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.
This will be the 16th International conference of the Telemedicine Society of India. The meeting will be in a virtual web mode in keeping with the current new normal.
The TN chapter along with four other state chapters (Delhi-NCR, Rajasthan, Maharashtra and Karnataka) have taken up the responsibility to conduct TELEMEDICON 2020 from 18th to 20th Dec 2020.
Telehealth in India has grown exponentially in a very short time after the notification of the Telemedicine Practice Guidelines by the Govt. of India. In keeping with the above the theme of the conference has been aptly adopted as ‘Telehealth – From the Fringes to the Mainstream’
The conference will have 2.5 hours of morning and another 2.5 hours of evening deliberations with 4 hours of virtual exhibition and sponsored webinars in the afternoon from our potential sponsors.
Medicall – an established medical exhibition company for the last 20 years has agreed to take up the responsibility for handling our virtual exhibition.
The registration amount for the three days web-conference is very nominal.
TELEMEDICON 2020 will connect healthcare professionals, policy makers, industrialists, health insurance providers, online pharmacy chains, nurses, students, and various stakeholders from the field of Telemedicine and Health Informatics, over one common platform and bring to the fore the pain points, as well as the possible solutions, that could resolve existing issues.
Association with entities
Telemedicine Society of India invites you to participate at various levels –
Industry sponsor of the conference with its various benefits to showcase the brand and products.
Knowledge partner, whereby, an organisation can add value in terms of policy development and organise webinars keeping the above program in mind with mutual agreement.
Affiliate partner, whereby, the partnership adds value in terms of providing services such as hosting of the conference on a platform, hosting the website, creating design, sending mailers, helping with sponsorship or any other way to help the conference. TSI will share the logo and acknowledge such partnerships.
Planned Themes
1. Transforming Telehealth Training for Registered Medical Practitioners in India
a. Format of Training b. Current Experience with Training c. Virtual and augmented reality d. The way forward
2. Legal & Ethical Aspects – The Grey Areas
a. TPG – what needs to be changed? b. Data Protection Act and Health c. Good Practices – learnings from abroad
3. Challenges in Health Data Integration – National and State
4. 5G and Telehealth – the Larger Impact
5. AI, Block chain and Telehealth
6. Wearables and impact on Tele-health
7. Remote Monitoring – How to cut costs and Improving Patient care
8. History of Telemedicine
a. India b. International
9. Standards
10. Health Apps in India
11. COVID-19 and impetus to Telehealth
12. Wellness & Telehealth
13. STEMI project in Cardiology
14. ECHO global project
15. Health Insurance and Telehealth
16. Online pharmacies – Getting it Right for Telehealth in India
17. How can Rural Health care be Transformed Using Telemedicine?
18. Planned Workshops & Parallel Tracks
a. How to set up a Telehealth consultation Platform – DIY b. Taking care of Security issues in Telehealth c. Setting up Payment Gateway d. Standards – software and Hardware e. Teleopthalmology – Joint meeting with WHO group & ITU f. International Telehealth Societies – working together and sharing of good practice documents g. Tele- health Initiatives by central & State Govt in India – Examples of Excellence
Dr. Sunil Shroff Organizing Secretary President, TN – Telemedicine Society of India
Telemedicine pRoject for screENing Diabetes and its complications in rural Tamil Nadu (TREND) project
Dr. V. MOHAN, MD,FRCP, Ph.D, D.Sc, FNA,FACE, FTWAS, MACP, FRCE Chairman, Dr. Mohan’s Diabetes Specialities Centre and President, Madras Diabetes Research Foundation, Chennai.
Awareness, diagnosis, regular checkups and other ways of preventing as well as treating NCDs especially diabetes, are very low among the rural sector. Hence, to study the status of diabetes and associated complications in rural Tamil Nadu, the Madras Diabetes Research Foundation (MDRF), Chennai and the University of Dundee, UK have taken up a joint research collaboration to screen 15,000 people in 25 shortlisted villages in Kancheepuram and Chengalpet districts of Tamil Nadu. The program called as the TREND (Telemedicine pRoject for screENing Diabetes and its complications in rural Tamil Nadu) project focuses on finding the burden due to diabetes and its complications in rural Tamil Nadu and providing novel solutions for its management. This project is funded by the National Institute for Health Research (NIHR) of the Department of Health, UK to take up the INdia-Scotland PartnershIp for pRecision mEdicine in Diabetes (INSPIRED) project. The TREND project is part of the overall INSPIRED program. Through the TREND project, we aim to address the challenges with innovative use of technology that will enable even remote areas gain access to quality medical diagnosis and care.
Early and timely screening for diabetes and pre-diabetes, prevalence of hypertension and obesity, screening diabetic complications in eye using retinal images, foot and kidney as well as assessing diabetes control among individuals etc. are being carried out through this project. We are utilizing telemedicine technology in the chosen villages to screen for diabetes related complications. A fully equipped mobile telemedicine van fitted with all equipment necessary for screening for diabetes and its complications has been set up. The infrastructure in the telemedicine van includes an inexpensive mydriatic Remidio “fundus on Phone” apparatus, computerized electrocardiography (ECG), Doppler and biothesiometry. The telemedicine van also includes facilities for blood sampling. So far, nearly 10,000 individuals aged =18 years have been screened for diabetes and other metabolic NCDs.
Tele Counselling Solutions From Sankara Nethralaya S. Chandra Mouli
Chief Information & Technology Officer,
Sankara Nethralaya, Chennai.
INDIAN TELE HEALTH MARKET TRENDS : MARCH – JUL 2020
50 MILLION INDIANS ACCESSED HEALTHCARE ONLINE
700% GROWTH IN TELE OPHTHALMOLOGY
80% EXPERIENCED IT FIRST TIME
44% WERE FROM NON-METRO CITIES
67% DROP IN PERSON DOCTOR VISITS
The pandemic outbreak was a perfect storm warranting fast tracking innovation in health tech.and its adoption at a rapid pace never thought of before with the providers and its participants.
Sankara Nethralaya being a pioneer in the country in adoption of Technology through its adoption of specialty EMR and Hospital Management systems fast tracked its adoption of its Innovative Tele counselling solutions to its Patients as its COVID response. Social distancing, concerns on Hygiene warranted disruption to the OPD at large and forced Medical fraternity to adopt newer ways to engage with Patients and also provide services on demand.
In view of the early lock down SN realized that it needs to reach out to all its patients who were operated upon and provide counselling. We realized the need for an autonomous, smart and self aware system that
Need to manage appointments for the patients with their respective doctors with whom they consulted
Provide the doctors with relevant clinical information for decision making
Capture Action plan and update the EMR
Provides a frictionless compute & highly automated with the least manual intervention in view of remote working and servicing.
Solution & approaches
Key objectives – Provide patient delight and actionable insight to Consultants through smart solutions.
Key design principles
Zero UI concept – Familiar Email interface, smart texts leveraging SMS, proven APPS for patient engagement, Web based solutions and Voice based services
Simplicity in design
Focus on superior user experience
Development approaches
Agile / Extreme programing
Remote working & usage of collaborative tools & technologies
Working code as a measure of progress
Incremental build – over 90+ enhancements and feedback were factored as changes
Secure coding practices IT Infra, Cyber security & Cloud
Leveraging existing highly resilient data center
Multi cloud and best in class on demand services like voice telephony, messaging and email
Disaster recovery on private cloud
Secure infrastructure and continuous monitoring for performance
Monitoring for any cyber attacks and ensuring high availability
Leveraging IT Help desk for proactive support
Technology used
Microsoft based Techstack
MS SQL2016
.net 4.5 framework
Cloud telephony & voice basedservices
MESSAGINGServices
Emailintegration
Secure hostedsolutions
API based integration into coreservices
Analytics
Outcome
Over 10,000 SN patients were provided tele counselling services leveraging the platform since April 2020. 98%ofthepatientswereextremelysatisfiedandprovidedravingfeedbackonthequalityofservices. Dissatisfied patients or negative or feedback were followed up and continuous enhancement to servicesmade.
Lessonslearnt
Keep communicating Every resource isimportant Distribute work and manage stress & also risk Progress is important. Working code is the best test of success. Manage surprises & have a plan B for every contingency Leverage proven tools Incremental innovation – no big bang approaches. Continuous feedback and go the extra mile to provide patient and user delight Train and educate users and reduce adoption risks.
