings.

The COVID-19 pandemic demonstrated the potential telemedicine offers in augmenting health systems capacity in the UT. During the pandemic, there were operational challenges at multiple levels and there was an urgent need to find the right solutions for contactless healthcare delivery where SKIMS has efficiently used its telemedicine resources to the full extent by using Telemedicine and virtual meetings as the crucial link between all the stakeholders in tackling the pandemic.

Following the outbreak of COVID-19, India’s government has launched new telemedicine guidelines to help healthcare professionals and the ICT industry provide medical services to the population during the lockdown. Even as the health systems transformation envisaged through establishing primary care networks and health and wellness centres under Ayushman Bharat are being established, the Telemedicine Guidelines 2020 provide the opportunity to leapfrog and invert the healthcare delivery paradigm.

Large-scale telemedicine practice in UT would also facilitate the adoption of electronic health records and thereby realize the grand vision for the digital health backbone as envisaged in the National Digital Health Blueprint and strategies outlined by Niti Aayog in Health Systems for a New India: Building Blocks—Potential Pathways to Reforms.

In Summary
As with all technological innovations, telemedicine will be as best at the hands of human experts who leverage it to their advantage. It would be paramount that the health professionals at SKIMS leverage telemedicine to their competitive advantage.

In the long term, empowering citizens, and enhancing user experience in healthcare delivery are likely to improve health-seeking behaviour.

It is high time that digitalisation, cloud solutions, and analytics technologies are leveraged in the healthcare setting, especially at SKIMS. Digitally connected processes enable paperless operations. It is high time for a perception change of viewing IT as an enabler of healthcare delivery.

Further, the process of health planning needs to evolve through the use of Telemedicine in healthcare delivery and distribution and public health decision-making at every level.

AI for Radiology Being Used in Russia

Ms. Filippova Anna
Diagnostics and Telemedicine Center, Moscow Health Department.

Smart algorithms aids doctors in 15 research areas. Now neural networks determine the signs of arthrosis in the knee joint on x-rays and emphysema on computed tomography. This was announced by Ilya Tyrov, Deputy Head of the Moscow Health Department.

“Thus, smart algorithms help doctors in 15 research areas. In total, it already has processed more than 7 million x-rays studies. Further, we intend to expand the application of AI to 29 different areas.” he said.

AI simplifies and speeds up the work of a doctor. It detects and reports even minor deviations and report about it. The doctor receives a picture already marked by the algorithm and describes it independently.

“The radiologist may disagree with artificial intelligence and make a decision himself. The use of such services is not intended to be a substitute for the work of a specialist. You can draw an analogy between modern dictionaries and old ones. You had to open the dictionary and spend a lot of time looking for the right words, now you just need to click on the right link,” said Yuri Vasilyev, Chief Freelance Advisor for Radiation and Instrumental Diagnostics of the Moscow Healthcare Department, CEO of the Center for Diagnostics and Telemedicine.

Nowadays, thanks to smart assistants, it has become less demanding for radiologists to find signs of lung cancer, COVID-19, spinal osteoporosis, thoracic aortic aneurysm, coronary heart disease, stroke, pulmonary hypertension, hydrothorax, as well as lung pathologies, breast cancer and flat feet on CT scans. Neural networks have been introduced into the work of Moscow institutions, which recognize symptoms of 7 different pathologies in one medical image of an X-ray examination at once.

An experiment on the introduction of computer vision into medicine was launched jointly by the Moscow Social Development Complex and the Department of Information Technologies on the basis of the Center for Diagnostics and Telemedicine. Since the start of the Experiment, AI services have processed over 7 million studies. The Center has become a platform for the development of artificial intelligence technologies in Russia, as well as support for domestic developers.

Briefly on the Diagnostics and Telemedicine Center: Diagnostics and Telemedicine Center was established in 1996. It is a top scientific and telemedicine organization under the Moscow Health Department. It specializes in AI implementation in medicine, researches radiation diagnostics, manages departments in medical organizations, including the telemedicine approach.

TELE ICU – Challenges and Solutions

Dr. Raj Raval
President of Telemedicine Of India – Gujarat Chapter

The Indian healthcare industry is under severe pressure owing to a large population and a massive shortage of skilled healthcare professionals including doctors, nurses and intensivist.

There is a shortage of intensivist in India, and the demand for them is only going to increase with the aging population.
India will have 5,00,000 ICU beds by 2023, but only 8,350 critical care specialists / Intensivist to monitor it
Need 50,000 Critical Care Specialists but has just 8,350, As per, the Indian Medical Association source.
Having timely access to critical care doctors, medical facilities and treatment centers is limited to only a small portion living in developed metro cities leaving a large part of the population living in rural areas without access to quality healthcare.
Lack of protocols driven ICU.
High Mortality Rate in ICUs.
Lack of real time interventions to treat patients.

How Tele-ICU Works
TeleICU is an advanced intensive care solution powered by revolutionary technologies that aim to offer round-the-clock critical care even in the remotest corners of the country.

TeleICU solutions allow hospitals to become robust in early interventions for critical care patients even when they lack professional resources like critical care specialists on-site. Through a multi-pronged, technology-driven approach, Entel Healthtech looks forward to providing best-in-class intensive care facilities to patients requiring advanced level care.

• Entel Healthtech is a technology-driven organization which aims at revolutionizing the existing healthcare infrastructure in the country. Founded by an expert team of medical specialists and technology veterans, Entel Healthtech looks forward to providing high-quality critical care to patients even in the remotest corners of the country, round the clock.
• Using advanced Artificial Intelligence tools and robust technologies, Entel Healthtech aims to solve India’s problem of lack of critical resources in the field of healthcare.
• An expert team of tele-intensivists keeps an eye on patient’s health and vitals using 24×7 tele-coverage feed acquired by the mobile kiosk. Along with real-time feed, they access the patient’s health records and information on on-going treatment.

Direct benefits for a Hospital & Patient through tele-icu

1/3rd Cost Saved through TeleICU Services
Shorter length of Stay for ICU patients
Lesser Mortality rates
24X7 remote monitoring “Crisis Prevention over Crisis Intervention”
Implementation of International Critical care best
Digitising ICU Data
Improving the quality and clinical output
Acts as an extra pair of Eyes & Ears in the Hospital ICU
Capacity Building of Bed Side Staff

Entel Healthtech has implemented Tele-ICU located at Godhara, Mahisagar district. The unit established in November 2021.

Saving Life Remotely
A 47- year old female patient, was admitted to General hospital Godhra on December 07 2021. On admission patients have symptoms like tachycardia, Breathlessness,. patient had known case of HTN/ DM .Patient have no any other previous medical history. And vitals are, BP- 190/109 mm hg, pulse- 125, Temp- normal.

Using technology developed and set up at a remote ICU, Team of Experience Critical Care Specialist at Entel Healthtech’s Command Centre clinically examined the patient thoroughly and showed stability in all vitals parameters. During this period of time necessary Reports like Blood investigation + ECG + Chest x ray + ABG had been done.

In this examination there was an abnormality found in ECG and ABG(Compensated respiratory acidosis ). CXR shows pulmonary congestion. By this way Patient was diagnosed with Acute congestive cardiac failure/COPD.

