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Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

What is New? Launch of Telehealth Diabetes Online Course by TSI In its pursuit to promote telehealth training, Telemedicine Society of India has been conducting training for telemedicine since April 2020. On the 30th July, during the 8th Edition of Dr. Mohan’s International Diabetes Update, the society launched Telehealth Diabetes online course for medical practitioners. This is the second online course on Telemedicine launched this year by TSI. The course has interactive video lectures, power-point presentations and theory material and is divided into four broad segments as follows: Module I- Introductory Primer to Tele-Diabetes Module II. Setting up a Diabetes & Telehealth Practice Module III- Legal & Ethical Aspects Module IV – Optional Material The total duration of this online course is four to six hours with post course assessment to get a proficiency certificate of completion of the course. The specialist course faculty include – Dr. V. Mohan, Chennai Dr. Jothydev Kesavadev, Trivandrum Dr. Sanjay Sharma, Bengaluru A short video of the course is included below. Those interested in taking up this course please click on the link below – https://tsi.org.in/courses/diabetes-and-telemedicine-practice/ Thank You. Dr. Sunil Shroff Chief Editor President – TN Chapter – TSI

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Webinar on ‘Ethical Issues in Telehealth Practice’

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

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

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

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Confidentiality and Data Protection in Telemedicine

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

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

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

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

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

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

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

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

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

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

References:

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

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

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

Preamble

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

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

Beginning

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

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

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

Telemedicine Implementation

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

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

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

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

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

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

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

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

Outcome of ISRO’s Initiative:

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

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

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Telemedicine Practice Guidelines – A Foundation Course for RMPs by TSI

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

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Feedback for Telemedicine Practice Guidelines Course

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

A snapshot is presented a below:

1. Did you find the live interaction useful?

 

 

 

 

 

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

 

 

 

 

 

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

 

 

 

 

4. Overall rating

 

 

 

 

 

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Telemedicine – News from India & Abroad

India

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

International

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

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

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

 

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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.

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Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

What is New? We had an excellent webinar on telemedicine technology by Mr. Mathur from Ahmedabad and the report is covered in this newsletter. The self-learning course with live interaction with the course faculty has been already upgraded to Ver.2 with more interactive lecture videos to provide better learning experience. The online self-learning course ‘Train to Practice Telemedicine’ is a foundation course for all practicing RMPs. This month we are also launching a speciality course on diabetes and telehealth with help of Dr. V. Mohan, Dr. Jothydev Kesavadev, and Dr. Sanjay Sharma. Please visit https://tsi.org.in/courses to view all the courses. If you wish to contribute as a TSI member you are most welcome to join us in development and delivery of these courses. Thank You. Dr. Sunil Shroff Chief Editor President – TN Chapter – TSI

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Tele Rehabilitation : The Time has come

 

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

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

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

Introduction to Telerehabilitation Services

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

Advantages and Barriers in TeleRehabilitation

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

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

Tele Rehabilitation potential in India

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

Tele Rehabilitation; A peep into the Future

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

Conclusion

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

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

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

 

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

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

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

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

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

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

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

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

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

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Medical Negligence in the Telemedicine Era

 

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

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

 

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

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

Standard of reasonable care

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

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

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

Documentation and Consent

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

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

Delay in seeking treatment

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

Incorrect mode of teleconsultation

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

Prescriptions

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

REFERENCES

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

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

 

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

 

 

 

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

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

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

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

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

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

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

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

Reference

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

 

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Telemedicine Practice Guidelines – A Foundation Course for RMPs by TSI

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

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Telemedicine – News from India & Abroad

India

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

International

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

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

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

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

 

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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.

Click Here to Download PDF Version

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

What is New? I am pleased to inform you about the online telemedicine course from TSI for the RMPs. This self-learning course with live interaction with the course faculty became operational this month. The course is called ‘Train to Practise Telemedicine’ and is housed on the learning management platform called MOODLE. In the near future ‘Telehealth speciality courses’ will also be developed. Please visit https://tsi.org.in/courses to view all the courses. If you wish to contribute as a TSI member you are most welcome to join us in development and delivery of these courses. With the last issue of the Newsletter we have introduced visual abstract of articles. Please find the second visual abstract from TELEMEDICON2020. We have also shared the Telemedicine course video – we request you to forward this in your groups to make the course popular. Thank You. Dr. Sunil Shroff Chief Editor President – TN Chapter – TSI

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Towards Blockchain Based Secure Healthcare Information Systems

Prof. Prabhu Rajagopal
Faculty-in-charge, CFI, IIT Madras, Associate, Center for Non-destructive Evaluation

A team guided by Prof. Prabhu Rajagopal, Lead Faculty – Remote Diagnostics at the Center for Nondestructive Evaluation (CNDE), Department of Mechanical Engineering, IIT Madras (IITM) has developed a first-of-its-kind Blockchain-based secure medical data and information exchange mobile application “BlockTrack” currently out on trial at IITM Institute Hospital. The BlockTrack project aims to securely digitize Healthcare Information Systems while ensuring protection of sensitive personal information and medical records by decentralizing the control and ownership of patient data, through a Blockchain-based innovation. Additionally, the algorithm to generate identification codes for users ensures uniqueness across boundaries with very little chance for duplication.

This disruptive innovation opens up the promise of a universal and transferable Healthcare Information Management with a strong emphasis on data privacy, and tracking the spread of infectious diseases across geographies. The Android version of the application has been developed separately for both patients as well as doctors.

Key outcomes from this project are:

• Universally Unique Identification: Blockchain-based identifiers that are nearly impossible to duplicate
• Interoperability of Systems: multiple hospitals, institutes, and healthcare organizations can join the system.
• Single point records: The patient can choose to visit any healthcare facility which is on Blocktrack’s Blockchain Network without having any concerns about duplication of records or re-registrations. The consistency of the data flow is maintained without any branching issues.
• This Blockchain platform developed by the team can further be used to integrate medical supply chain management and proactive tracking of the spread of contagious infections.

Reflecting on this innovation, PI Prof. Prabhu Rajagopal said “Initiated at the height of the COVID pandemic, BlockTrack is an exciting project close to my heart, as this work showed that engineering innovations have disruptive potential to transform multiple domains. This is one of the first implementations of Blockchain technology for securing Healthcare Data management systems and we see the immense impact this approach can make in securely digitizing and maintaining unique patient records across the country and indeed across the world eventually. The system of permissions natural to Blockchain based distributed ledgers allows editability while maintaining privacy, opening up the possibility to integrate this system across primary healthcare, prescription, pharmacy, distribution and even insurance networks.We are grateful to Dr Sapna Poti at the office of Principal Scientific Adviser (PSA) to Government of India who brought the opportunity for funding this project under COVID themed support, and Infosys Limited for backing our vision. Dr Ravi Kumar of Infosys has been a gracious and supportive patron for this effort”

Prof. K. VijayRaghavan, PSA to the Government of India said “The National Digital Health Mission launched by the Government of India last year had the secure processing of individual data, and the easy accessibility of digitalized personal and medical records by individuals and health service providers, as its two important objectives. Effective implementation of these objectives will require leveraging emerging technologies. BlockTrack is a step in the right direction and I congratulate the team from IIT Madras for developing an innovative solution for a complex health information system. This will enhance and enable the efforts of health systems to efficiently track disease spread, and maintain confidentiality while storing personal data in a network.”

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Teleophthalmology Adoption – Barriers and Solutions

Dr. T. Senthil MBBS DO FICO
Ophthalmologist and CEO Welcare Health Systems Chennai
Honorary Secretory, Telemedicine Society of India Tamil Nadu Chapter

 

 

 

With the COVID-19 Pandemic, as with any other modality of Telemedicine, Teleophthalmology Teleconsultations also saw a huge uptake initially- but as time progressed, the no of Teleophthalmology consults gradually came down to almost precovid levels. This article would evaluate the barriers and possible solutions for Teleophthalmology revival.

Teleophthalmology is done through the following modalities:

• Teleophthalmology Consultation between Patient and an Ophthalmologist,
• Image Based Teleophthalmology for Diabetic Retinopathy Detection,
• Teleophthalmology for Retinopathy of Prematurity.

