Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

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

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

TELEMEDICON2020 – Highlights
‘From the Fringes to the Mainstream’

 

 

 

 

 

Dr.Sunil Shroff, Organising Secretary, TELEMEDICON2020

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

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

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

 

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

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

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

Chief Guest for Inauguration function of TELEMEDICON2020Dr. Vinod KPaul, Member, NITI AAYOG delivered his chief guest address.	Dr Dharmendra Singh Gangwar, IAS, Addl. Secy. & Fin Advisor Min of Health & Family Welfare delivering the Keynote address. He inaugurated the Virtual Exhibition for TELEMEDICON2020

Presidential Oration by Maj Gen (Dr) AK Singh (Retd.)	Dr. B.N Gangadhara, Chairman, Ethics & Medical Registration Board, National Medical Commission gave his keynote address on ‘Emerging Ethical challenges in Digital Health’

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

Synopsis of Presidential address

 

 

 

 

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

In his own words –

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

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

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

Please ensure positive participation in all TSI activities.

 

The New President Speaks

 

 

 

 

 

 

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

TELEMEDICON2020 Stats

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

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

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

Further breakup showed that the registrations included:

TSI member Registration – 220
Doctors – 586
Students 154

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

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

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

Claim Credit Hours for Attendance to TELEMEDICON 2020

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

TELEMEDICON2020 – A Summary of the Event

 

 

 

 

 

 

Bagmisikha Puhan
Executive Member, TSI

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

TELEMEDICON2020 – Free Papers and their Winners  

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

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

These were as follows:

PODIUM WINNERS

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

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

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

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

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

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

First

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

Second

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

Third 

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

 

TELEMEDICON2020 Feedback

 

TELEMEDICON2020 – ‘Picture that Said It All’

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

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

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

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Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

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

TELEMEDICON 2020
www.telemedicon2020.com

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

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

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

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

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

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

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

Association with entities

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

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

Planned Themes

1. Transforming Telehealth Training for Registered Medical Practitioners in India

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

2. Legal & Ethical Aspects – The Grey Areas

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

3. Challenges in Health Data Integration – National and State

4. 5G and Telehealth – the Larger Impact

5. AI, Block chain and Telehealth

6. Wearables and impact on Tele-health

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

8. History of Telemedicine

a. India
b. International

9. Standards

10. Health Apps in India

11. COVID-19 and impetus to Telehealth

12. Wellness & Telehealth

13. STEMI project in Cardiology

14. ECHO global project

15. Health Insurance and Telehealth

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

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

18. Planned Workshops & Parallel Tracks

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

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

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

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

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

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

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

 

INDIAN TELE HEALTH MARKET TRENDS : MARCH – JUL 2020

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

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

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

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

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

Solution & approaches

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

Key design principles

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

Development approaches

• Agile / Extreme programing
• Remote working & usage of collaborative tools & technologies
• Working code as a measure of progress
• Incremental build – over 90+ enhancements and feedback were factored as changes
• Continuous release of working code
• Integration with proven cloud solutions for reuse
• EMR integration & leveraging existing applications
• Secure coding practices IT Infra, Cyber security & Cloud

• Leveraging existing highly resilient data center
• Multi cloud and best in class on demand services like voice telephony, messaging and email
• Disaster recovery on private cloud
• Secure infrastructure and continuous monitoring for performance
• Monitoring for any cyber attacks and ensuring high availability
• Leveraging IT Help desk for proactive support

Technology used

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

Outcome

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

Lessonslearnt

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

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

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

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

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

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

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

(Next Issue – Radio & Marine Telemedicine)

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Telemedicine – News from India & Abroad

India

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

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

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

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

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International

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

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

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

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

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Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

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

 

Vision Centres

 

Dr. Kim Ramasamy
Aravind Eye Hospitals, Madurai

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

 

 

 

What is TeleICU?

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

What are the various models of care?

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

 What are the advantages?

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

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

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

Are TeleICU services available in India?

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

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

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

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Blockchain Use and Opportunity in Healthcare

 

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

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

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

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

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

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

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

Applications and Studies

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

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

• Toward Application of Blockchain for Improved Health Records Management and Patient Care
• Blockchain as a Foundation for Sharing Healthcare Data
• Blockchain as a Foundation for Sharing Healthcare Data
• DMMS: A Decentralized Blockchain Ledger for the Management of Medication Histories

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

• Enforcing Human Subject Regulations using Blockchain and Smart Contracts

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

• The Last Mile: DSCSA Solution Through Blockchain Technology: Drug Tracking, Tracing, and Verification at the Last Mile of the Pharmaceutical Supply Chain with BRUINchain
• Evaluating Blockchain for the Governance of the Plasma Derivatives Supply Chain: How Distributed Ledger Technology Can Mitigate Plasma Supply Chain Risks
• Leveraging Blockchain Technology to Enhance Supply Chain Management in Healthcare

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

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

 

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India leads the world in Telehealth Cross-Sector Partnerships

 

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

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

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

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

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

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

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

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

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

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

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

 

Dr.Sunil Shroff, MS, FRCS, Dip. Urol (Lond.)

President, Tamil Nadu Telemedicine Society of India, Editor, www.medindia.net,   Consultant Urologist & Transplant Surgeon, Madras Medical Mission Hospital, Chennai, India (shroffmed@gmail.com)

 

 

 

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

“Mr. Watson, come here, I want you.”

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

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

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

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

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