The TeleICU platform used to consult with the primary consultant and patient’s relatives about the future treatment and course of action.It was decided to give medication that can help to reduce chest congestion, control blood pressure and decrease breathlessness.

Throughout the observation and treatment period,Regular discussions were done with the primary consultant about regular reports and medication via TeleICU platform.The patient’s condition improved and he is getting better by each passing day.

These success stories will go a long way in accepting remote monitoring for critically ill patients.

Tele ICU Facility Inaugurated at Visnagar, Gujarat

Interesting Telemedicine Research Studies

a.Impact of Telemedicine on Prenatal counseling
The transition from an in-person consultation to a tele-consultation has been significant since the pandemic due to COVID-19. Expecting mothers with a pregnancy complicated by a fetal surgical anomaly were studied before using tele-consultation and after using tele-consultation by a team of researchers. A Mixed method study was performed on the expectant mothers, where both qualitative and quantitative data were analyzed. To know more, please click the link below.
https://www.sciencedirect.com/science/article/abs/pii/S002248042200470X

b.Exploring mHealth potential to improve kidney function: secondary analysis of a randomized trial of diabetes self-care in diverse adults

Individuals living with Chronic Kidney Disease (CKD) are likely to have comorbid Type 2 diabetes. A team of researchers used Telemedicine intervention to reduce the glycemic index in the patient and studied whether it reduced the progression of CKD. The telemedicine support intervention emphasized medication adherence, diet and exercise which significantly improved the individual’s glycemic index. The details of the study can be found by clicking the link below.
https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-022-02885-6

Telemedicine – News from India & Abroad

Your Smartphone can Now Measure Blood Oxygen Levels: Here’s How?
No need to search for pulse oximeters. Your own smartphone camera and flash can now help measure blood oxygen levels easily at home, suggests a new study…..Readmore

Can AI-Powered Robots Laugh at Human Jokes?
Artificial intelligence-powered robot Erica is now trained to laugh at human jokes. Since at least the time of inquiring minds like Plato philosophers and scientists have puzzled...Readmore

Artificial Intelligence Shows Promise in Tuberculosis Detection
An artificial intelligence (AI) system developed could help detect tuberculosis (TB) in chest X-rays at a level comparable to radiologists resources.TB is an infectious disease ….Readmore

Telehealth Linked to Reduced Opioid Overdose Risk?
During the pandemic, the extended use of telehealth for opioid use disorder is linked to decreased risk of overdose, revealed a new study.Published today in JAMA Psychiatry, this study was ….Readmore

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Telemedicine Practice Guidelines – A Foundation Course for RMPs by TSI Faculty

To know more about the Telemedicine Foundation Course click on the link below:
https://tsitn.org/tpg-course/

Report can be from 500 to 600 words
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Send full authors name, degrees, affiliations along with a passport sized photograph of good resolution. If multiple authors only main author photo to be sent.

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

Tele-health-Newsletter August 2022

Click Here to Download PDF Version

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

What is New?

The month of August issue has three interesting articles. The first is from Anay on consultations between two doctors, relating to the care of a patient, as telemedicine consultations and the legal requirements.

The second is from Prof Ganapathy about having a band of clinician scientists and clinical technologists to help with growth of telehealth. He also emphasizes the role of clinical research.

Teladoc has been in the news and we bring you the experience on how these telemedicine robots have the capabilities to carryout basic clinical examination (such as checking blood pressure and heart rate) on their own, as instructed by the doctors. At Meenakshi Mission, these robots have empowered the doctors to treat patients anywhere and anytime.

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

Teleconsultations between doctors

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

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

Telemedicine, as a practice, is typically associated with consultations that take place remotely between a doctor and a patient. While doctors are familiar with the Telemedicine Practice Guidelines, 2020(“Telemedicine Guidelines”) and its applicability to such consultations. However, it should be noted that the Telemedicine Guidelines has adopted a broader interpretation of what amounts to a teleconsultation, and classifies consultations between two doctors, relating to the care of a patient, as telemedicine consultations.

In practice, a doctor (“treating doctor”) may often need to consult with another doctor (“consulting doctor”) to determine the best course of treatment for a patient. For example, while consulting with a professional of another specialty or with extensive experience in treating a certain condition. Such consultations would generally take place when the patient is physically present with the treating doctor, but there is no bar on all three participants consulting remotely.

The mechanism for such consultations is largely similar to traditional teleconsultations between a patient and doctor. However, there are certain considerations that a doctor should be mindful of while engaging in a consultation involving another doctor.

Explicit Consent
The general principle is that when a patient initiates a teleconsultation with a doctor, their consent is implied. However, in case of a consultation between two doctors and the patient, even if the patient has initiated the consultation, it is best to obtain explicit consent from the patient for the consultation with both doctors.

In the event that the treating doctor initiates the consultation, explicit consent is required to be sought from the patient prior to proceeding with the consultation. Such consent may be obtained through a text message, email or voice recording, or the doctors may have the patient categorically confirm that he/she consents, and record the same. As a matter of practice, both the treating doctor and the consulting doctor should record the consent in their notes.

The treating doctor should also obtain explicit consent from the patient before sharing information or records with the consulting doctor, even if the patient has consented to the consultation.

Patient History
The consulting doctor may rely on the information provided by the treating doctor, including their findings in a physical examination. In addition, the consulting doctor may gather additional information from the patient, as they deem fit. The consulting doctor may recommend to the treating doctor that certain additional tests be carried out if required.

Control of case
As per the Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002 (“Code of Ethics”) the consulting physician is required to discuss the diagnosis treatment plan with the treating doctor, and should not take charge of the case.

In case of a consultation involving two doctors, the consulting doctor should be mindful that the case has not been handed over to them, and that the ultimate control rests with the treating doctor. The treating doctor must exercise professional discretion and determine how to proceed with the patient’s care.

While recommending a treatment plan, the consulting doctor should be mindful of the restrictions, if any, that the treating doctor may be subjected to. For example, if the treating doctor does not have the training to administer a treatment or procedure, the consulting doctor should clarify that the patient would need to seek such treatment from another professional. However, in doing so, the consulting doctor should be careful to not professionally undermine the treating the doctor or his treatment plan.

Necessity for formally dually trained Clinician Scientists and Clinician Technologists

Prof. K. Ganapathy
Past President, Telemedicine Society of India & Neurological Society of India | Hon Distinguished Professor The Tamilnadu Dr. MGR Medical University | Emeritus Professor, National Academy of Medical Sciences | Formerly Adjunct Professor IIT Madras & Anna University | Director Apollo Telemedicine Networking Foundation & Apollo Tele Health Services | URL: www.kganapathy.in

Healthcare necessitates bridging the gap between full time clinicians, full time medical researchers and full time engineers and technologists working in Healthcare. I have pioneered Stereotactic radiosurgery in 1995 and have always been interested in the use of Technology in Healthcare. In the article that has a link provided, I speak about the relevance in emerging economies and strongly supports the plan to create a band of clinician scientists and clinician technologists. This will also ultimately help the growth of Telehealth. The article is available at:https://issuu.com/verticaltalk/docs/ahhm-issue-57/20

2. RELEVANCE OF CLINICAL RESEARCH

The growth and development of any discipline or area ultimately depends on providing unequivocal scientific evidence that a particular facility / intervention in this case Telehealth (Remote Health Care) has indeed made a significant difference. Unfortunately in the real world priorities for clinical research takes a back seat. In this presentation I share “Lessons learnt & Opportunities missed: over 54 years in Clinical Research”. Hopefully the present generation with all the technology at its command will not only evangelise Telehealth but equally important produce hard core irrefutable evidence that telehealth needs to be incorporated into the mainstream of Healthcare.