This article mostly covers the Teleconsultation part of Teleophthalmology.

Acceptance by Ophthalmologists and Patients

Teleophthalmology adoption by Ophthalmologists was very minimal before COVID, but once the pandemic struck and lockdown announced, Ophthalmologists started reaching out to their patients using Digital modalities, and patients also were accepting this newer modality. According to a study done by All India Ophthalmic Society only 17.5 % of Ophthalmologists were using Teleophthalmology currently, in another study 98.6 % of Ophthalmologists were willing to incorporate Teleophthalmology in their practices. There was an initial hesitation for the patients to make payment for Tele consults, but as time progressed patients started paying and this barrier was overcome.

The pandemic has hence created good acceptance level of Teleophthalmology among Patients and Doctors.

Dependence on Diagnostic Tests and Equipment’s

This is the most Important barrier to Ophthalmic Teleconsultations, since unlike psychiatry or dermatology, an Ophthalmic examination involves various tests right from testing Visual acuity, Intraocular pressure, anterior segment imaging and fundus evaluation. An Ophthalmic examination on a patient can only be done, if we get lot of information about the condition of the eyes, for which all these equipment’s are invaluable, it may not be possible to conduct these tests at patients houses, hence the number of conditions which can be treated by just doing a tele consult and seeing images of the Eye through regular computer or mobile cameras becomes grossly limited. This barrier can be addressed when there is app-based tests of visual acuity and mobile cameras getting in higher quality images etc. Till that time a model wherein patient can reach a nearby centre (Example an Optometry clinic, or Optical shop) where these equipment’s are available and tele consult done from that centre may be a viable option.

High Cost of Equipment’s and Poor Quality of Images

Other challenges

• Lack of Trained Staff
• Policy and Regulatory barriers
• Privacy and Security concerns

With Innovations in Ophthalmic Devices and with advancements in machine learning and Artificial Intelligence, Image based Teleophthalmology will definitely see a growth in the coming years, Ophthalmic Tele consult will take its time, but as home-based devices are improved and available for a lower cost, there will be increase in Teleconsultations in Ophthalmology in the coming years.

The Author Dr. Tamilarasan Senthil can be contacted at senthil@welcaretelemed.com

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Reference: Sivalingam, Arun & Wadhwa, Ankita & Amol, Gramle. (2021). Perception of Health Care Professionals (HCPs) on Telemedicine in India. International Journal of Management and Humanities. 5. 10-14. 10.35940/ijmh.F1284.045821.- Arun Kumar S, Ankita Wadhwa & Dr. Gramle Amol

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TAKING YOUR PRACTICE ONLINE (PART 2): LEGAL COMPLIANCES AND GOOD PRACTICES

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

 

 

In our last article, we wrote about general considerations to be kept in mind before venturing into telemedicine. In this article, we will discuss important legal considerations to be kept in mind for operating a virtual clinic.

The Telemedicine Guidelines published last year recognize voice-video and text-based modes of consultations, so a doctor may choose to offer teleconsultation over any telemedicine apps, messaging/videocall app, SMS, email, or even set up a personal website for teleconsultations. But, while offering teleconsultations, it is important to be clear about legal dos and don’ts.

Registration of Online Clinic
A common question that doctors have is whether they ought to register their work premises (or home) with any government body since they are offering medical services from the premises. In other words, does a doctor need to obtain a registration from a government department to operate a telemedicine “clinic”? The answer is NO, at least not at the moment. The existing clinical establishment or nursing home laws in various states in India regulate only those premises which receive patient footfall. By definition, virtual consultations between patient and doctor do not involve patient footfall at the premise from where the doctor is offering medical consultation. Therefore, clinical establishment or nursing home laws are presently not triggered by medical teleconsultations. Needless to say, if the venue is also used for in-clinic consultations, it would require registration under applicable clinical establishment/nursing home law.

Please note that this position may change in future if the law starts recognizing telemedicine-focused clinics as “clinical establishments”.

Website and privacy-related compliances
If a doctor decides to offer teleconsultation through his or her own website, then there are certain legal requirements that must be complied with. The most important requirement would be to put in place a privacy policy. The exhaustiveness of the privacy policy would depend on the type of website that the doctor is operating. For example, if a website’s sole purpose is to enable patients to book an appointment, which is then conducted off the website (on a call, WhatsApp, Zoom, etc), a basic privacy policy specifying that the patient’s information is being collected so that the doctor can set up the appointment, would suffice. In such a case, the doctor should refrain from using a form on the website to collect information about the patient’s health condition since it would invite more stringent data privacy related compliances.

If a doctor is operating a website through which he/she can directly consult with the patient, the privacy policy would need to specify what kind of data (e.g. mental health data, physiological data, diagnostic reports, discharge summary etc.) is being collected, the purposes for which the collected data will be used and for how long will the patient’s data be stored, at the minimum.

The website should also have a term of service available as a link on the website itself, which outline the conditions under which services are being made available to the patient. An appropriate legal disclaimer should also be put on the website as applicable, such as that the telemedicine services over the website are not intended to be used in emergency situations.

Furthermore, a website or an app that offers teleconsultations would be considered as an e-commerce entity and as per the Consumer Protection (E-Commerce) Rules, 2020, an e-commerce entity must compulsorily be a company. Thus, a doctor has to incorporate a company if the doctor wishes to offer telemedicine services through the doctor’s own website to his or her patients.

Non-Solicitation
The MCI (Professional Conduct, Etiquette and Ethics) Regulations, 2002 explicitly prohibits doctors from soliciting patients by “inviting attention to him or to his professional position, skill, qualification, achievements, attainments, specialties, appointments, associations, affiliations or honors and/or such character as would ordinarily result in his self-aggrandizement”. The Telemedicine Guidelines also specify that a doctor may not solicit patients for telemedicine through any advertisements or inducements. Therefore, whenever a doctor lists his or her experience and expertise on a telemedicine website or application, it should be limited to a description of the doctor’s recognized qualifications and years of experience only. The use of the expressions such as “expert”, “gold-medalist”, “best”, “leading” etc., may be held to be instances of solicitation and are best avoided.

While individual doctors (or groups of individual doctors) cannot advertise, clinical establishments can. Therefore, doctors who wish to market and advertise a telemedicine website or platform should do so through a separate legal entity such as a company or a limited liability partnership only.

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When was the Term Telemedicine first used?(History and Evolution of Telemedicine – 8^th 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).

 

 

Telemedicine was used for the first time in a publication in December 1927

Geo W. Gale’s Article “Wants Plane to Change Weather Here”

“If we have telephotography, why can’t we have telemedicine, so that you could walk up to the radio machine, drop your dollar in the slot, take down the particular receiver required and apply it to that part of your anatomy where the pain is?

The cited article was dated December 29, 1927.

 

When was the Term Telemedicine first used in Scientific Literature?
• Telemedical technique – 1970
• Telemedicine – 1972

The term “telemedicine” appeared in the description of the telemedical project of the Arizona Medical University in an article – Arizona TeleMedicine Network: Engineering Master Plan, 1972.

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Telemedicine Practice Guidelines – A Foundation Course for RMPs by TSI

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

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Telemedicine – News from India & Abroad

India

New Software Identifies Patients Who may Require Ventilator Support
A new software helps identify whether a patient will require ventilator support in an ICU or referral, and will make necessary arrangements before emergency sets in. At a time when sudden ICU and other emergency requirements during the pandemic have been a challenge for hospitals to manage, timely information about such situations.….. Read More

International

Omron, Kyoto University team up to study AI use for early cardiovascular disease prevention
Omron Healthcare and Kyoto University are set to undertake a study under a joint research programme to use artificial intelligence and home-recorded health data in predicting early signs of cardiovascular diseases.Their upcoming study under the Healthcare Medical AI research programme will focus on two themes…..….. Read More

Ophthalmology: A pioneer in the field of artificial intelligence
Ophthalmology, with its heavy reliance on imaging, is an innovator in the field of artificial intelligence (AI) in medicine.Although the opportunities for patients and health care professionals are great, hurdles to fully integrating AI remain, including economic, ethical, and data-privacy issues… Read More

Life Whisperer launches its third global IVF clinic collaboration at ESHRE to apply Artificial Intelligence to Oocytes
LONDON, June 25, 2021 /PRNewswire/ — Life Whisperer, fertility arm of AI healthcare company Presagen, will invite clinics to participate in its third global IVF clinic collaboration at the 37th European Society of Human Reproduction and Embryology (ESHRE) Annual Meeting in June 2021.….. Read More

 

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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.