Transmission of ECG over Telephone Lines – 1905 (History and Evolution of Telemedicine – 3rd Milestone)
Dr. Sunil Shroff, MS, FRCS, Dip. Urol (Lond.) President, Tamil Nadu Telemedicine Society of India,Editor, www.medindia.net, Consultant Urologist & Transplant Surgeon, Madras Medical Mission Hospital, Chennai, India (shroffmed@gmail.com).
On March 22nd 1905 Willem Einthoven, a Dutch professor of physiology recoded the first tele-cardiogram. He utilized a telephone cable to transmit the signal from the hospital to his laboratory 1.5 km to record the ECG. He was the first to introduce the Latin term ‘tele’ as a prefix to indicate remote delivery of medical service. The term he used for this was “telecardiogramme.” The original ECG Machine weighed 270 kilograms required five people to operate and the patient had to immerse their legs and hand in saline water. It also required cooling for the powerful electromagnets.
Einthoven graduated in medicine from the University of Utrecht and served as professor of physiology at the University of Leiden from 1886 until his death. It was in 1903 he first invented a galvanometer that was used to measure the changes of electrical potential caused by contractions of the heart muscle and to record them graphically and he coined the term electrocardiogram for this process. Apparently his hospital did not allow him to use the ECG machine in its premises and he hence transmitted the ECG over the telephone line and recorded it in his lab. He received Nobel Prize for this important invention of ECG in 1924.
In current age of so many technical advances with so many tools to evaluate and treat the heart we can still refer to Einthoven’s remarks in 1920s when he said – “An instrument takes its true value not so much from the work it might possibly do but from the work it really does” and “Truth is all that matters, what you or I may think is inconsequential.”
Artificial Intelligence Smartphone Tool Could Diagnose Strokes Within Minutes Novel tool can diagnose stroke with the accuracy of an emergency room clinician from interaction with a smartphone, reports a new study. The tool can diagnose a stroke based on abnormalities in a patient’s speech ability and facial muscular movements within minutes from an interaction with a smartphone….. Read More
Novel Wearable Sensor Help ALS Patients Communicate New wearable sensor was developed by MIT researchers to help those living with amyotrophic lateral sclerosis (ALS) communicate. The findings of the study are published in the journal Nature Biomedical Engineering. ….. Read More
Virtual Reality Helps Patients Address Eating Disorders Virtual Reality (VR) technology can significantly impact the validity of remote health appointments for those with eating disorders. Through a process known as Virtual Reality Exposure Therapy (VRET) ….. Read More
Novel Chili-shaped Device may Reveal Just How Hot That Pepper is Novel chili pepper-shaped device containing a paper-based electrochemical sensor can be connected to a smartphone to know how much capsaicin is in hot pepper, reports a new study. The findings of the study are published in the journal ACS Applied Nano Materials.….. Read More
International
Abboud Chaballout Is Using AI to Revolutionize the Healthcare System Abboud is an entrepreneur and thought leader in the field of health and medicine. He earned his law degree from the University of California Berkeley School of Law, one of the most prestigious institutions and one of the top ten universities for law studies….. Read More
United Airlines Rolls Out Digital Health Passport (CBS DETROIT) – United Airlines is testing out digital health passports. The digital health dossier houses Covid-19 tests results for passengers. Travelers can take coronavirus tests up to 72 hours pre-flight and then input their results on what’s called the common-pass app.. Read More
India & EU explore possibilities of enhanced cooperation In a statement, the MEA said that leaders explored the possibilities which can help to strengthen India-EU strategic partnership in the post-COVID-19 world. In the meeting, decisions which were taken at the 15th India-EU Summit held in July 2020 were also reviewed….. Read More
Scientists Develop First Smartphone App That can Detect Ear Infections in Children University of Washington researchers have created a new smartphone app that can detect ear infections in children. The app detects fluid behind the eardrum by simply using a piece of paper and a smartphone’s microphone and speaker..….. Read More
TN – TSI invites all the TSI Chapters and Members to submit information on their upcoming Webinar or Events (50 words), News related to Telemedicine (200 words) or short articles (500 words) for the monthly e-newsletter.
Submission may be sent to – tsigrouptn@gmail.com Editors reserve the rights for accepting and publishing any submitted material.
Editor in Chief – Dr. Sunil Shroff Editors – Dr. Senthil Tamilarasan & Dr. Sheila John Design – Sankara Nethralaya Technical Partner- www.medindia.net
Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India
TN – TSI invites all the TSI Chapters and Members to submit information on their upcoming Webinar or Events (50 words), News related to Telemedicine (200 words) or short articles (500 words) for the monthly e-newsletter.
Vision Centres
Dr. Kim Ramasamy Aravind Eye Hospitals, Madurai
With over a billion people living with blindness or visual impairment due to preventable or treatable conditions, universal coverage for eye care is still a largely unmet need. This is especially because those who need care are in remote and rural locations where service delivery is a challenge.
Primary eye care remains a challenge especially because it has been difficult to provide comprehensive care for all the conditions encountered at the primary level. However, with the arrival of broadband internet, this has become a possibility. Vision Centres or primary eye care centres now provide comprehensive and complete eye care to the rural population.
Most notably, Aravind Eye Hospitals and LV Prasad Eye Institute in India have a large network of rural vision centres. This model is now being rapidly replicated by national and state governments.
Comprehensive care:Patients who visit the vision centre receive a comprehensive eye examination by an allied ophthalmic personnel or vision technician. The technician captures the findings in a cloud-basedelectronic medical record – including any images of the eye. These records are accessed by an ophthalmologist at a secondary or tertiary eye care facility. The patient is able to have a teleconsultation immediately with the ophthalmologist, who gives the final treatment advice and prescription. The technician prints out the prescription and gives it to the patient along with counselling about the treatment.
Complete care:It is important that patients are able to act upon the doctors advice. So as to complete the loop,it is important that affordable spectacles and ocular drugs are made available at the vision centres itself for the patients. If the patient needs to be referred for higher levels of care, clear instructions and counselling needs to be given to ensure that patients act upon the referral.
Coverage:Each vision centre serves a rural population of 70,000-100,000. An estimated 30% of this population would need some form of eye care. Evidence shows that over four years 82% of those in need have been seen at the vision centres! This coverage is not only true at the level of gross patient numbers – but also for individual eye conditions too.
Vision centres, being closer to the community have a unique advantage to ensure treatment of chronic conditions are truly effective. Given that they are local to the patient, they are more accessible for regular follow up visits and can ensure patients stay on-track for their treatment. Aravind Eye Hospitals have ensured that patients with chronic conditions can procure medication and a patient registry helps to longitudinally monitor these patients over time.
The model has been successfully replicated and scaled up by other governments and NGOs in different parts of the Indian Subcontinent:
Aravind assisted the state government of Tripura to set up 40 vision centres across the hilly state of Tripura where access to health care is a major issue.
Aravind is also working with other state governments in India to replicate this model: so far, 10 centres have been set up in Chhattisgarh and 32 in Tamil Nadu, as pilot initiatives.
Aravind has helped the Government of Bangladesh set up 50 vision centres, with another 40 in the immediate pipeline. The commitment is to set up a total of 400 vision centres across the country.
A senior ophthalmologist at the State Blindness Control Society of Tripura observes how the tertiary government hospital at the capital city used to receive several patients with minor eye ailments. This not only meant that critical resources of the hospital were being used for minor treatment but also meant a great financial burden on the patients who travelled so far. But now, a much larger number of such patients are seen locally at the vision centres and only those with more complex eye conditions show up at the tertiary facility.
What does it take to set up a successful vision centre network?
Patient centric workflows
Comprehensive eye examination
One-stop services (eyeglasses, ocular drugs etc. should be made available)
Staff trained to provide high quality, patient centric care
Telemedicine consultation
Affiliation with a referral hospital
Strong monitoring system to ensure quality of care (patient feedback surveys)
Staff engagement, motivation and continuous education
Tele-ICU: Distance is not a real barrier for Critical Care
Dr. N. Ramakrishnan AB (Int Med), AB (Crit Care), AB (Sleep Med), AB (Obesity Med), MMM, FACP, FCCP, FCCM, FAASM, FISDA, FICCM Founder & Managing Director, Chennai Critical Care Consultants & TACT Academy for Clinical Training Director, Nithra Institute of Sleep Sciences
What is TeleICU?