Mobile Teladoc Health Robots at MMHRC

Mr. P. Sundarraj
Head – R & D, Meenakshi Mission Hospital and Research Centre, Madurai

In India, despite several advancements made in the medical field, the benefits are still available to the privileged who are residing mainly in the urban areas. It is known fact that 75 percent of the qualified doctors practice in urban centres, whereas the vast majority of India’s population live in the rural areas. To address the issue, Meenakshi Mission Hospital and Research centre in Madurai extends its support by establishing Telecare centres in remote rural areas. So far it is established 15 centres in and around southern Tamilnadu with the support of public undertaking sectors & corporate.

To bridge the health and technology intensively, MMHRC gone for next phase and establish India’s first telehealth robots.

First of its kind in India, Meenakshi Mission Hospital and Research Centre have deployed 16 mobile Teladoc (USA) health robots. The primary objective of the Teladoc robot is to argument the diagnostic abilities and efficiency of health care delivery of patients irrespective of their physical location.

The Teladoc telemedicine robots have the capabilities to carry out basic clinical examination (such as checking blood pressure and heart rate) on their own, as instructed by the doctors. As 10T devices, they can be used to control other advanced diagnostic equipment such as CT and MRI scan machine. These robots can collect and process data from other diagnostic equipment and present it to doctors to help them make precise clinical questions with the help of Teladoc, doctors from different disciplines, from all parts of the world, can come together to treat and monitor patients all the time.

At Meenakshi Mission, these robots have empowered our doctors to treat patients anywhere and anytime. Our ambulances will also be equipped with Teladoc robots. By doing this, the patient can immediately get in touch with the emergency and ICU specialists along with the other specialists of all departments. This means that specialists like neurologists and cardiologists can begin vital treatment even as critically all patients are on their way to the hospital.

We are all set to explore ways to use this novel technology to provide expert diagnosis from Madurai to patients in other parts of the country and put world class health care with in every ones reach.

Telemedicine – News from India & Abroad

Can Artificial Intelligence Detect Autism Early?
Artificial intelligence (AI) can soon be used to detect autism spectrum disorder (ASD) early, reveal researchers at the University of Arkansas.Han-Seok Seo, an associate professor with a joint appointment in food science…..Readmore

AI Algorithm Helps Cure Epilepsy
An artificial intelligence (AI) algorithm developed by researchers detects subtle brain abnormalities which cause epileptic seizures.The Multicentre Epilepsy Lesion Detection project (MELD) used over 1,000 patient…Readmore

New Stamp-sized Ultrasound Stickers can Monitor Your Internal Organs
New stamp-sized ultrasound sticker has been developed by a team of engineers in the US. The device can stick to skin and can provide continuous ultrasound imaging of internal organs for 48 hours….. Readmore

Can Artificial Intelligence Improve Stroke Diagnostics?
Artificial intelligence (AI) technology identifies when a patient is having a stroke caused by emergent large vessel occlusion (LVO), therefore making them a candidate for endovascular therapy (EVT)….Readmore

Click here to Become a Member of Telemedicine Society of India

Telemedicine Practice Guidelines – A Foundation Course for RMPs by TSI Faculty

To know more about the Telemedicine Foundation Course click on the link below:
https://tsitn.org/tpg-course/

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

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

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

Tele-Health-Newsletter July 2022

Click Here to Download PDF Version

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

What is New?

The executive committee (EC) of Telemedicine Society of India has for the last few months been working on amendments of the society’s bye-laws. In the last 20 years so much seems to have changed including the term telemedicine. First Medicine was replaced with health (Tele-Health) and then Tele was replaced with Digital. The amendments will be circulated by the secretary of the society (Dr.Murthy) and all members should try and send their input so that the new bye-laws are all inclusive. We have published the link here of the bye-laws for the convenience of the members and for their feedback. The Special General Body that was called for this purpose had only 30 members in a society of over 700 members.

The month of July also saw the physical meeting of the EC at Kochi to discuss these amendments plus review the arrangements for the forthcoming annual meeting in November at Kochi.

At Kanpur, Dr. Saroj Mishra put up a great meeting on AI in healthcare and at Srinagar Dr. Farooq Ahmad Wani celebrated the Digital Week – reports are enclosed.

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

Draft Bye Laws of TSI

Article I: Name of the Society
The name of the of the society shall be “Telemedicine Society of India” herein after referred to as “TSI” or the “Society”; an independent scientific body operating on a notfor-profit basis and not aligned to any particular political party or religion.

Article II: Title
These byelaws shall be called the byelaws of the Telemedicine Society of India.

Article III: Office of the society:
1. The registered office of the society shall be situated in Room No.303, 2nd Floor, School of Telemedicine & Biomedical Informatics (STBMI), Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Raibareli Road, Lucknow- Uttar Pradesh226014, India.

Article IV: Status of Society
1. The Society shall be juristic person and shall have a perpetual succession and can sue, and also be sued, in its own name through the person appointed by the TSI for the purpose.

Article V: Aims & objectives
1. The aims and objectives of the Society will be in furtherance of the activities it wishes to undertake in the field of digital health, and any ancillary activity which has to be accounted for the smooth and continued functioning of the Society. The specific objects have been outlined as below:

(i). To promote and encourage application of Telemedicine along with development, advancement and research in the field of Telemedicine/Telehealth/eHealth/Digital Health (which terms may be used interchangeably in different contexts) and associated fields; for improvement in the overall Healthcare access.

(ii). To promote, increase awareness on matters related to telemedicine, via all means and media which exist currently, or may be developed in future.

(iii). To encourage and promote application of telemedicine technology in clinical care, education and research in the health sector. The Society may work with any person for promotion of corporate social responsibilities of the companies, under the law.

(iv). Fostering networking and collaboration among interest groups in telemedicine technology and professionals from different streams of science, health care providers, policy makers, NGOs and industry.

(v). To promote training of students, health professional, research fellows and technicians in various aspects of telemedicine, on free of cost or suitable arrangement to meet out the expenses as the EC decides Also, to co-ordinate with academic institutions and premier think-tanks in the TM/associated field, industry associations, regulatory authorities, (like National Medical Commission/DCI, AICTE, DOEACC, as the case maybe); in developing curriculum for training courses and incorporating appropriate modules in the healthcare and associated training programmes.

(vi). To conduct regular meetings, symposia, seminars on matters related to digital health.

(vii). Spearheading the development of appropriate clinical and industry policies and standards, in view of adoption of and integration with Telehealth.

(viii). Disseminating knowledge in telemedicine field by publishing brochures, periodicals, and journals, through Society’s own website, or third party literature.

(ix). To work in close collaboration with scientific organizations and the industry in development and implementation of innovative products & services related to Telehealth. Organizing trade exhibitions during annual meetings of the society or at any opportune event.

