Prof. K. Ganapathy Past President, Telemedicine Society of India & Neurological Society of India | Hon Distinguished Professor The Tamilnadu Dr MGR Medical University | Emeritus Professor, National Academy of Medical Sciences | Formerly Adjunct Professor IIT Madras & Anna University | Director Apollo Telemedicine Networking Foundation &, Apollo Tele Health Services | URL: www.kganapathy.in
December 10th 2021 is indeed a Red letter day for Indian Telehealth. On this day the ISO 13131-2021, certification for Telehealth Services was obtained for the first time anywhere, by Apollo Telehealth Services . This brief note points out the necessity for raising the bar and setting high standards, so that the world will strive to achieve India class.
For decades, Telemedicine/Telehealth services was not centre stage in the healthcare delivery system. COVID-19 changed this. The world has now accepted that the forced lockdown- enforced acceptance of Remote Health Care will become the new normal even after the pandemic is de notified. Universal acceptance, increases the responsibility of all health care providers deploying technology, to ensure constant high quality while bridging the urban rural health divide.
Quality is never an accident. It is always the result of deliberate intention, sincere effort, intelligent direction and skillful execution. Though Henry Ford opined that quality means doing it right when no one is looking, in the real world this is difficult to implement. ISO certification ensures that “Big Brother” is watching all the time. The necessity for re certification is like the Sword of Damocles hanging above us. However it drives home the message that Quality is everyone’s responsibility at all times and not during the audit alone. One has to keep running to stay where you are. To maintain the initial global recognition, maintaining quality needs to become a habit, a unique opportunity to transform one’s DNA if necessary!! Success is the sum of small efforts, repeated day-in and day-out. Standardising systems, processes, documentation and re documentation alone will ensure providing quality remote healthcare for anyone, anytime anywhere.
International Organization for Standardization (ISO) – An OVERVIEW
The, International Standards Organization, TC 215 Health Informatics Committee developed a Technical Specification, ISO/TS 13131 Telehealth services, based on a risk and quality management approach. This standard, supports healthcare planning, service and workforce planning, organization responsibilities, financial and IT management. ISO was established in 1947 in Geneva, Switzerland. An Independent, non-governmental international organization it develops standards that are recognized and respected globally. It brings experts together to improve quality and provide world-class healthcare services. Experts are from 166 national standard bodies. ISO standards are developed by various advisory groups. Presently ISO has 255 technical committees, 515 subcommittees, and 2498 working bodies. Since 1947, ISO’s technical experts have created more than 18,800 standards for all possible business. ISO standards ensure that administration and product/work flow systems are carried out legally, safely and effectively. ISO technical experts have developed several assessment protocols to ensure that certified organizations apply these guidelines in their workplace. The approved protocols aid organisations to ensure that their frameworks, devices and workforce are actually in compliance with ISO standards. ISO 13131 provides recommendations on guidelines for Telehealth services deploying Information and Communication Technology (ICT) to deliver quality healthcare services.
Implementing ISO/TS 13131 means facilitating cooperation and interoperability of its different health systems to ensure quality telehealth services. It also ensures a reliably high standard of service, irrespective of where a person lives, across the globe. This standard provides guidelines for developing quality plans and managing company resources, while putting the right policies in place to safeguard clients’ private data. Securing ISO 9001 for quality management and ISO 27001 for information security management reduces the complexity involved in getting the IOSO 13131 branding. Realising that excellence is always a moving target it was the logical next step in the company’s journey to go (to paraphrase Captain Kirk of Star Trek)“ where no Man had ever gone before”.