Tele-ICU or Tele-Critical Care is a customized solution for hospitals using technology to bridge experienced Critical Care Specialists (Intensivists) and nurses to monitor and support care for patients in the Intensive Care Unit (ICU). The Intensivists and nurses operate from a centralized monitoring center
What are the various models of care?
Remote monitoring is referred as ‘continuous’ when care is provided proactively round the clock usually from a centralized monitoring center (often referred to as ‘Command Center”).
Alternatively, ‘episodic’ care could be provided reactively ‘on-demand’ when the ICUs requiring support could request services as needed. With increasing use of smartphones and tablets, this model has been facilitated by specialized Tele-ICU applications (apps).
Tele-ICU rounds have been helpful in assisting ICUs. In this model the Intensivists remotely connects with the Doctor at the user end and is available to facilitate and discuss about patients and assist with care plans. Focused rounds for Nutrition support, implementing antibiotic stewardship are also an option with this model
What are the advantages?
It is currently not feasible to staff every ICU with qualified Intensivists as they are far and few and mostly concentrated in tertiary care centers in larger cities. Tele-Critical care helps to reach specialized services anywhere, anytime.
Remote monitoring services have consistently shown to improve implementation of evidence based best practices
Monitoring by specialists has shown to improve outcome such as reduction of length of stay, implementing care bundles and reducing infections and also reducing mortality rate.
Hospitals have noticed that there is an increased retention of patients who would have otherwise been transferred out.
ICU care is complex – How can it be provided remotely?
Critical care involves several interventions by a multidisciplinary team. Most of these are ‘cognitive’ while some involve bedside procedures.
It is important to understand that the remote ICU model complements and does not replace the bedside team. The input from the bedside team is crucial for the remote Intensivist to provide input.
Specialist team of Intensivists, Physician assistants, Respiratory Therapists, Critical Care Nurses, Clinical Nutritionist & Pharmacist can remotely offer several cognitive inputs that could greatly benefit patient care. They need to closely interact with the bedside team to implement these decisions and also for any procedures that may be required.
Are TeleICU services available in India?
Chennai has been a leader in healthcare in our country and has several firsts to its credit. The first TeleICU anywhere outside the USA was a collaborative effort by Chennai Critical Care Services. We partnered with Advanced ICU Care, USA and started providing Tele-ICU for hospitals in America from 2010.
The fact that the first successful remote monitoring services in India were for ICUs in USA clearly confirms that distance is not the real barrier. We continue to provide these services successfully for over 10 years now.
Proactive continuous monitoring services in India were provided by us (InTeleICU™) and providers including Critinext. With the new telehealth policy of Ministry of Health, there is a scope for modified services particularly in a reactive episodic model to extend the outreach of specialized services.
We refer the readers to our recent article calling for an urgent action on Tele-ICU services published in Indian Journal of Critical Care Medicine cited below:
Ramakrishnan N, Vijayaraghavan BKT, Venkataraman R. Breaking Barriers to Reach Farther: A Call for Urgent Action on Tele-ICU Services. Indian J Crit Care Med 2020;24(6): 393–397.
Blockchain Use and Opportunity in Healthcare
Tory Cenaj, Founder, Partners in Digital Health, Publisher, BHTY
According to a 2018 a SERMO survey, physicians across all specialties lack awareness for blockchain technology impacting healthcare providers and payers at institutions and clinical settings around the US.
47% of physicians polled have not heard of blockchain
25% indicated blockchain is ready to enter healthcare
28% reported blockchain was not ready to enter healthcare
In 2020, an American Medical Association (AMA) Survey reported:
Physicians weighed in on emerging technologies such as blockchain and augmented intelligence (AI), which is often called artificial intelligence. While 46% of physicians are familiar with the blockchain technology, 0% are using it.
Before we explore the potential applications for blockchain, let’s first provide a top line definition for it. Blockchain is a shared distributed digital ledger technology (network platform), that securely facilitates interoperable data management and provides any original source of ownership, that can potentially transform healthcare. The technology is currently utilized in pilots and scaled ecosystems in healthcare around the wordto optimize business processes, lower costs, improve patient outcomes and enable better use of data interoperability.
Unlike traditional centralized databases, data on a blockchain can be distributed across multiple databases and computers (also known as ‘nodes’) so that everyone has the same version(or “ledger) of a process or transaction. ‘Blocks’ of data are linked together by a hash (a digital signature of random letters and numbers) that form a ‘chain’ of data containing a complete history of the performed transaction that cannot be changed – only added to, so it is considered “tamper resistant.” Data is secured through cryptography (advanced encryption) for participants can trust the ‘blocks’ of data posted are authenticated and verifiable. These features result in decentralized data systems that are not controlled by a central authority that are usually vulnerable to breaches or points for failure. Blocks represent a single source of information all participants agree to as true, resulting in higher levels of trust by participants.
Applications and Studies
Blockchains offer the option to be permissioned/private or consortium networks, not open to the public but used by a group of participants to limit the participation and access to shared data, or they can be public blockchains.
The technology as an appropriate network sharing platform electronic health records to reduce errors and increase interoperability while preserving data privacy. It also enables analysis and payments for claims or contracts between provider, health system(s) and patients. Most physicians aren’t aware of the efficient, error free utilization the technology provides – particularly since the onset of the Covid-19 pandemic has highlighted deficiencies in the marketplace. To learn more, view articles below:
Blockchain technology can significantly reduce the cost and speed of clinical trials. This includes a shared data ledger, security of data, patient recruitment and retention, interoperability between all devices used, efficient and validated clinical and patient data management and analysis, increased data integrity, and payment portals – all while reducing human error and increasing security. See the article below for more details.
Pharmaceutical supplies also include multidisciplinary stakeholders including manufacturers, wholesalers, packagers, logistics, regulators, hospitals, pharmacies and patients across countries creating a global ecosystem.Consider drug fraud, mismanagement, quality and safety. Blockchain resolves many supply chain challenges and provides cost efficiencies and faster turnaround. Tracking and tracing becomes seamless in a modernized system. Consider the publications below describing methodologies and pilots in more detail. We already find blockchain utilized in other industries.
Many breakthrough articles have been published in Blockchain in Healthcare Today (BHTY), the world’s first open access peer reviewed journal that amplifies and disseminates distributed ledger technology research and innovations in the healthcare sector. We encourage authors to submit manuscripts and join the ecosystem. The journal is published on a continuous basis with a world-class peer-review board and registers original research article provenance on the blockchain. The journal is indexed in Science Open, Unpaywall, Google Scholar and the PKP Indexes.
The journal hosts the annual ConVerg2Xelerate (ConV2X) conference. Registration is open for the November 10 and 11 symposium with the theme “US -World Health Transformation.” Attendance is free. For more information click here.
India leads the world in Telehealth Cross-Sector Partnerships
Dr. William B. Eimicke is Professor of Practice and Director of the Picker Center for Executive Education at the School of International and Public Affairs at Columbia University. He retired from the FDNY as Deputy Commissioner for Strategic Planning and Performance Management and served as New York State Housing “czar” under Governor Mario M. Cuomo. He is also the co-author of Management Fundamentals (2020) and Social Value Investing (2018), both published by Columbia University Press
Adam Stepan is the Director of the Picker Center Digital Education Group, and Adjunct Professor at the Picker Center. Adam oversees creation of online class materials and audiovisual case studies for the global EMPA program and works with SIPA faculty on the research and creation of audiovisual case studies.
In 2014, my colleague Adam Stepan and I began a project to develop original video and written case studies for a new hybrid MPA at the School of International and Public Affairs (SIPA) at Columbia University. We focused on innovations in providing essential public services such as police, fire, education, sustainable agriculture and health care. After considerable research, our innovation in health care focused on telemedicine and electronic record-sharing identified India as being at the cutting edge of that innovation.
Our team then made several trips to India to meet with Dr. K. Ganapathy, film what was going on at Apollo Hospitals, look at the history of telemedicine and its future and then make what is now a widely used case film and written case study ( https://vimeo.com/200378894 ), comparing India to less advanced efforts in the United States and Brazil. The case study was presented and discussed at a major conference here at SIPA, appropriately simulcast to other experts across the global.