(x). “To develop, co-ordinate and conduct knowledge and capacity building exchange programmes, with national/international organizations engaged in activities in the field of telemedicine

(xi). To work towards getting recognized as an accreditation body for Telemedicine/Telehealth/eHealth etc.

(xii). Spearheading or collaborating in the development of appropriate clinical and industry policies and standards, in view of adoption of and integration with Telehealth

(xiii). Facilitate Individuals/organisations to start/improve TM practice with proper networking and necessary guidance

Article VI: Definitions
1. In the interpretation of the Byelaws, unless there is something inconsistent or repugnant with the subject or context, the following words shall have the meaning given as hereunder:

(i).“The Society” shall mean the TSI Society having its registered address at School of Telemedicine, SGPGIMS, Raibareli Road, Lucknow

(ii).“Member” shall mean any type of Member as defined in article VII, whose application for Membership: has been accepted in accordance with the Byelaws and is a Member paying the appropriate subscription charge(s) as applicable to their category. For the purposes of proceedings under the Societies Registration Act, 1860 (the Act), no Member shall be entitled to vote or be entitled to the benefits of membership, if their subscription at the time of voting have been in arrear for a cumulative period of 2 months.

(iii).“General Body” shall mean the general body of the Society consisting of all the members of the Society. The General Body of the Society shall be comprised of President, Vice President, President-elect, Treasurer, Members of the Executive Committee and other Patron, Corporate, Professional, Startup and Academia Members.

(iv).“Executive Committee” (EC) is same as the Governing Body of the Society defined by the Act and shall mean the Committee that is constituted in accordance with Article IX of these Byelaws and to whom the management and affairs of the Society are entrusted. The Society shall have the following officers, who shall be the members of the Executive Committee – President, President Elect, Vice President, Immediate Past President, Hony.Secretary, Jt.Secretary,Treasurer and such other nominated members of the Society as confirmed during the AGM. The term of an EC will be for a period of 2 years.

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One Day National Workshop on Telemedicine & Artificial Intelligence held at the IIT Kanpur Outreach Centre in NOIDA

Prof. S. K. Mishra, MS, Dip NB, FAMS, FACS
Distinguished Visiting Professor,
Gangwal School of Medical Science and Technology,
Indian Institute of Technology, Kanpur

One day national workshop on Telemedicine & Artificial Intelligence was held on 2nd July 2022 at the IIT Kanpur Outreach Centre in NOIDA. This event was organized by newly launched Gangwal School of Medical Science & Technology, IIT, Kanpur in hybrid mode involving digital health policy makers from government, Telemedicine practitioners from medical community both from public and corporate hospitals and academics from technological institutions from country and overseas.

The workshop was inaugurated by Dr. R S Sharma, CEO, National Health Authority, Government of India who enlightened the participants on the activities undertaken at National level to facilitate rapid adoption on digital technologies for health in the care delivery pathway ensuring universal access to health care services. Earlier Prof. Ashutosh Sharma, former Secretary DST and currently Professor at IIT Kanpur welcome the chief Guest, dignitaries, invited speaker and participants. Professor Abhay Karandikar, Director, IIT Kanpur in his address spoke about the vision of IITK in setting up the School of Medical Science and Technology and various Centres of Excellence in the campus. He stressed the relevance of medical technology in advancing modern healthcare in particular and the need for self-reliance in making quality health services affordable and accessible to billions of population of not only India but low and middle income countries around the world.

The scientific sessions were divided into three sections, the first section covered detailed deliberation on policy and procedures on digital health by Mr. Vikram Pagaria from National Health Authority. The second section addressed the telemedicine technology and it’s applications in various domains like Radiology, Pathology, Surgery, Ophthalmology as practiced in public and corporate hospitals were addressed by medical experts. The National Telemedicine System using e-Sanjeevani was presented by C-DAC, Mohali in great detail. The future plan of development of Version 2.0 of e-Sanjeevani was announced which will have options of integration of third party medical devices in particular point-of-care diagnostics based on IoT technology. The third section focused on application of artificial intelligence addressing it’s usage in remote patient monitoring in ICU setting, Mental health, rural telehealth care system etc.

The concluding Round Table had a brain storming session involving more experts in additions to session experts to develop strategy and vision of developing actions plan in the upcoming centres of excellence in telemedicine and AI.

The list of Speakers include; Mr. Vikram Pagaria, National Health Agency, Govt. of India, Prof. K Ganapathy, Apollo Telehealth Network Foundation, Chennai, Mr. Praveen Srivastava, Associate Director & Head, Health Informatics Dept., C-DAC, NOIDA, Dr. Suchita Markan, Scientist E, Medical Device and Diagnostics Mission Secretariat, Indian Council of Medical Research, Rajesh Kaushish, Asst. Director, Dept. of Health Informatics & Medical Electronics, Center for Development of Advanced Computing, (C-DAC), Mohali, Dr. Arjun Kalyanpur, Chairman, Tele-radiology solutions, Bangalore, Dr. R Kim, Director, Arvind Eye Hospital System, Madurai, Dr. Sangeeta B. Desai, Head, Dept. of Pathology, TMH, Mumbai, Prof. S K Mishra, Distinguished Visiting Professor, Gangwal School of Medical Science & Technology, IIT Kanpur, Dr. Vijayakumar Chinnadurai, Scientist F. Cognitive control and machine learning center, INMAS Delhi, Prof. T K Srikanth, eHealth Research Center, IIIT, Bangalore Tele-mental Health Mission Task Force, MoH&FW, Govt. of India, Dr. Raghu Dharmraju, President, ARTPARK (AI & Robotics Technology Park)@ IISc, Bengaluru, Dr. Dileep Raman, Co-founder, Cloud Physician, Bengaluru, Dr. Presanna Desikan, University of Minnesota, USA, Mr. Vimal, Wakhlu, Former CMD, TCIL, DoT, Govt. of India & Vice President, ITU-APT Foundation, Prof. Sunil Shroff, Sr. Consultant Urology and Renal Transplant Surgeon , Madras Medical Mission, Chennai & President, Tamil Nadu state Chapter, TSI, Editor, TSI News Letter, Prof. P K Pradhan, Dept. of Nuclear Medicine, Nodal Officer, SGPGI, Lucknow Telemedicine Programme & President, Telemedicine Society of India, Prof. Anjali Mishra, Professor, Dept. of Endocrine Surgery, Member, SGPGI.

The workshop highlighted the necessity of telemedicine and AI in the health system in the country. In an effort, several govt. policies over the past couple of years led by the National Health Authority have paved the path for changing Indian healthcare through the advancement of AI and Telemedicine in healthcare.

In view of the inadequate healthcare, the speakers deliberated the below mentioned aspects:

The necessity of the work plan to transform the digital structure in the rural areas is devoted to developing telemedicine to provide quality healthcare services locally and at lower costs.

Artificial intelligence also plays a significant role in diagnostics and digital patent evolutions. An analysis of health-related data collected and measured by digital devices. AI-based systems in performing medical work in specializations including radiology and pathology are becoming increasingly prevalent and desirable in preventative medicine in the Healthcare domain.

Digital pathology plays a vital role in deep learning for identifying the target of interest. Also, highlighted the challenges in digital pathology image analysis. The nature of diagnostics has rapidly changed owing to an explosion in the availability of patient data for disease diagnosis.