Click Here to Download PDF Version

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

What is New? I am pleased to inform you about the online telemedicine course from TSI for the RMPs. This self-learning course with live interaction with the course faculty became operational this month. The course is called ‘Train to Practise Telemedicine’ and is housed on the learning management platform called MOODLE. In the near future ‘Telehealth speciality courses’ will also be developed. Please visit https://tsi.org.in/courses to view all the courses. If you wish to contribute as a TSI member you are most welcome to join us in development and delivery of these courses. With the May Newsletter there are two additional features being introduced: 1.With this issue we are introducing visual abstracts and articles to make the newsletter more appealing and easy to read. 2.We have also introduced a new medico-legal digital health section and welcome contributions in this area. Mr. Anay Shukla from Arogaya Legal has agreed to contribute a short article for the next few issues. Thank You. Dr. Sunil Shroff Chief Editor President – TN Chapter – TSI

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Publication of TELEMEDCION2020 Abstracts and Select Articles in ‘Telehealth and Medicine Today’ Journal

Prof. K. Ganapathy
Guest Editor, Special issue on TELEMEDCION2020 in ‘Telehealth and Medicine Today’ Journal
Past President, Telemedicine Society of India & Neurological Society of India | Hon Distinguished Professor Tamilnadu Dr. MGR Medical University | Director Apollo Telemedicine Networking Foundation & Apollo Tele Health Services

The 16th International Annual Conference of the ‘Telemedicine Society of India’ (https://telemedicon2020.com/) was held virtually from 18th to 20th December, 2020.

The Tamil Nadu chapter of TSI under the leadership of Prof. Sunil Shroff, Organising Secretary along with four other TSI state chapters – Delhi-NCR, Rajasthan, Maharashtra and Karnataka organised this conference as a semi emergency, within 8 weeks. For the first time in two decades abstracts of papers presented have been published in a special issue of a US based journal Telehealth and Medicine Today https://telehealthandmedicinetoday.com/index.php/journal/issue/view/20

This is in addition to the full text of nine papers presented at the conference (peer reviewed) besides two editorials.

John F. Kennedy in his inaugural address on 20th January 1961 remarked “ ……all this will not be finished in the first one hundred days. Nor will it be finished in the first one thousand days, not in the life of this Administration, nor even perhaps in our lifetime on this planet. But let it never be said that a beginning was not made “. I am much more optimistic. This optimism comes from the actions of my teacher Prof B. Ramamurthi. In the year 1951 four young men, driven by a passionate vision conceptualised, created and constituted India’s first ever neurological society. Dr. Jacob Chandy, Dr. B. Ramamurthi, Dr. S.T. Narasimhan and Dr. Baldev Singh brought all the disciplines associated with the science of neurology under one roof. The NSI was born. The four founding members were all office bearers !! This was audacity at its highest.

Within a year in March 1952, the society had its first meeting in Hyderabad, with 30 members from all over the country. The first presidential address was aptly titled “Neurology Comes To Life”. It was at this meeting the society decided to publish its own journal Neurology India. Today 69 years later Neurology India is a globally recognised journal with thousands of citations and 20% overseas contributions.

The world in April 2021 has turned upside down. If a journal could be started in 1952 in a then developing country in an unknown super speciality in the BC ( pun intended !) era with 30 individuals in the whole of India, I fail to see why we cannot start our own journal. Future Ready Next Generation Sequencing is now available across genetics labs in the country. It is time that the NG of Telehealth enthusiasts with access to all the resources in this planet step in and take over. Septuagenarians have shown the way.. “ Lead kindly light, lead thou me on, I do not ask to see the distant scene. One step enough for me” Saint John Henry Newman could very well have been referring to the Founding editors of TSI’s first journal.

I would like to once again place on record our thanks to the EC of the TSI to permit this exercise and also to Tory Cenaj and Prof Amar Gupta of Telehealth and Medicine Today for the unstinted support extended. HAPPY READING of the Special issue https://telehealthandmedicinetoday.com/index.php/journal/issue/view/20

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Tele Ophthalmology Society of India – Launch Webinar on 1st May 2021

Dr. BNR Subudhi

I am happy to inform you that the Launching of Tele Ophthalmology Society of India was held on 4th April 2021 in Presence of President and Secretary of AIOS, President of Telemedicine Society of India and few international dignitaries working in the field of Teleophthalmology.

Padmashree Awardee Prof. S. Natarajan of Mumbai is the President of the Society I am the Hony Secretary, Dr. S. Pattanayak is the Treasurer and eminent Ophthalmologists of the country like Dr. R. Kim is the President elect, Dr. Rajeev Raman is the Vice President and Dr. Sheila John, Dr. Senthil, Dr. Abhesek, Dr. Ashok Nanda, Dr. Kavita Rao and Dr. Sandipak Ray are the executive members nominated to carry forward the objects of the Society which is primarily to provide Ophthalmic services to the needy rural and underprivileged people through tele consultation utilising digital technology, block chain and artificial intelligence.

As an initial step we have started collaboration with ECHO India, an organisation sharing their digital platform for Organising meeting, education, tele consultation facilities etc.

The first virtual Symposium of TOSI was organized on 1st May 2021 with Mr. Boman Irani, the Bollywood artist as the Chief Guest and other speakers from different fields of telemedicine and tele Ophthalmology like Dr. SB Gogia, Dr. K. Ganapathy of Apollo Telemedicine network, Dr. Sunil Shroff from Telemedicine Society of India, Dr. Ganesh Joshi from CRC Bhopal, Dr. Padmaja Rani from LV Prasad Eye Institute Telemedicine network and others. This gave us tremendous insight about planning ahead for the spread of Teleophthalmology systematically.

We have decided to have one monthly virtual symposium during this COVID time to interact with the members and the other stalwarts and Institutions and industry representatives to plan ahead for the members to reach the people through digital technology to prevent blindness.

The goal of Tele ophthalmology is to decrease the global burden of vision threatening diseases and improve the quality of life for patients worldwide. It will provide high quality, cost effective community eye care at the door steps of the community.

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TAKING YOUR PRACTICE ONLINE (PART 1): LEGAL COMPLIANCES AND GOOD PRACTICES

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

During the COVID-19 pandemic, telemedicine has proven itself to be a perfectly legal, effective and safe way for doctors to connect and consult with their patients.

However, before initiating a consultation over a phone call, email or through a mobile app with a patient, it is important that doctors familiarize themselves with the legal framework within which telemedicine can be safely practiced. In this article, we have enumerated key things to be kept in mind by doctors before they take their practice online-

Medical Council Registration. While a doctor does not need to be registered in every State where his or her patients are located for practicing telemedicine, a doctor still needs to have a valid registration with the medical council of the State in which he or she resides and practices.

Familiarity with Treatment Guidelines Every doctor must familiarize himself or herself with telemedicine-specific treatment guidelines applicable to his or her specialty. If no such guideline exists for a speciality in India, a doctor may refer to international guidelines that are easily available on the internet.

Exercising Professional Judgement with Caution. No guideline can substitute a doctor’s own professional judgement to treat his or her patient. However, as a thumb rule, it may be pragmatic to err on the side of caution while offering remote consultation given the lack of physical access to the patient.

Limitations of Technology and Communication Medium. A doctor should always be conscious of the limitations of today’ technology and the medium of communication – mobile network, WiFi, internet speed, camera quality, audio, video, text, email, etc. and should offer his or her services virtually with full awareness of these limitations. It is not wrong on the part of a Doctor to request his or her patient to switch to a different teleconsultation medium or an in-person visit, if the doctor desires so in the interest his or her patient’s health.