As we continued our research, we observed a series of emerging public-private partnershipsin India. By 2018, another colleague, Howard W. Buffett and I published what is now a very well-known book—Social Value Investing (https://www.sipa.columbia.edu/svi) which features an array of cross-sector partnerships called Digital India that developed from the earlier foundation by a wide array of public and community partners.This this spring and summer, telemedicine emerged as one of the most effective tools in fighting the COVID-19 virus in the United States and now in India and other countries across the world.
For example, in New York City telehealth insurance claims have accounted for approximately 13% of patient activity compared to 0.15% only a year earlier, according to one monitoring organization. Another survey in April found 50% of responding patients said they were using telemedicine, many for the first time. Among doctors, 85% reported using telemedicine, compared to 25% at the end of 2019. A major heath care service provider, New York-Presbyterian reported that its telemedicine service use during the pandemic reached 70,000 cases per month and is continuing to rise steadily.
In India, Modi government sees Common Service Centres as a cornerstone of Digital India, as they provide access points to every corner of India to the increasing number of services and assistance the government hopes will create a much more inclusive society that will improve the quality of life for India’s very large population of poor families and individuals. Many organizations seethe program as an opportunity to do good while simultaneously attracting new customers and perfecting a new way of delivering medical services.
While the potential is great, this initiative is complex and expensive with a relatively high risk of failure. Indian telemedicine continues to face ongoing technical challenges: unreliable electrical supply, inadequate Internet bandwidth, video distortions, and software malfunctions. Even so telemedicine examinations provide reliable diagnoses for 80 percent of patients. Telemedicine examinations are generally videotaped (with permission of the patient), providing the physician with an opportunity to review, or “see” the patient again several times, to make sure the initial diagnosis was correct and that no important information was missed.
In the United States, major providers face challenges as well such as getting thousands of physicians, behavioral health specialists and office staff onto a telehealth platform and training them on how to use it. Also, many low-income patients had insufficient data plans and/or limited internet-connected devices. In some cases, this requires a regular phone call rather than a video chat. From a reimbursement perspective, health care providers are working to figure out how to incentivize the use of telehealth services while still covering their operating costs overall.
These partnerships of public and private organizations are providing potentially world-class health care for patients in urban and rural areas and even serving those with little or no income. Telehealth creates the opportunity to attract new patients, more easily offering virtual second opinions, more effectively treating addictions, improving management of chronic conditions and enhancing the lifestyle choices for doctors. In this COVID-19 pandemic, the telemedicine model developed in India helped hospitals in the United States and many other countries manage the burden on hospital emergency rooms, diagnosis and provide medicine to vulnerable patients unable or unwilling to leave their homes and ultimately help control the spread of the virus. Through the effort and expertise and hard, sustained work by several groups starting two decades ago,thousands of dedicated doctors, nurses and health care workers in India and the Indian government and its civil servants are now leading the way to a more affordable and accessible health care system for all.
Telephone call for Tele-Consultation (History and Evolution of Telemedicine – 2nd Milestone )
Dr.Sunil Shroff, MS, FRCS, Dip. Urol (Lond.)
President, Tamil Nadu Telemedicine Society of India, Editor, www.medindia.net, Consultant Urologist & Transplant Surgeon, Madras Medical Mission Hospital, Chennai, India (shroffmed@gmail.com)
For doctors ‘Tele-consultations’ is nothing new. It started soon after the telephone was invented by Alexander Bell in 1876.Little do people know that the first call that Mr. Bell made was for medical help or for an emergency of sorts. Mr. Bell called his assistant Thomas Watson and said:
“Mr. Watson, come here, I want you.”
What had happened was that the sulphuric acid from the wet battery which was powering the telephone transmitter had spilled on clothes of Bell. And after the very first conversation on the telephone for medical help, Watson quickly appeared to administer the first aid.This first call on the telephone for medical help from Mr.Bell, was almost prophetic and 140 later, the mobile phones are now being considered to be the preferred device that will help provide universal and affordable healthcare to the people of the world.
Just two years after the invention of the telephone two letters to the editor appeared in the famous medical journalLancet on 9 February1878, The first, from “A.B.M.” of Hornsey suggesting that the telephone could improve medical diagnosis and that it might be specially useful in “demonstrating and studying the sound produced by a muscleduring contact, the negative contraction, etc.” This way of listening-auscultation in medical terminology-could be done, according to A.B.M., by applying the electrodes (presumably of the telephone transmitter) directly to the muscle.
And on Nov’1879 another piece in Lancet spoke of Practice by telephone and its use that could bring down the visits to doctors clinics in the future.The commonest consultation on the telephone over the years perhaps has been – ‘Doctor I have a headache, what can I do.’
Next issue: Read about Willem Einthoven and how ECG was transmitted over telephone lines.
Telemedicine – News from India & Abroad
India
Apple Watch Saves Man’s Life
In India, the electrocardiogram (ECG) feature on Apple Watch has saved the life of a 61-year-old Indore resident. Apple CEO Tim Cook wished him fast recovery post-surgery.R. Rajhans, a retired pharma professional who uses an Apple Watch Series 5 …Read More
Younger and female doctors adopted telemedicine more during Covid in India, study says
More of the younger and female doctors adopted telemedicine or online consultations as a practice in India compared to male and older doctors in the June-July period this year, reveals a new study.A joint study by India-based healthcare research organisation Strategic Marketing Solutions & Research Centre (SMSRC) l…… Read More
India’s Telemedicine Service Completes 5 Lakh Consultations
eSanjeevani, India’s new telemedicine platform, has recorded five lakh teleconsultations. The last one lakh consultations were completed in a record time of 17 days.As a digital modality of healthcare services delivery ….. Read More
Telehealth Trains Parents to Improve Behavior Skills of Autism Kids
during the coronavirus pandemic or in other instances when in-person instruction is not possible, according to a Rutgers researcher.The study, which was published in The Journal of Applied Behavioral Analysis, broadens the treatment options for parents of children with autism who lack access to in-person training as they do now …. Read More
Demand for Telemedicine to Rise Post Covid-19: Survey
A survey on growth in telemedicine consultation in India since Covid shows that digital adoption of medicinal services grew three times during this period. According to the survey, conducted by DrOnA Health in collaboration with Mankind Pharma, 60% of respondents reported high satisfaction with telemedicine consultation…. Read More
DIVOC Health Set To Launch 20 New Telemedicine Laboratories In India By 2021.
India, October 2020: With a mission to create the most advanced digital diagnostic laboratory network enabling the connected world and to provide telemedicine and instant care, DIVOC Health launched its first, one-of-a-kind, technologically advanced DIVOC Laboratories in New Delhi in August 2020… Read More
International
New Tool Allows Easy, Effective Disease Tracking
New study used the novel IDseq tool to confirm and sequence the whole genome of the country’s first case of COVID-19. The findings of the study are published in the journal GigaScience.This tool can distinguish pathogens before there is an available complete genome sequence…Read More
Telehealth Services: A Post COVID-19 Reality? The regular use of telehealth services for cancer patients was found to have long-lasting and unforeseen effects on the provision and quality of care, said an article published in JAMA Oncology, Trevor Royce, MD, MS, MPH, an assistant professor of radiation oncology at the University of North Carolina Lineberger Comprehensive Cancer Center and UNC School of Medicine. Read More
Morneau Shepell launches unified telemedicine solution to enhance Canadians’ total wellbeing
Morneau Shepell, Canada’s largest provider of wellbeing and mental health solutions, has expanded into the rapidly growing telemedicine market to provide the employees of Canadian clients and their families with easier, more convenient access to digital health care services. . … Read More
StudyKIK Introduces Remote eConsent Technology Solution with Integrated Telemedicine Video Calling for Clinical Trials
StudyKIK, a full service patient recruitment & retention technology company headquartered in Irvine, CA announced today the release of their fully remote eConsent platform with Telemedicine Video Calling technology. Now, any sponsor who has provided their enrolling sites access to StudyKIK’s…… Read More
Health Recovery Solutions Announces Lineup of Telehealth Experts for October Vision to Virtual Conference
Health Recovery Solutions (HRS), a national provider of Telehealth and Remote Patient Monitoring (RPM) solutions, is excited to announce its incredible lineup of speakers for the upcoming Vision to Virtual conference. From October 15 to October 16, HRS will welcome telehealth experts from across the healthcare industry including those from health systems,… Read More
The “Global Next-Generation Surgical Robotics Market: Analysis and Forecast, 2020-2030” report has been added to ResearchAndMarkets.com’s offering.