Digital technologies in current surgical practices & potential AI contribute a new development to core the subfield of AI reviewed and identified the key concept and techniques within AI that are driving innovation across industries. AI has the potential to revolutionize the way surgery is taught and practiced with the future optimized for the highest quality patient care.

The guidelines of telemedicine were discussed and how to overcome the challenges like ethical concerns and lack of infrastructure in rural regions. Reimagining the healthcare industry by embracing telemedicine and AI.

The workshop concluded successfully achieved the aim by the valuable prospects from attendees. A compendium document will be developed in a fortnight time with further inputs with well laid down guidelines for the future activity at the Centres of Excellence on Telemedicine and Artificial Intelligence.

At Srinagar – SKIMS Celebrates Digital Week 2022

The department of Electronics & Communications/ Information & Technology and Hospital Administration SKIMS celebrates digital week showcasing various digital services at SKIMS.

Director SKIMS & Ex-Officio Secretary to Government, Prof. Parvaiz Ahmad Koul while speaking on the occasion emphasized for making all the services available in the hospital On-line to benefit patients as well as to enhance efficiency, transparency,accountability and accessibility, which are embedded with digital system and services , he said. He appreciated the department of E&C/IT, Hospital Administration for taking initiatives in this direction and making some of the services digital end-to-end in the hospital.

On the First day of the programme, a review was taken in the SKIMS Auditorium on the implementation of various digital services in the Administration of SKIMS like e-Office, e-Tendering, JKPaysys and other on-line services in these areas and also hands-on training on e-office implementation in un-covered areas of SKIMS was organized.

On the occasion Additional Director SKIMS & EOSSG (Mr. Gulzar Ahmad Shabnum), HOD Endocrinology (Prof. Bashir Ahmad Laway), Medical Superintendent (Prof. Farooq Ahmad Jan), Superintending Engineer E&C/IT, Er. Farooq Ahmad Wani) and Superintending Engineer Mechanical, Er. Muzaffar also addressed the audience and highlighted the importance of e-services.

The programme was attended by the officers/officials of General Administration, Hospital Administration, Materials Management, Finance & Engineering departments.

Issued through,
PR Office SKIMS

Namma Bengaluru Award for Dr. Bhaskar

Dr. Bhaskar received the prestigious ‘Namma Bengaluru Award’ under the Health care professional of the year 2021 category – recognising the service during the Covid 19 pandemic.

Telemedicine – News from India & Abroad

New Discovery on Mental Illness Indicators Using the AI

New research may lead to early diagnosis of devastating conditions such as Alzheimer’s disease, schizophrenia and autism — in time to help prevent and more easily treat these disorders, as done by Georgia State University’s TReNDS Center…..Readmore

Artificial Intelligence to Diagnose Birth Defects in Fetal Ultrasound Images

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Neuroendovascular Robotics Improves Safety of Complex Procedures

Through robotics, stroke surgery and other neuroendovascular procedures could be made safer and easier. A new multi-articulated, self-steering microcatheter for neuroendovascular surgery has the potential to increase technical precision….Readmore

Can Artificial Intelligence Help Predict Future Impacts of Coronavirus?

Developing Artificial Intelligence (AI) can help forecast the future impacts of the coronavirus, its variants and other evolving viruses, suggests a new study. The National Institutes of Health have awarded Michigan State University….. Read More

Click here to Become a Member of Telemedicine Society of India

Telemedicine Practice Guidelines – A Foundation Course for RMPs by TSI Faculty

To know more about the Telemedicine Foundation Course click on the link below:
https://tsitn.org/tpg-course/

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

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

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

Tele-Health-Newsletter June 2022

Click Here to Download PDF Version

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

What is New?

This issue covers important topics related to Tele-Neurology. We are hoping to bring such focussed newsletters from time to time.

This month also saw submission of draft guidelines of the National Medical Commission and includes some of the many recommendations sent to the apex body. These guidelines would have an impact on over a million medical practitioners of the country. Ms. Bagmishika Puhan our health technology lawyer with many others have submitted a document to NMC and so has TSI national body.

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

National Medical Commission, Registered Medical Practitioner (Professional Conduct) Regulations, 2022- Recommendations to the Draft Guidelines

Bagmisikha Puhan
Dr Sunil Shroff
Wing Cdr (Dr) Lavanian Dorairaj (Retd)
Col (Dr) Ashvini Goel (Retd)
Mayank Agarwal

An extensive review and multiple discussions have resulted in the following suggestions for implementation in the draft National Medical Commission, Registered Medical Practitioner (Professional Conduct) Regulations, 2022

Guideline 11 – Guidelines for Practice of Telemedicine in India: Enabling Registered Medical Practitioners to Provide Healthcare Using Telemedicine.

1. Under Scope at 1.2 – it is necessary to convey it to the practitioners that the exclusions are only rendering them to be outside the scope and applicability of these Guidelines and are not illegal in practice or otherwise. There is a lot of incongruity amongst the minds of the practitioners, with respect to cross-border consultations (during international holidays), standards and interoperability.

2. Under 1.4 – discussing Telemedicine Applications, there is reference to “emergency consult for immediate assistance or first aid etc.” – this should be amended to state emergency consult for immediate assistance, life-saving measures, first aid only with advice for immediate in-person consult or ER visit as available locally.

3. Under 3.2- Identification of the RMP and patient is mandatory – there is a requirement that RMPs should begin consultation by introducing themselves, with mandatory details – there is no clarification provided with respect to consultation in continuity of an in-person consultation/ follow-up consultation; this requirement should not be applicable in such situations.

4. Under 3.4, there is a mandatory requirement to have patient consent which has been further segmented into implied and explicit – depending on who initiates telemedicine consultation. It is imperative that this cannot be the case because tied to the telemedicine consult is the process of seeking personal and sensitive personal information of the patient and the applicable information technology laws mandate that the explicit prior written consent of an individual is acquired, prior to the collection and processing of any sensitive personal data so shared. Hence, while implicit consultation may be acceptable for initiation of a telemedicine consult, there is a requirement to process explicit consent prior to processing of sensitive personal information.