Maintaining Patient Privacy. A doctor’s virtual clinic should be conducive to maintaining the patient’s privacy, just like his or her actual clinic. As a good practice, a doctor should also ensure that his or her patient is present in a comfortable surrounding from which the patient can have an open discussion.

Identifying Oneself to the Patient. As in physical consultation, a patient should be able to verify a doctor’s credentials and contact details in a remote consultation. If the teleconsultation is through a reliable teleconsultation App, the App will most likely display the doctor’s name, registration number, qualifications and contact information. However, if a doctor is consulting through WhatsApp, email, videoconferencing service etc., he or she should consciously display his or her registration number and name. In cases where the doctor and patient are unknown to each other, it is expected that the doctor will introduce himself or herself along with his or her qualifications to a patient, and also confirm the patient’s identity by asking the patient’s name, age, and contact information. A doctor has the legal right to request that the patient displays/shares a proof of identity with the doctor before the start of consultation, if necessary.

Maintaining Records. Before venturing into telemedicine, every doctor should establish a process to maintain and preserve records electronically. For instance, a log book for each interaction with patient should be maintained. A record of patient history, diagnosis, prognosis and prescriptions issued, if any, should also be maintained. The patient’s consent for the consultation should also be recorded, if the patient has not initiated the consultation. It is a good practice to maintain these records for a minimum period of three years.

Prescriptions. A prescription generated in course of a telemedicine consultation should not be different from a physical consultation, and should contain all information as is associated with a prescription generated during a regular consultation (for example, patient identifiers, patient history, date of consultation, provisional diagnosis, investigations recommended, medicines prescribed etc.). The prescription may be handwritten or digital, but it should be signed by the doctors, preferably by hand.

Insurance. As a safeguard against consumer complaint or legal liability, doctors who offer remote consultations should ensure that they have purchased a professional indemnity policy that either explicitly covers teleconsultations, or does not explicitly exclude it. This is not to imply that telemedicine may result in a legal issue. It’s just one less thing to worry about!

Reference:
Telemedicine Practice Guidelines

NEXT TOPIC- TAKING YOUR PRACTICE ONLINE (PART 2): LEGAL ISSUES AND CHALLENGES

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Space Travel and Telemedicine (History and Evolution of Telemedicine – 7^th 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).

As space travel became a reality, scientists were curious in the 1960s to find out if the human body could function adequately in outer space or not. And this brought NASA contributing to the growth of telemedicine in 1960s. They first sent animals into space who were connected to medical monitoring systems and their biometric data was transmitted back via a telemetric link.

 

NASA soon established an Integrated Medical and Behavioral Laboratories and Measurement Systems (IBLMS) to study changes in human physiology in outer space with zero gravity and its effects on human body.

The report described the objective of this centre as – “..It was meant to develop a system that could acquire, display, analyze and record, “…a wide variety of medical, biochemical, microbiological, and behavioral, measurements and experiments designed to study in detail man’s well being and operational capability.

NASA also launched a program, called the Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC). It leveraged the remote monitoring technology that they had developed for space travel to serve terrestrial, rural populations.

The project was conducted on the Papago Indian reservation in Arizona. It evaluated the practicality and efficacy of a large-scale telemedicine operation. This truly gave a new spin to telemedicine for ‘reaching the unreached population to provide healthcare.’

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Telemedicine – News from India & Abroad

India

Need to take telemedicine to villages: PM
In an interaction with doctors on Monday, PM Narendra Modi drew attention to the importance of telemedicine, how it has played a big role for patients in home isolation and asserted that it needs to be expanded in rural areas as well. The PM also urged doctors to include oxygen audits in their daily routine.….. Read More

80% diseases can be nipped with primary healthcare
Healthcare workers, across country, with constant training, have the potential to de-clog and reset the healthcare system. Data Driven Decisions and support for carrying out their tasks should be one of the priority.….. Read More

International

Mental health chatbots might do better when they don’t try to act human
Digital mental health platforms have seen something of a renaissance during the Covid-19 pandemic, as in-person appointments have been relegated to the digital sphere. For those who cannot access therapy from a human clinician, mental health chatbot platforms are an increasingly popular digital alternative…….. Read More

 

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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.

Click Here to Download PDF Version

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.

Registration for Telemedicine Online Course

Telemedicine Society of India runs regular courses on how to practice telehealth within the framework of ‘Telemedicine Practise Guidelines’ as notified by the Govt of India in the month of May 2020. Over 3500 doctors and other medical professionals have undergone the training so far. To know more about the course and view the feedback please visit https://tsi.org.in/learn

By registering here you would be able to book your space for the next available course. We are also in the process of starting a Speciality Course in Telehealth and will keep you updated if you are registered with us.

Click here to join ‘Train to Practise Telemedicine’ Course conducted by TSI.

Thank You.
Dr. Sunil Shroff
President – TN-TSI

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National Telemedicine Day of TSI Celebrated Virtually

In view of the ongoing pandemic, an abridged program was conducted on 25th April virtually to commemorate the National Telemedicine Day of TSI. This was decided 20 years ago on 25th April 2001, during the 1st National Telemedicine Conference held at SGPGI Lucknow, to raise a Society to promote Telemedicine in India and to name it Telemedicine Society of India (TSI).

A panel discussion that included all the Past Presidents (Margdarshaks) was organised with the theme – ‘A Perspective of Journey of Two decades of Telemedicine Society of India & The Road Ahead.’

The discussion was aimed towards TSI’s contribution towards the global effort to promote Telemedicine, roadmap for progress and increased footprint of TSI.

Dr. Mahendra Bhandari who was the director at SGPGI during the launch of TSI joined from USA and shared his fond recollections from the past.

The presidents who joined included the following-

Dr. SS Badrinath, sent a short video of his tenure as he is not keeping well. Mr. A Bhaskarnarayana could not join. The discussion was moderated by Dr Sunil Shroff, President TSI (TN Chapter).

The following areas were discussed –

1.  All the presidents shared – one impact area that they considered significant that led to growth of telemedicine during their tenure and one memory that they would always cherish of their tenure.

2. They all discussed the impact of emerging technologies in the domain of ‘Digital Health’ that would help with the evolution of Telemedicine.

3. Deliberations were made on the how TSI could play an active role and work with the Government for policies in the growth of telehealth in India.

4. TSI functioning was broadly discussed and included –
    a. TSI’s role in keeping the Telehealth ecosystem safe in India.
    b. How should state chapters of TSI evolve.
    c. Should TSI start its own journal.
   d. How should TSI professionalise its activities.
   e. What should be the roadmap for next 5 to 10 years for TSI.

Welcome by Dr Ashvini Goel & Inauguration by Dr Mahendra Bhandari

Panel discussion with Presidents (Margdarshaks)

Theme – ‘A Perspective of Journey of Two decades of Telemedicine Society of India & The Road Ahead.’
Moderator: Dr.Sunil Shroff, President, TN-TSI

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eSanjeevani – India’s National Telemedicine Service

Sh. Lav Aggarwal¹, Dr. Sanjay Sood² & Dr. P.K. Khosla^2
1 Ministry of Health & Family Welfare, Govt. of India, New Delhi
² Centre for Development of Advanced Computing, Mohali

eSanjeevani – National Telemedicine Service is a cutting-edge, indigenous telemedicine system that is not only bridging the rural-urban, digital health divide but is also provisioning health services for the Indian populace in the confines of their homes. eSanjeevani is an initiative of the Ministry of Health & Family Welfare, Govt. of India it has been developed and is being managed by the Health Informatics Group at the Centre for Development of Advanced Computing (C-DAC) in Mohali. eSanjeevani is providing telemedicine services in two variants: 1. eSanjeevaniAB-HWC: A Doctor-to-Doctor telemedicine system under Ayushman Bharat Scheme of Govt. of India at Health & Wellness Centres, to provision specialised health services in rural areas and isolated communities, and 2. eSanjeevaniOPD: a Patient-to-doctor, telemedicine system that is enabling people to get outpatient services in the confines of their homes.