The market size of next-generation surgical robotics was valued at $10.9 million in 2019. The global next-generation surgical robotics market is expected to grow at a robust rate. It is anticipated to reach $884.5 million in 2030 with a CAGR of 44.6% during the forecast period 2020-2030…Read More
TN – TSI invites all the TSI Chapters and Members to submit information on their upcoming Webinar or Events (50 words), News related to Telemedicine (200 words) or short articles (500 words) for the monthly e-newsletter.
Submission may be sent to – tsigrouptn@gmail.com Editors reserve the rights for accepting and publishing any submitted material.
Editor in Chief – Dr. Sunil Shroff Editors – Dr. Senthil Tamilarasan & Dr. Sheila John Design – Sankara Nethralaya Technical Partner- www.medindia.net
Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India
TN – TSI invites all the TSI Chapters and Members to submit information on their upcoming Webinar or Events (50 words), News related to Telemedicine (200 words) or short articles (500 words) for the monthly e-newsletter.
Message from Maj Gen (Retd.) A K Singh, President, TSI
It gives me great pleasure and satisfaction that the Tamil Nadu Chapter of Telemedicine Society of India’s first Newsletter is being launched. Last three months have been very busy and productive. The training team led by Dr Sunil Shroff has done a commendable job of providing par excellent training to over 3500+ doctors. The Armed Forces Medical Services led by Lt Gen Madhuri Kanitkar had two sessions, in one the DGAFMS attended. That was the crowning glory of the TSI. The volunteering effort of the editorial team headed by Dr Shiela John is worth appreciating.
A short piece by our executive committee member Ms. Bagamishika Puhan about these training program also is enclosed.
I thank all members of the TSI in contributing to the growth of Telemedicine. The margadarshaks ( Past Presidents) have been a guiding force.
Jai Hind.
Maj Gen (Retd.) A K Singh President, TSI
Telemedicine in India: Personal Reminiscences from 1996
K. Ganapathy M.Ch (Neurosurgery) FACS FICS FAMS Ph.D is a Past President of the Telemedicine Society of India, Former Secretary & Past President Neurological Society of India, Past President, Indian Society for Stereotactic & Functional Neurosurgery, Formerly Adjunct Professor IIT Madras & Anna University, Madras & Emeritus Professor Tamilnadu Dr MGR Medical University. He is on the Board of Directors of Apollo Telemedicine Networking Foundation & Apollo Tele Health Services.
“Excellence is not a destination – it is a never ending journey”
The beginnings
It all started on the night of Sep 16 1996, I had just finished delivering an institute lecture an IIT Kanpur. Just after the Q&A ended at 09:00PM, Prof. Srivathsan, HOD of Electrical Engineering Department insisted I have dinner with him. He introduced me to the word “Telemedicine” and persuaded me to prepare a project report from 11:00PM – 04:00AM. Then commenced a love affair, which over the next 24 years has taken its toll. My legally wedded wife is often relegated to No. 3. Initially, I was wedded to Neurosurgery and now it is Telehealth. Looking back the journey has always been exciting. Arduous, often frustrating,sniggers were common, comments included “Telemedicine Ha ha ha”- but that was the 20th century. In 1998, I even had the audacity to request the association of Rural Surgeons of India to embrace Telemedicine ( Fig 1). .Having started the first Stereotactic Radiosurgery unit in South Asia and as Secretary of the then 2200 strong Neurological Society of India, conventional wisdom dictated that I should continue to focus my skills and energy completely, on what I was trained for, namely neurosurgery .However deep down was a nagging feeling , “Was there not something else, which I could do, which could help more than a few thousand neurosurgical patients ” and then the story began . I took the road less travelled by and the rest – as they say is history !! In fact I embarked on making Geography History ! and distance meaningless.
The Aragonda Story On March 24th 2000 Bill Clinton formally commissioned the world’s first VSAT enabled village hospital at Aragonda in Andhra Pradesh . In the first 2 years two hundred fifty echocardiograms were done there, telementored from Chennai by Dr Premshekar a pediatric cardiologist. Unfortunately we were all so inundated with clinical work that no papers were published, in what may have been a first of its kind initiative even globally. Every Tuesday morning, a tele–grand round took place with super specialists from the Department of Pediatrics at Apollo Hospitals, Chennai interacting with doctors in the village hospital.More than 200 tele grand rounds took place up to 2005. When Dr Vilvanathan Pediatrician who worked in this village hospital left it was not continued. Again this herculean effort was never documented.
Formation of ATNF In 2001 Apollo Telemedicine Networking Foundation was formally established as a not for profit Section 25 company . Taking modern healthcare to remote areas using technology was the mission of ATNF . In between my neurosurgical commitments I spent time and effort to help a skeleton staff of four full time employees to achieve , what in 2001 appeared preposterous – remote consultation !! Every opportunity to put a then hardly existent Indian telemedicine on the world map was utilised. I took part in the first intercontinental live multipoint telemedicine symposium on June 19 2001. Bill Gates was also a speaker .Though today it looks juvenile, it was thrilling to talk to people across the globe from Chennai. I could not resist starting with “ Good morning, good afternoon, good evening and good night ladies and gentlemen!!” Then started teleconferences with, Japan, USA, Saudi Arabia, Hong Kong. 19 years ago for a hospital to embark on video conferencing to conduct clinical meetings was certainly not the norm. Over the next 20years more than 230 regional, national, and international videoconferences in different medical specialties have taken place.
2002
Feb 15 2002 was a red-letter day for the growth of Telemedicine in India. The tension which India went through when Chandraayan 2 was to land on the moon , was experienced by me and my team when we enabled the first VSAT teleconsultation to be witnessed by the Chairman of ISRO. ISRO has publicly acknowledged that their foray into Telemedicine was influenced by that demonstration. Such was my enthusiasm then, that the Vice Chancellor of Anna University even agreed to let me address principals of 600 engineering colleges of Tamilnadu to start telemedicine units. Needless to say only four responded and that too for a short time.Telemedicine for Armed Forces -It has been my privilege to have persuaded the Indian Army to set up telemedicine units in the southern and central commands as early as 2002 with the assistance of Lt Gen Anoop Jamwal who retired as Adjutant General. Unfortunately we were too far ahead of the time and the commissioned Telemedicine units became non functional . In 2017 Telemedicine in the Armed Forces was rte established.
2003
The first formal University accredited 4 week certificate course on Telehealth technology was started with Anna University. Over the next 3 years 150 candidates in 6 batches were trained. Unfortunately due to lack of employment opportunities the course was discontinued. At about this time the Ministry of External Affairs Govt of India produced a documentary India 2.0 where Apollo telemedicine was featured.Franchised Remote Telehealth Centres gradually increased in Tier II and Tier III cities mainly in North Eastern India . Port Blair, Andaman Islands and various other remote places followed. We had almost 30 centres then
2004-05
IIT Madras started working on telemedicine enabled indigenous peripheral medical devices, designed to transmit temperature, pulse rate, blood pressure, oxygen saturation, heart and lung sounds and a 12 lead ECG .We went to the villages, used kitchens in houses, got a 100 volunteers together and transmitted this clinical data to Apollo Main Hospital Chennai for doctors to evaluate. Several such testings and clinical feedbacks led to the birth of Remedi the first indigenous stand alone Telemedicine “ Black Box” . Due to a sickness at home I was unable to attend an international Critical Care Congress. Adversity was turned into Opportunity. I gave the talk from an ICU bedside . This had a great impact. Years later I had just landed in Chandigarh for the TSI annual conference. I was informed that my grand daughter was critical and admitted in the ICU at Bengaluru. I took the return flight. The next day I gave my scheduled talk on a mobile phone from the ICU. My younger colleague Aditi did a great job projecting the slides perfectly. This unscheduled virtual talk in 2008 was more effective than a normal talk.Telemedicine enabled Hospital on Wheels – In 2005 As part of the Distance Healthcare Advancement Project, along with Philips Medical Systems, ISRO, and the DHAN Foundation, a Hospital-on-Wheels (HoW) was made. The HoW would go to different villages and provide virtual teleconsults. Concentrating on the vehicle, its contents and satellite communication infrastructure. the low lying branches of trees and mud roads in villages was overlooked !! Subsequent VSAT receivers were made smaller and portable.Formation of TSI At the Telemedicine conference organized by ISRO at Bengaluru a few of us got together and decided to formalize the concept of TSI first mooted by Dr Saroj Mishra in 2001 at Lucknow. I became the first Treasurer ( and Joint Secretary) of TSI with the membership number of 001!!