5. Prescription Template – There is a template provided within the proposed Guidelines which was also the same in the earlier iteration. It has requirements to the tune of having details about “provisional/appropriate diagnosis”, “LMP”, “special instructions”, “Investigations”, “Lab Findings”, “Chief Complaints” provided within the prescription.

a. While we agree that these parameters must be captured by the RMP, it is important to note that in the online set-up this prescription is also enabled to be shared with a pharmacy. Without any appropriate privacy laws in place, allowing such details to be shared ahead would not just trigger privacy concerns, but may also cause social stigma attached to medical conditions related to STDs/ VDs, Psychiatry-related, MTP, communicable diseases. Furthermore, it is not necessary for the pharmacist to review and retain information related to the “provisional/appropriate diagnosis”, “LMP”, “special instructions”, “Investigations”, “Lab Findings”, “Chief Complaints” – they need the seal, appropriate prescription made out, and the necessary details of the RMP for dispensation. This excessive sharing is in violation of the privacy of the individual, which has been recognized as a fundamental right by the apex court of the country in Justice KS Puttaswamy (Retd) v. Union of India.

b. It is noteworthy that these details can be retained by the pharmacy, and may be used for data analysis, which is not envisaged by the RMP or the patient and will amount to a strict violation of the privacy principles.

c. At pt. 9, there is a requirement that identification and contact details of the patient must also be added to the prescription – this is again inconsistent with the requirement, purpose of a prescription. This is also excessive in nature and is not in conformity with the template at Annexure 2.

d. There must be stress on digital signatures/ electronic signatures (including AdobeSign, DocuSign, etc.) to ensure that the prescriptions are properly time-stamped and are valid. In absence of this, where scanned files or images of signatures are used by the RMPs to issue a prescription – there could be abuse of this by online pharmacies, or the users themselves, to create / issue new prescriptions for seeking drugs.

e. There is also a requirement under pt. 9, that the e-prescription be valid for a period of 2 weeks from the date of issue or once a pharmacist dispenses the prescribed medications – this might not be a sustainable solution for chronic conditions – and also if a prescription is valid for 2 weeks only, the patient will have to pay further for issuance of another subscription even for a refill for a chronic condition or the likes – this provides platforms with an opportunity to deny treatment or deny dispensation of medication / drugs after a period of 2 weeks.

f. There is a separate template provided under Guideline 2 for writing prescriptions rationally. Similar template should be used for teleconsultations for reconciliation of digitization of electronic/ health records of the patients. The ePrescription for telemedicine consultations has excessive, and confidential data that is not relevant to the pharmacy. It is in fact a case summary and not a prescription. It should be made identical to a standard prescription as mentioned in para-Guidelines 2 Prescription.

6. The Guidelines do not permit technology platforms to indulge in providing ratings, feature testimonials of practitioners on the platform – this will be a hindrance to the users, for the ones who are not familiar with the region / practice of the physician – they tend to rely on these to be able to understand how the particular RMP may address a particular situation, or if they have good bedside manners in dealing with patients. This is indeed a guiding factor to the consumers/ patients of the platform – denying them this right, is impinging upon the users’ right to freedom of speech and expression. While the technology platform may be required to substantiate the ratings – to ensure parity with the listing the Guidelines should not strip this from the platform to enable users make an informed decision in engaging with an RMP for teleconsultation.

7. Under “duties and responsibilities of an RMP in telemedicine”, at para 15, there is a requirement for RMPs to ensure that their medical indemnity cover includes cover for telemedicine – we seek clarification with respect to legislative changes in line with this under professional indemnity and insurance norms.

8. Under “Consultations between RMPs with other RMPs” – there is mention of considering e- ICUs during emergencies like COVID-19 pandemic – remote areas invariably have a specific/ high demand for consultations of this nature. Limiting the prevalence of e-ICUs in cases related to emergencies like pandemics will defeat the purpose of this initiative.

9. Chapter 11 TPG2022 Para 3.5: There needs to be a distinction between a telemedicine consult with a NEW patient for the 1st time as compared to a telemedicine consult with an old patient for a new condition. In the latter case, many if not most details of the patient are already known to the RMP. So, in the latter’s case more Rx flexibility should be allowed.

10. Chapter 11 TPG2022 Para 3.7: Change “If the patient’s condition can effectively and appropriately be managed via telemedicine” to “Once the patient is triaged and the RMP is of the opinion that the condition can effectively and appropriately be managed via telemedicine”.

11. Chapter 11, 1.2. Autonomy and privacy of the RMP: add subpara 9: “The RMP has the right to announce that he/she is terminating the consult (along with the reason) if he/she feels that the same is a crank/prank or abusive call. Details of the same should be recorded to take forward legally, if so desired.”

Guidelines for RMPs and Technology Platforms

12. At 5.5, the onus of ensuring valid registration of the RMP is wholly on the owners and administrators of the technology platform. Owing to lack of continuous online/ physical access to national medical register or respective state medical councils’ registers, several tech platforms are already constrained to avoid onboarding such RMPs whose details cannot be verified by this process causing a loss of opportunity to the RMP and facilitating tech platforms to censure admission of such RMPs. A separate cell/ body should be created to enable platforms to achieve this or seek verifiable information from. There is no set pattern or manner provided to convey if the details of the RMP are legitimate or not; we seek clarification on this specific aspect.

13. At 5.7, tech platforms have been disbarred to counsel patients on the basis of AI and ML, it is pertinent to note that counsel is a wide term and may also include gathering of information from end users, triage of patients, provisioning of general information/ FAQs, which can all be done seamlessly, accurately by these automated tools without disrupting the functioning of the RMP. We are of the opinion that instances like triage, data gathering, or automated responses in form of FAQs be allowed by the usage of AI and ML.

14. At 5.9, its stated that the tech platform may be blacklisted for the violation of TPG by EMRB/ NMC, however, there is no avenue for RMPs to be able to access this publicly – a provision to that effect should be added. Following principles of natural justice, the tech platform should also be provided with opportunity to come back into the ecosystem in the event where this provision is triggered and made applicable to them.

15. It is also important to ensure that there is statement made to the effect that the TPG are technology agnostic and change in technology, mode and media of communication will not impact the compliance that is prescribed and expected under the laws.

In addition to this, our concerns with respect to the initial provisions of the draft guidelines are as below:

16. Chapter 2 Para 4: The prefix of Med Dr is not appropriate as a Doctor of Modern Medicine practices medicine as well as surgery. It would be better to continue to prefix Dr. followed by the full name and prefixed by the qualification. e.g. Dr. Name Family-name MBBS; Dr. Name family-name, MBBS, MS (xxx). The MBBS prefix clearly denotes modern medicine as compared to ayurveda or homeopathy.

17. Chapter 2 Para 4 (E): The RMP should be allowed train, utilize and to provide a certificate of competence to an assistant that he/she has trained under him/her. This would allow increased support in rural areas (especially via telemedicine) while ensuring that the responsibility of ensuring competency of the trained assistants rests with the RMP providing such certifications. This is to bring more clarity to this para with respect to point in chapter 2 para 10 (B) which essentially states the same.

18. Chapter 2 para 8: Suggest “Every RMP is expected to prescribe drugs using generic names” to “Every RMP, as far as possible, must try to prescribe drugs using generic names”.

19. Para 13 D: Suggest “the RMP shall fully digitize records.” To “the RMP shall digitize records.” This is because the efforts to digitize records may not be completed in 3 years.

20. Para 41 (8): An RMP cannot be restricted from practicing in any state. This would affect healthcare adversely especially government, armed forces, etc. doctors who are frequently transferred and who frequently travel to different states for short periods on temporary duty. It would also affect specialists who travel to different cities to provide specialist care to needy patients. Once a doctor is certified and registered in one state he should continue to be allowed to practice all over India as per need. He may, if he so desires, move to register in another state.

21. Chapter 10 CPD: No mention has been given as the age limit for mandatory CPD for registration license renewal. It is generally exempt for seniors. E.G. in Maharashtra it is 65 years after which a RMP need not CPD points for license renewal. Recommend an age limit of 60 years.