In a very short span eSanjeevani has evolved into South-East Asia’s largest telemedicine service. Collectively, the eSanjeevani network is operational in 31 States, around 35,000 doctors and paramedics have been trained and onboarded, and around 18,000 Health and Wellness Centres (HWCs) have been enabled for telemedicine services across the country. 256 online OPDs have been set up on eSanjeevaniOPD. eSanjeevani telemedicine network is providing safe, contactless medical consultations without having the patient to travel to the doctors. eSanjeevani is supposedly India’s largest telemedicine service. In less than one-year eSanjeevani has served over 3.7 million patients and daily around 45,000 patients are served through eSanjeevani. Numerous premier institutions like AIIMS Bathinda, AIIMS Bibinagar, AIIMS Rishikesh, Lady Hardinge Medical College and Hospital, King George’s Medical University etc. are offering specialised services through eSanjeevani. This flagship telemedicine application of Government of India is in a continuous state of flux, it is being enriched on regular basis (with innovative concepts and flows) based on the feedback received from the State Administrations that are using eSanjeevani, and also on the basis of the directions of Ministry of Health & Family Welfare, Govt. of India.

eSanjeevani is the first telemedicine platform that conforms to the Electronic Health Records Guidelines issued by the Ministry of Health & Family Welfare, Govt. of India. It being a cloud-based system, the system can be configured and expanded in no time. The telemedicine platform enables health administrators to efficiently utilise doctors in their team as the system permits health administrators to dynamically regulate doctors onboarding and offboarding in OPDs, based on the footfall. In eSanjeevani, the processes have been designed in such a way that patients do not need to wait for more than 15 minutes to get a medical consultation. As of now average patient waiting time in eSanjeevaniOPD is 8 mins 47 sec.

eSanjeevani empowers, doctors and patients additionally as it is also integrated with few healthcareIT applications that are being used in the States. eSanjeevaniAB-HWC is seamlessly (& wirelessly) integrated with a compact and integrated diagnostic device. It can gather over 30 medical parameters based on point of care tests (POCT) and rapid diagnostic tests (RDTs) besides the physiological parameters. eSanjeevani variants are available as web-apps (esanjeevani.in & esanjeevaniopd.in) and Android application of eSanjeevaniOPD is also available, it has been downloaded by over 500,000 users. The iOS version of eSanjeevanOPD is undergoing testing and soon it will be rolled out. With the launch of iOS based app of eSanjeevaniOPD, it is anticipated that the utilisation of eSanjeevani would grow further. At the moment over two-thirds of the consultations are being executed through mobile application. eSanjeevani is being readied to comply with the compliances specified by the National Health Authority in National Digital Health Mission of National Health Authority, Govt. of India.

In December 2020, at Digital India Awards 2020 eSanjeevani was adjudged as the country’s best innovation during pandemic and the award was conferred by Honb’le President of India. eSanjeevani has also been recognized by Computer Society of India, SKOCH Group and has won the Gem of Digital India Award. eSanjeevani is also amongst the front-runners at Govt. of India’s National Awards for eGovernance (NAeG).

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Foundation Day CME “COVID-19 and Telemedicine”: Department of Telemedicine, PGIMER, Chandigarh

The foundation day CME for department of telemedicine was inaugurated by Prof Jagat Ram Director, PGIMER and Prof G D Puri Dean Academics, PGIMER.

They congratulated Prof Meenu Singh Head, Department of Telemedicine on this occasion and appreciated all the work that has been done during the COVID – 19. Director emphasized on the importance of Telemedicine in this pandemic Scenario. This CME was chaired by distinguished dignitary, Dr K K Talwar health adviser Government of Punjab and Former Director, PGIMER.

The CME was presided eminent speakers Dr Sanjay Sood, Project Director eSanjeevani who briefed the audience that during the past one year of esanjeevani OPD almost 2.6 million consultations have been provided. Through Various other Telemedicine platforms run by govt of INDIA consultations have touched the 4 million mark. E Sanjeevani provides both doctor to doctor as well as doctor to patient consultations.

Dr Sood shed light on the future project such as SEHAT OPD, e Arogya Bharti and national HIV AIDS Telemedicine network which is first in the world.

The first panel discussion was chaired Dr Savita Malhotra Former Dean PGIMER and talks were given by Shri R K Saboo Past Rotary International Prident, Dr Vinayak M Prasad Senior Advisor, WHO, Geneva and Shri Anoop Kumar Gupta Principal Consultant, eVBAB Project, Ministry of External Affairs.

The discussion was centered on role of national and international Telemedicine agencies during the COVID-19 pandemic. The second Panel discussion was Chaired by Col. Dr. Ashvini Goel, President TSI and the speakers were Dr Sunil Shroff Foundation and Director MOHAN Foundation President TSI-Tamilnadu, Dr Murthy Remilla Hon. Secretary, TSI and Ms Bagmisikha Puhan Legal Expert technology Law Member EC TSI. The panel discussion was regarding Telemedicine practice guidelines

This followed talks by Dr Ravi Chittoria, Nodal Officer, Regional Resource Centre (Southern Region) JIPMER, Puducherry and Dr N. K Agarwal on Telemedicine activities in the NMCN project during COVID era and Clinical Application of Telemedicine respectively. This session was chaired by Dr S K Mishra Dean SGPGI Lucknow and Dr Biman Saikia from PGI Chandigarh.

The CME concluded by a lecture on role of health informatics in healthcare given by Dr Nishant Jaiswal Research Associate HEHTA, Institue of Health and well Being, University of Glasgow. This session was charied by Dr Nusrat Shafiq PGI, Chandigarh and Dr BS Bedi, Advisor to CDAC. Dr Meenu Singh gave the concluding remarks and thanks to all the dignitaries for their supports and Dr Amit Agarwal for organizing and smooth functioning of the CME.

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First use of the Prefix ‘Tele’ for Telemedicine
(History and Evolution of Telemedicine – 6th 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).

The credit for using the prefix ‘Tele’ goes to the speciality of cardiology. In the earlier issue of the newsletter, the transmission of ECG over 1500 meters by Willem Einthoven, a Dutch professor of physiology (Telehealth Newsletter -Vol.1, Issue.2 Nov 2020) was covered. It was Einthoven who first to use this Latin prefix Tele to denote distant medical care and called it “telecardiogram”. He went on to publish this in 1906 in the journal “Archives Internationales de Physiologie” describing this experiment as the first tele-medical technology (Einthoven, 1906). After this over the years, several publications were made on the use of tele-ECG application that avoided the need for the patients to travel.

But it was M. Franke and W. Lipinski 1936 who published an article about clinical application and variations in tele-electrocardiogram of patients with infectious diseases (in particular with scarlet fever and diphtheria). They invented the Franke-Lipinski tele-cardiological system and helped patients to avoid travel. Franke said in an article, “keeping the patient in one place allowed avoiding adverse events, associated with the patient’s transportation.” This was more required for patients with infectious diseases where remote monitoring was required. They also felt that it could be applied for critically ill patients on ventilation and this was the first indication of the use of telemedicine for intensive care.

In 1980 E. Sh. Halfen, said “One of the characteristic features of medicine of our time is authoritative, irresistible penetration of mathematics and cybernetics into medicine” He determined three main lines for tele-ECG application (Halfen E., 1980; 1985; 1974; 1977; 1980 a; 1980 b; 1980 c; Khramov A. et al., 1996):

1. Clinical medicine (including rural health care, emergency medical service, large enterprises, sanatoria, etc.);

2. Mass preventive onsite screening examinations (combined with automated ECG analysis);

3. ECG patient-activated transmission (auto-transmission) during outpatient treatment.

And between 1972 and 1979 about 250 000 ECGs were transmitted in Saratov region.