2006- 2010
The next few years witnessed evangelisation of Telemedicine in India and overseas. Talks were given at Baghdad, Kosovo, Riyadh, USA and many other countries in the Middle East and Africa. Every opportunity was used to promote telemedicine. By this time, India has been placed on the world map in Telemedicine.Gradually VVIPs’ from other countries started to take notice of the work done here. The Prime Minister of Mauritius, the President of Nigeria and many, many other heads of states started visiting us to understand how we were making a difference. This resulted in setting up of telemedicine units in Lagos and Mauritius.Following visits from ministers from Uganda I received a “summons” from the First Lady of Uganda for a discussion to set up telemedicne units in Kampala. CII, FICCI and other organisations were pro actively contacted . Seminars, symposiums, workshops and conferences were conducted on a war footing throughout the length and breadth of India. Telemedicine became my second name. The audience were not convinced – ravings of another mad man ! . When The National Science Centre located at the National Science Museum New Delhi started a new gallery to showcase recent advances in science and technology a Telemedicine kiosk with facilities for live demos was set up. ATNF became a member of the Standards Committee on Telemedicine, the National Task Force on Telemedicine, the Working Group on Telemedicine of the Planning Commission, and the Working Group of the SARC Committee on Telemedicine.
International Conferences personally organised : In Nov 2007 the 3rd national conference of the TSI was held in conjunction with the 12th international conference of the International Society for Telemedicine and eHealth at Chennai. The conference was inaugurated by the Chief Minister of Tamilnadu. Over 300 Indian and 35 international delegates participated. In 2016 the ISfTeH conference was again held in Chennai along with the annual Conference of Transforming Health Care with IT Over 750 delegates participated. THCIT annual conference has been held regularly for the last decade.
mHealth – In August 2007 Ericsson requested me, to study for the first time in South Asia, the feasibility of remote clinical examinations through wireless connectivity. Special license was obtained to use 3G spectrum .We demonstrated that 12 lead ECG’s, blood pressure recordings, lung and heart sounds ,ultrasound studies and ECHO cardiograms could be transmitted wirelessly using 3G. For the trial demo availability of power for 10 hours in the outskirts of Madurai was organised. Backup generators with diesel for 4 hours as a standby was arranged. Due to an unexpected demise, staff of the Electricity Board left and there was no power !!. Getting additional diesel would take at least 4 hours. Diesel from two ambulances and a bus was removed and used. An example of how determination can solve any problem.This 3G trial was so successful that Ericcson requested us to showcase this in Bhutan and Bangla Desh. In July 2008 The Rockefeller Foundation organised a Making the eHealth Connection Conference at Bellagio Italy. I was invited for the 5 day brain storming session. The very term mHealth was conceptualised by mygroup.
Global telehealth initiatives of Govt of India – The Ministry of External Affairs, Govt. of India initiated the Pan Africa e-Network project for teleconsultations in 2009. ATNF was a major player in this project .Unfortunately the project was not sustainable. Again to advise the government on the Central Asia e-Network Project. I visited Uzbekistan, Kazakhstan and Turkmenistan and submitted a project report. This also did not materialise.Formation of ATHS . With increasing activities it was realised that we needed a full time CEO to head a regular company rather than a full time Neurosurgeon involved in Telemedicine as a passion . This suggestion was accepted and in October 2010 Apollo Telehealth Services was formed. An excellent team under the leadership of Vikram Thaploo has made use of the rich heritage. Being future ready the outstanding team have managed to operationalise what were originally concepts. My wish list is becoming real . It is also true that “ nothing can stop an idea whose time has come”. Today ATHS has one of the largest Call Centres and is the oldest and largest multi speciality Telemedicine Network in South Asia.
2011
eHome Visits Belonging to the BC era ( Before Computers, Before Christ & Before Covid are the same !!) I was keen on reviving house visits which were in vogue in the early seventies. Electronic house visits were initiated with a laptop/ dongle carrying attender connecting from the uninitiated patient’s home.Interestingly this simple innovation got the best poster award at the World Health summit at Washington in May 2011
2012
World’s largest number of Teleconsults from a HoW – In a first of its kind initiative, 527 patients in 13 different specialities were connected simultaneously to six tertiary Apollo hospitals, in different parts of India from a HoW at a mega health camp held at Ajmer in Northern India on 11th and 12th February 2012.Remote clinical evaluation was followed by ePrescriptions. Subsequently similar telecamps were held in different parts of Tamilnadu in southern India.
2014
Patient empowerment in rural India by promoting eHealth Literacy -Deploying multi point Videoconferencing, a knowledge empowerment programme, at the internet enabled Village Resource Centers of the MS Swaminathan Research Foundation, in rural Tamilnadu was started in 2014 . 115 talks have been given in Tamil so far attended on 25,000 occasions from 18 villages.
2015 ONWARDS
Virtual visits to ICU I-SEE-U® was a state of the art solution developed to enable virtual visits to ICU patients, from anywhere in the world, by authorised consultants, friends and relatives. The remotely enabled networked camera in the individual ICU cubicle can also focus on various monitors. The product got an award at an international conference at Singapore. Due to subsequent regulatory and privacy issues it was discontinued.
International Educational Activities : Columbia University , Wharton School of Business, the London School of Economics, Harvard Business school, Ross School of Business, Atlanta state University, Indian school of Business are some of the international organisations who have used Apollo Telemedicine as study material .Software An in house, custom built software “Medentegra” which in addition, to a user friendly EMR (facilitating uploading of images, investigations etc.) has inbuilt video conferencing capabilities started being used regularly.
eICU : eICU’s where smaller ICU’s are connected to highly trained experienced intensivists in larger ICU’s are now a reality. One of the largest such networks operates from Apollo Hospitals Hyderabad where 15 ICU’s are connected. 600 plus teleICU consults in subspecialoitries have already been given.
Public Private Partnerships – a few illustrations
a) Himachal Pradesh . The first Telehealth PPP project in India commenced 5 years ago . Over 18,500 teleconsultations were given at a height of 14,500 ft. The world’s first 24/7 Tele emergency Services has seen about 1300 patients. Today we have four different Telemedicine Centres in Himachal Pradesh
b) Over 1 million teleconsultations have been provided under the Mukhyamantri Arogya Kendram (e-UPHC)- project covering 182 Centres from October 2016.
c) Jharkhand Digital Dispensaries programme In the first 15 months alone 328,648 patients have attended these Digital Dispensaries
d) Uttar Pradesh Telemedicine programme in the first one year 141,793 patients visited 114 Government Community Health Centres
e) Uttar Pradesh Teleradiology PPP program – Systematic implementation of operational activities, beginning from site development and installation of IT equipment to training of human resource and trial testing for assessing functional status of Centres has led to commissioning of 127 teleradiology centres in rural UP – a mammoth undertaking by any standards. On an average 360 images are reported daily with a turn around time within 4 hours
f) Tele ophthalmology A major project is being carried out in 115 existing Community Health Centres / Vision Centres run by the Department of Health and Family Welfare, Government of Andhra Pradesh in 13 districts. Through this Mukhyamantri e-Eye Kendram or MeEK project 1,5 million patients have been screened in 2 years. 355,000 fundus examinations were done remotely by 30 Opthalmologists from Chennai .
g) National Thermal Power Corporation . Located in rural Assam 30 km from the China Border this Telemedicine enabled center has made a major difference.