22. Under Chapter 2 concerning professional conduct of RMPs, at 9, there is a prohibition on fee splitting or commission imposed on RMP. In the event where the RMPs engaging with the tech platform, it is but obvious that the tech platform will be entitled to charge a fee towards the portal or services. This shall be a deterrent for the platforms. Also, this provision states that RMPs shall not use online forums for procuring patients – this is in conflict with the intent that may be evinced from an association of an RMP with a tech platform. For the entire ecosystem is premised on the fact that it allows the RMPs to widen their outreach, and also enables patients to identify and locate RMPs of their choice, accessibility and affordability.

23. In terms of prescription where the proposed guidelines expect that only generic names can be mentioned – it is worth considering that when RMPs use brand names, they are taking into consideration any enhanced efficacy in such drugs, affordability of the patient and also any positive feedback received or witnessed in their experience with other patients in consonance with their professional judgment. At times for chronic conditions, patients develop affinity, association with a particular brand over a period of time so prescribed to them; in this context, the substitution of the brand name with the generic name of the drug may erode their confidence in the advice of the RMP.

24. At the point of discussion of “Responsibilities of RMPs to each other”, it should be mentioned that in case of a treating physician and a consulting physician, there is a difference in the standard of care owed by an RMP, as opposed to the duty of care owed by the other. This was not mentioned in the earlier iteration, neither the first draft of the TPG, and this also does not find place here. As the draft regulations have delved deep into how relationships are forged or are perceived in case of ascribing duties and responsibilities, it must also consider commenting on the associated liabilities. Guideline 4 under “Assessment of attributability and the severity thereof” – at 2(9) indicates that the role that the doctor is expected to play will be considered – this could be expanded upon to bring out the specific relationship that exists between the treating and the consulting physicians/ RMPs. This becomes imperative in case of telemedicine consultation referrals, wherein the referred RMP may not have the necessary knowledge, history, comorbidities, with a particular patient, and must invariably rely upon the advice, inputs of the consulting physician.

We hope this is in order. We thank you for providing us with the opportunity to participate in this round of stakeholder consultation. We are willing to provide further information in this regard, should there be a need for the same.

Our group has also consulted several physicians, practitioners and have taken the liberty of providing changes to the draft so circulated, by including our suggestions within such document.

Teleneurology : Are we there?

It was in 2015 that the author had pointed out (https://www.neurologyindia.com/text.asp?2015/63/2/142/156274) that there was not a single neurologist or neurosurgeon for a population of 935 million Indians. With 773 districts in India likely to have a medical college, no doubt the urban rural health divide will reduce. However not in the life time of my great grand children will there be an equitable physical distribution of super specialists in India. Of the 675 million internet users (48% penetration) 80% use mobile networks. The slogan today is “ Roti, kapada, makan, and bandwidth” A strand of RNA acting as Global CTO has indeed radically transformed the deployment of telehealth worldwide. The 6000 odd neurologists and neurosurgeons cannot cater to at least 30 million(excluding neuro trauma and neuro infection) requiring their services ref (https://www.neurologyindia.com/text.asp?2014/62/6/588/149365.) Teleneurology is obviously the only solution to extend the reach of the super specialists predominantly located in urban and suburban India. It is gratifying to see that this is slowly being accepted by the consultants and the beneficiaries (DOI: 10.4103/0028-3886.232346)

There have been at least 20 publications in the last three years from India alone dealing with use of Telemedicine in various subspecialties of neurosciences including tele neuropathology (doi:10.4103/0973-029X.1859240 tele neurorehabilitation 10.4103/aian.AIAN_127_21, neuro trauma, (DOI: 10.1016/S0973-0508(04)80019-4, teleneurology during Covid-19 https://www.neurologyindia.com/text.asp?2020/68/3/555/288994 (telestroke (doi: 10.1111/ijs.12326) and Teleneurointensive care ( https://www.neurologyindia.com/text.asp?2021/69/2/245/314591) During the 2nd and 3rd wave many DM, M.Ch and DNB exams in neurosciences were conducted virtually using truly innovative methods https://www.annalsofian.org/text.asp?2020/23/4/429/290022

“Tele” is only a tool to achieve the end, which is making available the “neuro” component available in places where the latter does not exist., “Customer delight” is not a cliché used as marketing ploy. The role of the patient is changing. They are now at the center of self-care becoming a “digitally engaged” patient. Technology acceptance, behavioural modification, increasing digital infrastructure and requirements will cause a paradigm shift in delivery of teleneurology. For teleneurology to succeed the practitioners should strive to produce a “wow” effect. One needs to get into the mind of the end user. Healthcare is personal – it is very hard to feel your experience was excellent, when those treating you do not introduce themselves, or make eye contact, or say what they are doing to you and why. Conversely, when those simple things are addressed, the experience rapidly improves. Achieving excellence in healthcare is neither difficult nor expensive. It does not matter if care is cutting-edge and technologically advanced, if it does not take into account the patient’s goals. In fact it may not even be worth doing. Patients do not care how much the doctor knows. They want to know how much the doctor cares!!

Webside manners is replacing bedside manners of the 20th century. https://www.youtube.com/watch?v=BJYp7Ti8noo. Patient rapport is crucial particularly in neurology. 80% of messages are conveyed non verbally through body posture, voice intonation, the way one looks / sits, attire, movement of hands, arms and spontaneous smiling. The practice of medicine is an art, not a trade, based on science. This must be absorbed in the new science. Health care is a calling not a business.

Innovative methods like Group Telecounselling needs to be deployed. Contrary to a common misconception that doctor patient relationship is strictly confidential and always one to one, studies have revealed that patients are more @ home with other patients having similar problems. With acute shortage of neurologists and neurosurgeons, patients with common clinical conditions can be reviewed remotely in groups in one session eg seizures, post head injury sequelae, migraine etc. This would save time and be cost effective and enable larger numbers to get specialist care.

Distance has become meaningless. Geography has become History! The world will never be the same again. It is imperative that we accept and start deploying the “New Normal”. Technology enabled remote health care in neurosciences is here to stay.

Role of Telemedicine in Stroke

Veteran Major General Dr. S. Kumaravelu
Professor and Head Neurology, Ramesh Cardiac & Multispeciality Hospitals Pvt Ltd, Guntur

Stroke is the second leading cause of death after Coronary heart disease and the most common cause of disability in adults with huge social and economic burden. Telemedicine has revolutionised the management of stroke. It has a key role in prevention, hyperacute care, follow up and education of stroke. As regards prevention, it has a significant role to play in secondary prevention. We have regular telemedicine consultation for all our stroke patients to ensure proper diet control, and control of risk factors for stroke and ensure physiotherapy, both by a physiotherapist and caregivers.

Regarding hyperacute care, I shall narrate a different case scenario. Our patient a middle aged male was brought to our Emergency room at 11: 35 hours with history of sudden onset inability to speak, Confusion and staring look since 10:30 hours. He was a known patient of type 2 Diabetes Mellitus, Hypertension, Coronary artery disease with coronary artery bypass graft done and posterior circulation stroke on medication. He also had peripheral arterial disease as well with embolectomy done earlier. He came within a window period of 65 minutes. His imaging was done. His Magnetic Resonance Images and Angiogram are shown as Fig 1 and 2 respectively. The imaging was completed within 30 minutes. He was diagnosed as a patient acute ischemic stroke left middle cerebral artery territory with left middle cerebral artery occlusion. I, being the only Neurologist was away from the hospital. As the stroke was within 4.5hour window, it was decided to offer thrombolysis to the patient. Real time video consultation was given through a video portal. The family agreed to undergo thrombolysis. The thrombolysis clinical protocol was initiated. The indications and contraindications were enquired into. The severity of stroke was assessed using the NIHSS (National Institute of Heath Stroke Severity). His stroke score was 13. After taking informed assent from the wife, telethrombolysis was initiated with injection Actilyse 7 mg intravenous bolus followed by 63 mg intravenous infusion over the next one hour. Patient showed significant improvement with return of speech, and improving weakness of right half of body. Repeat Computerized Tomography angiogram of brain and neck revealed complete revascularization of the left middle cerebral artery.