Today India’s own STEMI project is an advanced application of remote monitoring through ECG transmission to reverse the fatal ST Elevation Myocardial Infarction (STEMI). This is a clinically a challenging condition that requires prompt intervention. In Tamil Nadu alone there have been over 2,400 early interventions in the last few years. The National Commission on Macro-economics and Health has projected the evolving epidemic of coronary artery disease in India. There were 60 million patients with coronary heart disease in the year 2015 with a yearly mortality close to 3 million. A substantial number of these were due to acute STEMI or the delayed consequences of STEMI. If the project is implemented nationally and connected to the 108 State Ambulance services it can save millions of lives.

Reference-
1. A Century of Telemedicine:Curatio Sine Distantia et Tempora by- Anton Vladzymyrskyy, Malina Jordanova, Frank Lievens
2. Telehealth Newsletter – Vol.1, Issue.2 Nov 2020
3. https://www.stemiindia.com/

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Telemedicine – News from India & Abroad

India

India’s First Artificial Intelligence-based COVID Testing Facility at IGI Airport

India’s first Artificial Intelligence (AI)-enabled COVID testing facility for international passengers has commenced operations at Terminal 3 of the IGI Airport. The facility under the Garuda brand name is owned by AI company Thalamus Irwine.….. Read More

International

How innovations in digital health are opening new doors in healthcare system
Technological advancements and innovation have played a big role in connecting people to healthcare professionals, allowing them to get the healthcare attention they need, especially during the COVID-19 pandemic..….. Read More

Companies That Are Taking Telemedicine By Storm
When Covid-19 struck, the use of telemedicine exploded. At Los Angeles-based UCLA Health, for example, the average number of telehealth visits went from roughly 100 to 3,000-4,000 per day between March and May 2020. Companies include – 1. Teladoc, 2. Livongo, 3. Navigating Cancer, 4. 98point6, 5. 23andMe & 6. Amazon.. Read More

World’s First 5G Disinfection Robot Removes Bacteria On The Go
The world’s first 5G-based disinfection robot automates anti-infection efforts against COVID-19 in health care facilities.….. Read More

New Model Predicts Spread of Covid-19
New model has been developed by scientists that helps predict the spread of covid-19. At first, a fragile, temporary state of immunity emerged during the early epidemic. Later, it got destroyed when people started changing their social behaviors leading to another wave of covid-19 infection..….. Read More

 

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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.

Click Here to Download PDF Version

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.

Technology in Telehealth

Prof. K. Ganapathy

Past President, Telemedicine Society of India, Neurological Society of India & Indian Society for Stereotactic & Functional Neurosurgery | Former Secretary general Asian Australasian Society of Neurological Surgery | Hon Distinguished Professor The Tamilnadu Dr MGR Medical University | Formerly Adjunct Professor IITM and Anna University | Director Apollo Telemedicine Networking Foundation & Apollo Tele Health Services

There is an erroneous perception that widespread adoption, upscaling and deployment of Telehealth is solely related to availability of cost effective, affordable, accessible, user friendly technology. There is no doubt that technology acceptance and behavioral modification, which we are witnessing particularly after the onset of COVID-19, has a major role to play. “ Customer delight” is what every e Commerce platform aims for. The Amazons and Flipkarts and Googles of the world package their products in such a way that even octogenarians from rural backgrounds get hooked to the incredible experience. Whom are we selling telehealth to? Who needs to get “ hooked on” to experience virtual remote health care. How do you convince a worried or sick patient tens, hundreds thousands of kilometers away that the specialist on the screen can do as good a job or even better than if he is holding your hands directly. How do you excite every individual doctor to evangelise Telehealth. This will happen only when his/her patient is convinced that telehealth is as good or better than a face to face consultation 5G, bandwidth of 100 Mbps, a 55” hi resolution screen, a future ready voice activated EMR where images uploaded with ease at the remote end can be digitally manipulated by the consultant, playing videos, a wide choice of highly secured payment gateways etc etc – the list can be never ending —– all this hi tech no doubt will help, but are we not missing the wood for the trees.

What does a patient using Telemedicine really want – even in 2021 . He wants TLC ( Tender Loving Care) “Listen, listen, listen he is telling you the diagnosis” said Sir William Osler 150 years ago. When I give a teleconsult I still listen!! Patients do not care how much you know. They want to know how much you care. Healthcare is personal – it is very hard to feel your experience was excellent, when those treating you don’t introduce themselves, or make eye contact, or say what they are doing to you and why. The doctor’s body language says it all. No AI, no technology will ever substitute for a doctor who empathises, sympathises with his far away patient, wiping the patients tears albeit virtually.

Alas the powers that be, including teleconsultants forget that providing remote health care is not like selling/ buying a pizza online or booking a train ticket. Technology in healthcare should only be a tool, a means to achieve an end, not an end by itself. Technology helps in producing remarkable solutions. Sometimes after this we go in search of problems! Lars Leksell the inventor of the Gamma Knife famously remarked half a century ago –“ A fool with a tool, is still a fool”. I belong to the BC era – not Before Covid but before Computers. Yes I am a technology buff. I even brought out a special edition for the journal Neurology India on “Extra Terrestrial Neurosciences” – the ultimate in Technology. Over the last 21 years when I first started Telemedicine, it has been my privilege to see the radical transformation and the exponential growth of Remote Health care . I am optimistic that soon Telehealth will be centre stage in the core of the health care delivery system. This phenomenal growth is no doubt a direct bye product of technological advances . An app a day may keep the doctor far far away but I would still like my tech savy doctor to be commiserating, to understand what I want so that he will prescribe the right apps for me !! “ Customer delight” is the only way that Telehealth will truly come centrestage and be integrated into the core of the health care delivery system. Worldwide remote health care is driven by technologists, software/ hardware entrepreneurs, communication engineers, mobile network operators, CEO’s of start ups. Manufacturers of peripheral medical devices, wearables etc. During the last 21 years 95% of the numerous talks I have given have been organized by the Telemedicine ecosystem!! Medical colleges, medical associations, clinical societies do not include Telehealth in any CME program. It is extremely unusual to find a clinician giving up a medical or surgical career to embrace telehealth .

The clinician should be the first among equals if patients are to get excited about telehealth abd take the initiative requesting his/ her doctor to appear on the screen. Circumstances and necessity will make doctors understand that this tool for connecting, ensuring a continuum of care will no longer be a choice but will become a differentiator The wrioting is on the wall !

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Telemedicine Society of India and Practo launch ‘Rise of Telemedicine – 2020’ report

Dr. Neelesh Bhandari, MBBS (AFMC), MD (Pathology)

Head, Doctor Relations and Engagement | Former Founder and CEO, Healtho5 Solutions Private Limited | Former Chairman, Social Media Committee, Indian Association for Medical Informatics.

Summary: A joint collaboration with the Telemedicine Society of India (TSI), the report highlights the emergence of telemedicine in India, the reasons behind its meteoric rise amid the pandemic, and the advantages it can continue to offer in a post-COVID world.

The report was launched at Telemedicon 2020, by Col. (Dr.) Ashvini Goel, President, Telemedicine Society of India (TSI) in the presence of industry leaders – Dr. Alok Roy, Co-Chair, FICCI Health Services Committee and Chairman, Medica Group of Hospitals, Dr. Girdhar Gyani, Director-General, Association of Healthcare Providers (India), Dr. Vijay Agarwal, President, Consortium of Accredited Healthcare Organizations (CAHO).

The sense of urgency created by the COVID-19 pandemic has spurred medical establishments to overhaul their healthcare delivery systems in pursuit of maximizing patient care and minimizing the risk of infection. This accelerated the adoption of telemedicine practices in India, effectively mitigating the impact of the pandemic while laying the foundation for an innovation-led, patient-centric healthcare system in a post-COVID world.

By tracing the trajectory of the meteoric rise of telemedicine in India since the outbreak, this report by Practo and TSI, launched at Telemedicon 2020, has attempted to recapitulate the key factors contributing to this spike and its long-term benefits.

Commenting on the report, Col. (Dr.) Ashvini Goel, President, Telemedicine Society of India, said, “To witness the significant growth of telemedicine in the past few months has been overwhelming. In a short span of time, the digital health space has evolved and online consultations have become the spine of healthcare delivery systems globally. The pandemic has only allowed us to reiterate our vision for future healthcare that’s convenient, accessible, and affordable for a billion+ Indians.”