2019
Extra-terrestrial Telemedicine . The ultimate in Remote Health Care would be to assist in providing health care to India’s first Vyomanauts in Outer Space . After editing a special supplement on “ Extra Terrestrial Neurosciences” for Neurology India and presenting the only medical paper at the Human Spaceflight Programme organised by ISRO, I have even offered my services !! 2020 Academic contributions – The crusade for popularizing telemedicine has included the presentation of more than 400 papers in regional, national and international meetings in India and 105 overseas . Over 180 articles have been published, on Telehealth including 45 in peer-reviewed journals and chapters in textbooks
Conclusion:
The journey has been exhilarating . I have no regrets for taking the road less travelled by. Encomiums and accolades received on reaching the destination is only ephemeral. The greatest danger for most of us, is not that our aim is too high and we miss it, but that it is too low and we reach it. The TSI should not believe in following high standards. We should set them. We no longer should strive to achieve world class. The world should strive to achieve India class. Looking back, the growth of telehealth during the last 20 years has been rather slow – many of us are in a hurry, impatient, wanting to get things done yesterday !!. The first decade was spent in evangelising the product, developing the product and generally creating awareness . For a product to excite the masses it must elicit customer delight and cater to the consumer. A major stumbling block retarding the take off of telemedicine is WiiiFM ( What is in it For Me). Every member of the telehealth ecosystem needs to get a RoI ( Return on Investment) not necessarily monetarily alone. In the third decade of telehealth business models are mandatory. Revenue generation is a must for sustenance. Philanthropy and corporate social responsibility can initiate an activity not maintain it.
Epilogue: Not in my wildest imagination would I have ever expected the slow incremental annual growth to radically transform into an explosion. A strand of RNA has become the Global CTO ( Chief Transforming Officer) for Telehealth. Contactless Health care will be the new normal.Distance will become meaningless. Geography will become History!. Recognition of Telemedicine by Insurance companies augurs well. Formal recognition of importance of Telemedicine by the Govt of India and state governments will make all the difference, I once gain thank the TSI for bringing out a Newsletter . Hopefully the newsletter will bring our ever expanding family closer .
Fig 1 Earliest communication for starting Telemedicine
Fig 2 Inauguration of world’s first VSAT enabled village hospital for Telemedicine March 24th 2000 @Aragonda, Andhra Pradesh
Tele-Ophthalmology – in a COVID world – Opportunities and Challenges Dr. T. Senthil, MBBS DO FICO. Founder and CEO Welcare Health Systems Pvt ltd – Honorary Secretory, Telemedicine Society of India Tamil Nadu Chapter. Dr. Senthil is an Ophthalmologist and Healthcare Entrepreneur, He established Welcare Health Systems in 2014 which has grown to become Indias Largest Teleophthalmology Company. He can be reached at senthil@welcaretelemed.com.
COVID 19 has brought in a drastic change in adoption of Teleophthalmology among Ophthalmologists in India. Since patients were not able to reach hospitals, and social distancing became the norm, hospitals in Corporate, Govt and Non-Profit sector started looking for Teleophthalmology Solutions to reach out to their patients. In Ophthalmology Telemedicine was used primarily in three scenarios. 1) Screening for Diseases such as Diabetic Retinopathy, Retinopathy of Prematurity etc. 2) Diagnostic Consultations. 3) For Long term follow ups of patients.
Screening for Diseases through Teleophthalmology has been the most successful of the above three models. There are many successful Screening projects in Teleophthalmology world over which has reached out to millions of patients. However, Challenges faced by Screening model providers are cost of the Technology such as fundus cameras, Internet connectivity, Paying capacity of patients etc.
The Diagnostic Consultation approach started getting traction during the COVID lockdown, since patients were not able to reach hospitals- they wanted to connect to Ophthalmologists from their homes. There was a huge spike in Teleconsultations during the initial lockdown periods. Hospitals and Clinics started teleconsultation services to reach patients. Many platform companies were able to generate patients to Ophthalmologists for consultation. The teleconsultation slowly started decreasing as Hospitals / clinics opened.
Challenges in Ophthalmic Teleconsultation a) Ophthalmology diagnosis includes a few basic tests such as Examination of Eye on a Slit Lamp, Fundus Examination, Refractory error examination etc which cannot be done in the patients’ homes since the equipment’s are not available for these tests. b) The willingness of Patients to pay for a online consultation was very poor. c) The Ophthalmologists also have a lot of apprehension on missing Diagnosis using a Teleconsultation mode.
The most effective model during the COVID time for Ophthalmology was for follow up of patients such as Postoperative patients where advise was given on Medication changes, or Tele triage wherein patients were seen online and decision was taken if they have to come to Hospital or can be advised online, or even if they come to hospital which specialist they had to see and so on.
For Teleophthalmology to Succeed 1) Low cost Diagnostic Devices such a Fundus Cameras and ROP cameras to be available in the market. 2) At Home Screening devices for Intra Ocular Pressure Measurements, Refraction and Visual acuity Measurements, Fundus / Anterior Segment Imaging to be innovated and made available. 3) Medico Legal Clarity and Data Protection Clarity to be brought in so that Doctors will be more comfortable in doing Teleconsultations.
Mobile Teleopthalmology
Dr. Sheila John, Consultant Ophthalmologist, Head of Teleophthalmology and E-Learning, Sankara Nethralaya, Chennai.
Mobile Tele-ophthalmology is evolving into an integral clinical tool in the Indian health care system. In a developing country like India, the ophthalmologist-patient ratio stands at a dismal 1:10,000. What makes this wide gap between demand and availability of eye care even more critical is its inequitable spread, 70% of the nation’s citizens live in rural areas while 70% of its eye care professionals live in urban areas.
Mobile Tele-ophthalmology BUS may potentially provide health services to underserve and remote rural populations who otherwise may not have access to specialized eyecare. Eye screenings are conducted within the community, often in schools, community halls, and places of workship.Bringing the facility directly to the patients allows health professionals to diagnose and prevent vision threatening diseases such as diabetic retinopathy, glaucoma, age-related macular degeneration and others By detecting causative blinding disease early on mobile, teleophthalmology allows for timely referral to appropriate experts and consequently, earlier treatment. However, on-site screenings may utilize the state of art equipment including an automated refractor, slit lamp with Applanation tonometer, Non-mydriatic retinal camera and others. An ophthalmologist is available in person at the hospital to do teleconsultations with the patient and develop an assessment and treatment plan for the screened patients. The ‘Mobile Refraction Van ‘accompanies the teleophthalmology van to the villages, addresses the refractive error, and dispense spectacles to rural people at campsite.
As an institution committed to its founding principle of cost free service with a personal touch to those who cannot afford to pay, Sankara Nethralaya realized right from the time of its inception that for every single indigent patient who visited its centers seeking cost free eye care there were two such patients outside needing such care. It also realized that patients in rural areas may not avail eye care dispensed at a base hospital in the city owing to several socio-economic factors and the only way to dispense preventive and curative eye care to this segment would be through outreach programs. ‘Mobile Teleophthalmology’ holds great potential to improve the quality, access and affordability in eye care especially for patients in rural areas by reducing the need for travel and providing virtual access to a super-specialist right at their doorstep.
Best practices!
Indiritta Singh Dmello, Director, Hospital Guide Foundation (An Oxford graduate in Politics, Philosophy & Economics with a PG Diploma in Medical Law & Ethics-National Law School, Bangalore)
“The developed India will not be a nation of cities. It will be a network of prosperous villages empowered by telemedicine, tele-education & e-commerce”-Dr. A.P.J. Abdul Kalam.
It is paradoxical that even though India has emerged as a hub for medical tourism, we are unable make healthcare accessible and affordable to the masses in India. As per the WHO statistics, India is far below the recommended Doctor Patient Ratio (recommended ratio 1:1000 & India1:1700). Further compounding the problem is that only 26% of these Doctors are present for 70 percent of the population in rural areas.
This is where Telemedicine plays a pivotal role in addressing this gap. Telemedicine is a tool that makes healthcare accessible and cost effective by engaging the Doctors and patients remotely through an integrated technology platform. This platform could be as basic as a simple Audio Visual with a software for patient details or as advanced as integrated diagnostic equipment, remote monitoring of Intensive Care Unit Patients or even remotely conducting a surgery.