Telestroke is an emergency telemedicine application that provides physicians with immediate access to neurologists who can support both the assessment and treatment of patients experiencing acute ischemic stroke symptoms. Using teleradiology to review Computerized Tomography (CT) images and videoconferencing solutions, the off-site neurologist can assess the patient and provide recommendations as to whether patients are candidates for thrombolysis and other interventions for acute stroke. The decision to use the thrombolytic (clot busting) agent tPA (tissue plasminogen activator) requires a Neurologist and the drug must be administered as soon as possible within the 4.5 hours following stroke onset. Telestroke is considered to be a key strategy to achieve equitable access to high quality care for stroke for all people. Without Telestroke, many patients living in and around communities lacking a neurologist would simply be denied the benefit of treatment with thrombolysis, or tPA, which is a best practice standard of care for acute ischemic stroke. This has been justified by the American Stroke association in their guidelines.

1. Telestroke/teleradiology evaluations of AIS patients can be effective for correct IV alteplase eligibility decision making.

2. Administration of IV alteplase guided by telestroke consultation for patients with AIS can be beneficial.

3. Telestroke networks may be reasonable for triaging patients with AIS who may be eligible for interfacility transfer in order to be considered for emergency mechanical thrombectomy.

4. Providing alteplase decision-making support via telephone consultation to community physicians is feasible and safe and may be considered when a hospital has access to neither an in-person stroke team nor a telestroke system.

Hence it may be concluded that Telestroke is the only solution to serve suburban areas and to increase thrombolysis rates.

Coming to the next aspect of telestroke, the most important aspect for advocacy and education regarding stroke is feasible through webinars and videoconferences. Imparting such knowledge will ensure equitable medical care beyond the urban limits to the needy patients in rural areas.

Fig 1. Magnetic resonance Image of the brain showing an acute infarct the left middle cerebral artery territory

Fig 2. Magnetic resonance Angiography showing occlusion of left middle cerebral artery.

Fig 3. Computerized Tomography angiogram of brain showing complete recanalization post thrombolysis.

Tele-Neurorehabilitation: A story from Mumbai

Prof. Nirmal Surya
Chairman, Surya Neuro Centre, Mumbai, Associate Professor, Bombay Hospital and Medical Research Centre, Mumbai.

Dr. Guhan Ramamurthy
Consultant Neurologist, Institute of Neurosciences and Neurorehabilitation, BG Hospital, Tiruchendur, Tuticorin.

Tele-Neurorehabilitation:
COVID-19 has ravaged economies, societies and human life across the world, and distanced people. The health care resources were strained and depleted. This had resulted in the inability of health care to cater to other non-COVID health services. With the increasing requirement of health care services, the inadequate reach of services to the needy patients and to make ends meet, the popularity of telemedicine emerged during these difficult times.

Telemedicine provides a platform for the exchange of information between the healthcare professionals, and the patient in arriving at the diagnosis and the management of patients. Telemedicine in Neurology (Tele-neurology) is useful for teleconsultations, tele-neurorehabilitation, and tele-research. The tele-neurology can be performed through mobile or computer-based applications. The Government of India has issued telemedicine guidelines for aiding the practitioners (https://www.mohfw.gov.in/pdf/Telemedicine.pdf). It is a prerequisite to obtain the patient’s consent (guardian’s consent in case of a minor).

Neurorehabilitation was no exception and had initially succumbed to the wrath of the COVID-19. However, the healthcare professionals had coped up with the new normal and adopted tele-neurorehabilitation. We were able to deliver tele-neurorehabilitation to patients with acute neurological deficits and chronic neurological deficits. It was useful to assess the patient’s deficit, formulate and tailor protocols to the requirements and needs of the patient and follow up on their progress. The tele-neurorehabilitation was as efficient as in-person neurorehabilitation in terms of clinical improvement. Further, the tele-neurorehabilitation had helped in providing the expertise in rural areas where it was scarce. The team members involved in tele-neurorehabilitation include a neurologist, physiatrist, physiotherapist, occupational therapist, speech and language pathologist, cognitive psychologist, nurse, social worker, and caregiver.

The story from Mumbai:
The Epilepsy Foundation India is aimed at providing comprehensive care to patients with epilepsy. The comprehensive care includes tele-neurology consultation (HIPAA compliant), pharmacological treatment, tele-neurorehabilitation, and abolishing the misconceptions associated with epilepsy. The needy patients were provided with drugs, free of cost.

The tele-neurorehabilitation session included yoga therapy, cognitive therapy, counselling, occupational therapy, and physical therapy. Yoga therapy was provided as a weekly session to reduce stress and improve seizure control. The clinical psychologist provided weekly counselling sessions for the patients to better handle stress due to the stigma of patients with epilepsy and the burden created by COVID-19. The cognitive therapist provided cognitive training. The caregiver was encouraged to perform 3-5 sessions of cognitive rehabilitation per week. The patients were provided with physical and occupational therapy and were encouraged to continue 2-3 sessions per day for 5 days/week.

The model adopted during times of COVID-19 that warranted social distancing is also useful to deliver expert care to patients in rural areas and ensure continuity of care. The comprehensive care was provided to patients through tele medicine platform and serves as a model in the comprehensive care of epilepsy patients. It can be extrapolated and tailored to the management of other neurological disorders.

The tele-neurorehabilitation is also useful in the rehabilitation of patients with postural imbalance and falls by improving balance, improving motor strength in upper and lower limbs through strength training, cognitive rehabilitation using restorative or compensatory strategies and rehabilitation of patients with multiple sclerosis.

The way forward:
Tele-neurology is cost effective, easy to use. It helps the patient to receive treatment from their home improving their comfort and saving travel time and cost. It also helps to prevent acquiring COVID-19, especially in the vulnerable patients with neurological disorders, who are at increased risk of complications resulting from COVID-19.

However, tele-neurology though it brings the world closer, it lacks the human touch and certain techniques of examinations are difficult to perform. It requires the doctor and the patient to be adept at modern technology and communication. The privacy, and confidentiality of patient data should be vigilantly maintained.

Tele-neurology has emerged during the times of COVID-19 and helped us deliver health care at times when social distancing was the norm. However, it has become an integral part of neurological evaluation and management that it is bound to fortify for the times to come as the COVID-19 fades into thin air. Updates and modifications to the existing guidelines shall be required as the practitioner faces newer challenges in delivering healthcare through tele-neurorehabilitation. The use of virtual reality in telerehabilitation can bring the healthcare professional and the patient together in the same virtual room augmenting the interaction.

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