Adding to that, Dr. Alok Roy, Co-Chair, FICCI Health Services Committee and Chairman, Medica Group of Hospitals, said, “TSI-Practo telemedicine report is like the Harry Potter magic portal, showing both current and future realities; a step in the right direction will transform the way healthcare is accessed forever.”

Extensively researched and backed by insights culled from the experience of crores of Indians who used Practo between March 2020 and November 2020, this report provides valuable information and factual evidence for all stakeholders of the healthcare ecosystem seeking to understand the role and impact of telemedicine in India.

Shashank ND, CEO & Co-Founder, Practo, said, “Our aim with this report is to ignite meaningful discussions around telemedicine as a critical first step towards establishing more collaborations among stakeholders, tied by a common commitment to one industry. We have tried to cover all aspects of the upward trajectory taken by telemedicine during the pandemic, and the direction it is expected to take in a world no longer under the threat of COVID-19 by carefully analyzing data captured since the outbreak.”

Key insights from the report:

• Physical appointments went down by 32%
  • Visits to secondary care specialists like neurosurgeon, somnologist, cardiologist, and oncologist grew dramatically
  • 3x increase in the number of people using online consultations
    • 26% of the consultations were with GPs, followed by Dermatology (20%) and Gynecology (16%) and others like Gastroenterology, ENT, and Pediatrics stood at 7% each
    • The fastest-growing health concerns included ophthalmology, ENT, orthopedics, pediatrics, and gastroenterology
    • Delhi, Mumbai, and Chennai saw an average of 16x growth in queries for ENT specialization
• Non-metros saw the highest growth of 7x in online consultations, as compared to the same period in the previous year
  • During the same period last year, the split between metro:non-metro for online consultations stood at 75:25. This year, it is 60:40, demonstrating that the number of online consultations from non-metro cities is on the rise
  • Tier 2+ cities like Manjeri, Arrah, Balasore, Etah, Orai, Khopoli, Jagtial, and Shivpuri used telemedicine for the first time in this time period
  • Cities like Meerut, Jammu, Srinagar, Nellore, Kochi, Gorakhpur, Kakinada, Tirupati, Bhagalpur, Gaya, and Shimoga recorded a 10x growth
• Non-metros saw the highest growth of 7x in online consultations, as compared to the same period in the previous year
  • During the same period last year, the split between metro:non-metro for online consultations stood at 75:25. This year, it is 60:40, demonstrating that the number of online consultations from non-metro cities is on the rise
  • Tier 2+ cities like Manjeri, Arrah, Balasore, Etah, Orai, Khopoli, Jagtial, and Shivpuri used telemedicine for the first time in this time period
  • Cities like Meerut, Jammu, Srinagar, Nellore, Kochi, Gorakhpur, Kakinada, Tirupati, Bhagalpur, Gaya, and Shimoga recorded a 10x growth
• Among metros, Chennai witnessed the highest growth of 4x as compared to the previous year
  • Bengaluru, Delhi-NCR, Mumbai, Pune, Hyderabad, and Kolkata grew by more than 300% as compared to last year
• More and more elderly people are now getting used to technology
  • There was a 502% spike in online consultations from people above the age of 50 during this crisis, who contributed to 12% of overall consultations, as compared to just 5% the previous year
• More women are going online
  • Last year the men:women ratio stood at 75:25, while this year it’s 68:32
  • Gynecologists and General Physicians were two of the most consulted specialists by women in 2020
• Online mental health consultations and queries continued to rise during this period
  • There was a 302% increase in overall mental health-related queries
  • Women contributed to 33% of overall queries for mental health specialists
• More consultations at late hours
  • 25% of online consultations were recorded between 10 pm and 4 am when people are not burdened with work responsibilities
  • One of the top specialties consulted during late-night hours was Psychiatry
• Preferred day(s) to consult doctors online were Tuesdays, Wednesdays, Saturdays, and Sundays, while Saturdays, Sundays, and Mondays were preferred for in-person appointments

To know more about Telemedicine and its evolution post the COVID-19 outbreak, please refer to the report here – LINK

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Apollo Tele Health – Teleconsultations during COVID-19

Dr. Ayesha Nazneen, Apollo Tele Health
Mr. Vikram Thaploo, Apollo Tele Health

The epidemic of 2019 novel coronavirus (COVID-19) has expanded from Wuhan throughout China and is being exported to a growing number of countries including India. In India, pandemic created unrest amongst the population and uncertainty towards medical services accessibility. Government of India realising the potential of Telemedicine, issued guidelines in March 2020 to address many of the key challenges in providing health services during the outbreak of COVID-19.

Apollo Tele health being the leader in Telemedicine, has created an impact by reaching out to the populace during and post COVID-19 lockdown by providing real time Teleconsultations in 16+ specialties covering 28 states of India. During lockdown, services were provided for COVID-19 screening, counselling, treatment and referral by bringing doctor at their home through Teleconsultations if not would have remained deprived from treatment. Teleconsultation services helped them to overcome the challenge of health services accessibility. The services did not limit to the COVID-19 conditions but largely catered to the patients at risk with other health conditions. It provided equal opportunity to all men, women, children and geriatric population overcoming the barriers of lockdown.

The Public Private Partnership projects with multiple state governments of India, enhanced Apollo Tele Health’s capacity to provide Telemedicine services at government health facilities – UPHCs, PHCs and CHCs to both COVID-19 and non COVID-19 conditions during pandemic and touched 460000+ through Teleconsultations.

Highlighting one of the initiatives from many projects, Government of Madhya Pradesh approached Apollo Tele Health to activate (Sanjeevani Tele Health service) Doc on Call with a dedicated Toll-Free number for the entire population of Bhopal and Indore districts and later extended to all districts of Madhya Pradesh for the month of April and May 2020. It covered health related consultations including suspected cases of COVID-19 and essential Non COVID-19 cases ranging from simple infections to chronic diseases and post-surgical follow ups. The consultations were provided by General Physicians and Specialist doctors. Sanjeevani Tele Health service has been widely promoted by Government of Madhya Pradesh, through local newspapers, digital and social. It started with 9 specialities and later with increased demand extended to 11 speciality Teleconsultation services. Most of the consultations were audio but provision of video consultation was also made available based on patient need and clinical judgement of doctor. Suspected COVID-19 and high-risk cases were referred to Government facilities for immediate action. Total 8,600 patient availed the services from GP and specialist doctors. This service reached out to 12 % elderly and vulnerable population of the total patient who availed services.

Apollo Tele Health’s through one of its service “Doc on Call” provided Teleconsultation and counselling services to 2200+ COVID-19 positive cases and 40000+ suspected cases. It helped them to get treated without stepping out from their home. It also helped them to overcome the myths of COVID-19 and face the challenge with confidence. Non COVID-19 patients benefited at large by taking consultation from home without exposing to the risk of COVID-19. The patient feedbacks were positive, one of the patients said “I am so fortunate to avail Doc on Cell service. It felt very personal and professional. I was impressed that the doctor took time to understand my condition. I never imagined; I will beat COVID-19 through virtual consultations.

Apollo Tele Health has helped to transform and showed the path to deliver technology enabled Telemedicine services during lockdown. The enormous impact Apollo had in lives with treatment and suffering eased during pandemic, further strengthen its commitment to provide Telemedicine services in the years ahead.

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The AmbuPod Project: Practical application of robotics in Rural Healthcare in India

Lavanian Dorairaj
Director, LYNK AmbuPod Pvt Ltd | Certified HL7 and DICOM Specialist | Past Deputy Director, Medical Services, IAF | director@ambupod.com

The AmbuPod project is a highly affordable, mass-production model for rural healthcare. It is a telemedicine supported, primary care mobile clinic that provides diagnostic, preventive and curative care along with its own ambulance with a setup cost of less than Rs 1 lakh per village. The ability to provide 6-days-a-week care to EVERY village within its jurisdiction is a powerful capability that is provided by almost no other such project at the price-point of the AmbuPod project.