Hospital Guide Foundation (HGF) has been running a Telemedicine project with the Govt of Uttar Pradesh in the rural area of Western UP, supported by the Doctors of National Heart Institute & Sita Ram Bhartia Institute of Research & Technology at New Delhi. While it is a Telemedicine project, the objective is to provide comprehensive healthcare with Telemedicine being an enabler. At HGF the following key factors were observed for making a Telemedicine project successful.
Holistic Approach: Telemedicine delivers significant advantages for the patients only with a complete treatment and support mechanism – ensuring tests & medicines, setting right expectations, counseling (about the process, disease & treatment), driving awareness, ensuring compliance with (tests, medicines & life style) and pro-active follow ups, which helps gain patient confidence & cooperation therefore delivering much better results.
Seemless process: Multiple touch points have to be managed seamlessly between patients, nurses,Doctors and telemedicine specialists for enabling a great healthcare experience. This makes it even more challenging in rural areas where we grapple with basic problems like electricity. Coordination to perfection is key for a sustainable telemedicine project, specially when the Doctor’s limited time should be well spent on communicating with patients rather than waiting for them.
Optimal technology: is also essential for a superior Doctor & patient experience. For eg the quality of internet bandwidth, audio visual can affect the dialogue between patients and Doctors who are trying to communicate remotely on sensitive health issues. The quality of communication will have a direct impact on the diagnosis, prognosis and treatment.
Quality diagnostics: Similarly, well calibrated high tech diagnostics is essential for the patients to get the right diagnosis, prognosis and treatment.
With the onset of the Pandemic COVID 19, Telemedicine has gained the much needed impetus that it has been yearning for. As it has become an important enabler in Healthcare delivery, not only for reasons of accessibility, affordability but for reasons of safety. In a country where there are several Telemedicine projects running in silos, it is important to continuously share best practices , for which Telemedicine Society of India (TSI) is a great platform & this newsletter a great initiative. With the astute leadership of TSI, I have no doubt that Telemedicine will be on a trajectory it so deserves!
Train to Practice Telemedicine Guidelines
Ms. Bagamishika Puhan, Advocate, Legal Advisor and EC Member, Telemedicine Society of India, Member, Indian Society for Clinical Research.
On April 04, 2020, after a tumultuous yet short ride, a group of TSI members came together to unfurl the Train to Practice project. This was the culmination of an informal mandate received from a benefactor to train and educate as many registered medical practitioners (RMPs) about the nuances of the Telemedicine Practice Guidelines (TPG) in particular and telemedicine in general.
The Society pioneered work in the field of telemedicine over the past many years, and now, is at the helm of inculcating the best practices in the field and has been successful in training over 3500+ RMPs directly under the project, and about 15000+ RMPs through the volunteers.
In this exercise, the focus has been to ensure that the participants take away an acute understanding of the legal aspects of telemedicine (TPGand allied laws), how to marry the legal concepts to their clinical practice, and also a basic understanding of how and when to triage a patient by means of telemedicine. As we continued with the project, we added another module which lends a helping hand to the practitioners who want to get started right after the discussion, with their own kit of telemedicine.
The project has witnessed roaring applause from various factions including the much revered Armed Forces Medical Services for the volunteering efforts and the dynamism of the project and the team. We have also sought support from entities who believe in this social and evolving practice of telemedicine. As the awareness amongst the user increases, we will continue to ensure that safety is not compromised, and we will continue to impart the necessary education concerning safe and convenient practices around telemedicine.
We welcome participation of volunteers to train, to learn, and to contribute to this endeavor of the Society in any manner and capacity that they wish to associate with the Society. Learn more at https://tsi.org.in/learn
History and Evolution of Telemedicine – Samuel Morse and Telegraph Dr. Sunil Shroff, President, Tamil Nadu Telemedicine Society of India, Consultant Urologist & Transplant Surgeon.
History and Evolution of Telemedicine – Samuel Morse and Telegraph (First of Ten important milestones). “The Past supplies the key to the Present and Future“ ~ Ancient Historian. The history of telemedicine is the history of evolution of distance communication. If it was not for the legacy laid down by many of the scientists, telemedicine may have never evolved as it has done currently.The start of this was the invention of the public telegraph system set up by Samuel Morse. Why did Samuel who had developed a reputation as a portrait painter go on to invent the telegraph system?
This is an interesting piece in the history of communication. Apparently he was hired to paint a portrait of a famous person and travelled out of his town. Back at home his wife fell ill and died of heart attack and it took Samuel days to reach back home and when he did return the wife’s funeral had already taken place.He was so upset with this episode in his life that he left his art career and started looking at ways to establish a way to communicate information at a distance. His pursuit lead him to become interested in the telegraph system.
He went on to invent a single-wire telegraph system and the first Intercity public telegraph services were set up between Washington and Baltimore in 1844. In almost all the wars that followed the telegraph was used by the military to order medical supplies, transmit list of casualty and it is probable that some use of the telegraph in its early decades involved medical consultations.He was also the co-developer of Morse code that helped the commercial use of telegraphy. One of such codes was the internationally recognized distress signal SOS. The SOS letters were chosen because they are easy to transmit in Morse code: “S” is three dots, and “O” is three dashes.
Telemedicine – News from India & Abroad
India
500% rise in healthcare teleconsultation in India, 80% are first-time users: Report Besides COVID-19 related symptoms, some of the other most-discussed queries included back pain, eye health and mental health issues. Online consultation for healthcare has increased by 500 per cent between March 1 to May 31, 2020…… Read More
Digital Care: The Way Forward for Management of Chronic Conditions The use of digital care in driving positive health outcomes, especially for chronic patients, it is possible because of the availability of remote monitoring and virtual care tools backed by the spread of affordable smartphones and data consumption, it’s the next major emerging disruption in India after e-commerce, fin-tech ….. Read More
Telemedicine is the roadmap to improve medical Care in rural areas : Ayush Mishra According to the Medical Council of India the doctor to patient ratio in India may be as low as 1:2000 if not lower. This is a serious challenge to the health of Indians and is compounded by the fact that most doctors practice in larger cities where opportunities are greatest …. Read More
Today technology can make physicians available to patients: Sunil Wadhwani Artificial intelligence really can have dramatic impact on how we address healthcare in India, how we can become the leading country in the developing world, on how AI is being applied to improve healthcare…. Read More
Telemedicine Guidelines Released in India Notified and Gazetted The Government of India Notified and gazetted the Telemedicine Guidelines that were released on 25th March 2020. What it means is that this framework is here to stay even after the current COVID-19 pandemic recedes. While 25th March was a historic day when the guidelines were released by the BOARD OF GOVERNORS – In super session of the Medical Council of India under NitiAayog, 14th of May the guidelines have officially been notified and gazetted. Read More
International
Telehealth Services: A Post COVID-19 Reality? The regular use of telehealth services for cancer patients was found to have long-lasting and unforeseen effects on the provision and quality of care, said an article published in JAMA Oncology, Trevor Royce, MD, MS, MPH, an assistant professor of radiation oncology at the University of North Carolina Lineberger Comprehensive Cancer Center and UNC School of Medicine. Read More
Heart Failure Assessment Via Telemedicine The jugular venous pressure is an indicator of fluid retention and build-up of pressure inside the heart. Being able to check jugular venous pressure using telemedicine, virtually, will help doctors assess heart failure patients remotely by just using the camera on a smartphone. Read More
Digital Health Unplugged: August news team debrief During the Covid-19 pandemic primary care was forced to go digital-first to avoid unnecessary face-to-face consultations in a bid to control the virus, but now lockdown restrictions are easing are those services here to stay? Speaking at a Royal College of Physicians event in the UK on the future of healthcare post-Covid, Hancock said teleconsultations would allow the NHS to provide a “much better” service. Read More
Telemedicine Market- Growth Insight, Rising Demand, Share and Healthy CAGR in the Upcoming Forecast 2024 BY NEWS@RESEARCHNESTER.COM ON AUGUST 11, 2020 Global Telemedicine Market is growing immensely due to its growing application; Tele-cardiology, Tele-radiology, Tele- dermatology, Tele-gynecology etc. At 19%, Tele-dermatology had the highest share in the global applications market in 2015 and is expected to lead in next five years followed by Tele-cardiology. The report titled, “Global Telemedicine Market 2024”, projects the global Telemedicine market to grow at a CAGR of 14.8% during the forecasted period of 2017-2024 according to our research report. Read More
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