The AmbuPod is fully equipped with diagnostics, medical and life-saving equipment to cater to mainly primary and preventive care. However, with the advent of 5G and the possibility of real-time remote instrumentation, it is the opinion of this author that the time is now ripe to apply real-time robotic telemedical instrumentation into rural care so as to provide the remote doctor the ability to remotely image, manipulate and, as we gain more experience, actually carry out remote procedures.

Robotics has traditionally been an area of esoteric and expensive research and work and mostly carried out in the US and the UK. The excellent work done by Boston Dynamics, an American engineering and robotics design company comes to mind. This author feels that it is now time to bring such technologies to the common man while also lowering costs to ensure true affordability. India with its numerous IITs and other centres of excellence could support us in this endeavour. If ISRO could successfully launch a satellite to reach Mars successfully in the verry first attempt, and that too, with a budget 1/10th of that spent by NASA for the same job, I do not see why we cannot take remote healthcare robotics to rural India.

We are now reaching out to centres of excellence (CoE) to work with AmbuPod to strategize and design remote healthcare robots to carry out a remote-doctor manipulated examination of the ear, nose, throat, lungs and heart. The proposal is to look for fund providers for this project and support from CoEs for a 2 year pilot utilizing 5G connectivity.

Any organisation interested it working with us on this pilot is welcome to contact this author.

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Television for Telemedicine
(History and Evolution of Telemedicine – 5th 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).

Television was used in an interactive format for medical consultation in 1959 between a state mental hospital and Nebraska Psychiatric Institute through a microwave link. They actually used it for neurological examinations and other information across campus to medical students. They next explored its use for group therapy consultations, and in 1964 they established a telemedicine link with the Norfolk State Hospital (112 miles away) to provide speech therapy, neurological examinations, diagnosis of difficult psychiatric cases, case consultations, research seminars, and education and training. And slowly it was established and recognised as a powerful medium akin to face to face consultation.

However the idea of using television for such consultation emanated the first time in 1927 for a dialysis patient. The patient saw the consultant on one monitor and herself on another (See picture below).

It is thought that Marshall McLuhan may have coined the term coined “telemedicine” He said “time has ceased, space has vanished, we now live in a . . . simultaneous happening. Ours is a brand new world of all onceness.” McLuhan’s argument that broadcast television, as a form of “the most recent and spectacular electrical extension of our central nervous system.”

Electronic media have been the source of a biomedical revolution as much as antibiotics, anesthetics, or organ transplants.

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Telemedicine – News from India & Abroad

 

Apple Watch yields heart data nearly as good as clinical tests, report claims

Apple has been playing a long game in digital healthcare. The main focus – where Apple is right now – CEO Tim Cook recently said , is “…to empower people to own their health.” And as the tools to enable such ownership develop, more opportunity knocks.….. Read More

The rapid uptake of 5G and its real potential

In name it may feel like just one small step from 4G. But the fifth generation of cellular networks is much more than blazing fast mobile broadband. By: Josh Aroner, vice-president: global customer marketing at Nokia.….. 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.

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

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

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

– Dr. APJ Abdul Kalam

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

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

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

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

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

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

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

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Privacy and Digital Health in India

Bagmisikha Puhan, Member, EC – TSI
Associate Partner, TMT Law Practice, C-2/39 | Safdarjung Development Area New Delhi – 110016 | India.

The digital health ecosystem in India found a fillip last year, and ever since, the industry has been generating and consuming large volumes of personal as well as sensitive personal data. This has led to increasing concerns amongst the end users who are submitting their data to the digital platforms who are facilitating remote delivery of health care services and are fostering continuity of care.

With a rise in the number of people opting for at-home diagnostic services, and a rise in the number of tele-consults which are being opted by the end users, there is a pressing need to address the inadequacies of the present data privacy framework. While the present framework outlines the basic requirements, which are essential for compliance, they do not provide sufficient safeguards for the protection of all the information which is flowing through the entire ecosystem.

Simply put, while the Telemedicine Practice Guidelines (TPG) have provided a basic guiding element with respect to the procedure to be followed to preserve privacy of a patient, they do not provide a framework within which the same must play out. Additionally, the TPG carries a template for prescription, and the identifiers that can be captured therein, are extremely exhaustive in nature, and may lead to complete disclosure of a patient’s health and medical information when it is being shared on a third-party digital platform or is being shared with a pharmacy. Issues around this will continue to influence the minds of the consumers who are willing to realign their preferences with the digital world. As a consumer intends to move towards a digital based ecosystem, they might find the lack of a comprehensive legislation under which they can seek redressal, unsettling, which in turn will deter the geometric flourishing of the entire sector.

Under the pending Personal Data Protection Bill (PDP Bill), the entire life cycle of a person’s health information is being captured. As it is oft-put, digital health ecosystem has built a situation where the entire life cycle, that is the journey from the womb to the tomb, can be mapped out by the information fed to the digital systems. The PDP Bill promises safeguards and accounts for scenarios which are related to emergency situations, as well as continuity of care.

To surmise, the PDP Bill premises itself upon a nearly homogenous ecosystem, which is also allowing for interoperability. This is being supplemented by the expected National Digital Health Mission (NDHM), and the policies issued thereunder. The PDP Bill in conjunction with the NDHM will be in a position to bring in a certain degree of uniformity in the compliance conditions, in re the expected behavior on the part of the healthcare organizations, healthcare providers, and will also clarify on the obligations that the data subject is to be comply with. While the entity which seeks information is expected to ensure that the data available with them is accurate and updated, the onus in provisioning of such information is on the data subject or the patient who has to ensure that they are providing the information which is commensurate and essential for the healthcare service provider to address the concerns and medical situation of the patient.

The PDP Bill features exceptions whereby sensitive personal information of a person may be processed without the explicit consent of the patient for scenarios where vital interests of the end users must be preserved. The extreme caution and safeguard afforded to the elevated status of sensitive personal information are with the view that the end user must not be discriminated against on the grounds of any inherent bias or prejudice on the basis of inappropriate or unauthorized usage of sensitive personal information. It is with these concerns in mind that service providers, system participants and service recipients are waiting for the legislative framework with bated breath.

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Telemedicine Enabled Clinics with Last Mile Healthcare Delivery

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

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

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

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

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

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

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

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

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Radio & Marine Telemedicine
(History and Evolution of Telemedicine – 4th Milestone)
Dr. Sunil Shroff, MS, FRCS, Dip. Urol (Lond.)
President, Tamil Nadu Telemedicine Society of India,
Editor, www.medindia.net,
Consultant Urologist & Transplant Surgeon, Madras Medical Mission Hospital, Chennai, India (shroffmed@gmail.com)

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

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

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

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

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

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

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

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

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Access the Latest News on Telemedicine and Telehealth

This is another source for the Latest News on Telemedicine and Telehealth that is brought to you by our TSI member Dr. Lavanian Dorairaj.

Each news article is carefully and painstakingly distilled from reliable sources from across the world, by actual human beings. We pride ourselves in providing focused and human-curated news. There are no BOTs or impersonal Algorithms involved here. We put in hours of hard work to ensure that YOU do not have to work hard.

Do visit http://www.telemedicinenews.com for updates.

Telemedicine – News from India & Abroad

India

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

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

International

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

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

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

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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.

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

TELEMEDICON2020 – Highlights
‘From the Fringes to the Mainstream’

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

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

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

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

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

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

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

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

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

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

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CME on Cyber Security for Doctors and Medical Staff

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

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

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

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

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

The relevant part of the amendment is as follows:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Training for Telemedicine in India for Registered Medical Practitioners – Seminar

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

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

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

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

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

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

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

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

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

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Teleophthalmology Symposium – An overview

By Dr. Sheila John

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

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

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

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

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

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

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

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

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

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TELEMEDICINE IN DIABETES CARE Symposium

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

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

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

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

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

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

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

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

The key take-home message included:

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

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

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

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

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

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

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

Take-home message included:

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

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Panel Discussion on DIGITAL AYUSH

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

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

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

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Virtual General Body Meeting of Telemedcine Society of India

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

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Announcements

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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.

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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