The decision to get certified though it was time consuming, labor intensive and expensive was the determination to set a benchmark for the whole telehealth sector. A leading market player faced with competition, the company needed reassurance that its high-quality standards would provide a stamp of recognition and help distinguish it from its competitors. As a pioneer in the field, it was important to set the conditions of competition, to prevent some potentially harmful practices of others, from compromising the reputation of all. Considering the high risks involved in securing patients’ data privacy, it was crucial for the organization to be sure it’s IT systems and processes were stringent, fulfilled the highest expectations in this sensitive sector and conformed to security legislation.. A preliminary gap analysis was conducted and where ISO/TS 13131 provided more specific criteria than the ones actually in place, these were ear marked for improvement. Consumers draw confidence from the stringent certification process. ISO standards will help organisations comply with new regulatory requirements, enhancing efficiency of internal processes and quality of remote health services provided. Documenting the much needed framework necessary for supply of services, improves value of the product. The more diverse and competitive the market, the more guidance consumers need, to be sure they are purchasing the service they want at the best price. International Standards helps maintain a healthy competition in the marketplace.
We need to identify the right quality metrics, and ensure that the information is readily available to patients, health systems and providers themselves. Consumers should be helped to gauge telehealth providers, and provide healthcare workers/systems with feedback for continuous improvement. Best practices for virtual care need to be standardised, notified and applauded so that it will be increasingly sought after. As the pandemic further disrupts the balance between in-person care and telemedicine, we no longer have the luxury of waiting. The time to define, implement and enforce quality in all aspects of telehealth is not tomorrow but today. Formal certification by an international organisation requires hundred percent fulfilment of stringent criteria. This pre supposes commitment of a very high order and the realisation that excellence is always a moving target. One can never ever rest on one’s laurels. We need to keep running to stay where we are.
School of Telemedicine & Biomedical Informatics, SGPGIMS, Lucknow hosted the 17th International Conference of Telemedicine Society of India from 12th Nov. to 14th Nov. 2021. It was an annual conference of the Telemedicine Society of India being held every year in different parts of the country to create awareness, sharing new experiences and learning from each other in the field of telemedicine and digital health.
First Day i.e. 12th Nov. 2021, the event started at 9.00 AM with welcome note of the Prof S.K. Mishra, Chairman, Local Organizing Committee, TELEMEDICON2021. First session was devoted only for beginners of Telemedicine where Prof. B.N. Mohanty, Prof. Jayant Mukhopadhya, IIT, Kharagpur, Prof. Meenu Singh, PGIMER, Chandigarh and other 46 National speaker, 20 Chairs & panelist shared their experiences in the field of Telemedicine & digital health and demonstrated how this technology can help for delivering health care in rural parts of India. Mr. Baastian Quast, ITU, Geneva, delivered talk on ITU-WHO Focus Group: Benchmarking AI and Health Solutions as a special Invited speaker. Workshops on Telemedicine & Digital Health Policy & Strategy and Legal & Regulatory Issues, & Telemedicine Practice Guidelines conducted in IV sessions. Following were participated from India and abroad during panel discussion; Prof. J.A. Jayl, Professor of Surgery., National President, Indian Medical Association, Dr. Achal Gulati, Director Principal & Director Professor of ENT in Dr Baba Saheb Ambedkar Medical College & Hospital, New Delhi, Dr. Balaji Ramachandran, Digital Health Transformation Expert, Bangalore, Mr. Anay Shukla, Founder Editor, Arogyalegal, Mumbai. A panel discussion on developing guidelines of Telecare for chronic diseases like diabetes, cancer, neurological disease was considered by ICMR, National Centre for Disease Informatics and Research, Bengaluru with the help of country wide experts. For the first time, IIT Bombay, which had just established Koita Centre for Digital Health (KCDH), participated in National telemedicine conference to conduct a workshop on future Health technologies with the collaboration of National Medical Commission experts, IMA and NGOs. Telemedicine Society senior members addressed legal ethical policies issues relating the Telemedicine and digital health and carried out a workshop.
A total of 700+ registered delegates from Medical Institutions, IITs, Dental Colleges, Technical Universities were participated in the first days of conference in virtual as well physical mode. The scientific programme ended at 8.00 PM.
Second Day i.e. 13th Nov. 2021, the event started at 8.00 AM with three parallel Hall under COVID award sessions which specially designed for the speakers to present their work done during the COVID time. Prof. Abhay Karandikar, Director, IIT, Kanpur delivered Key note Lecture on Wireless Health : Promising trends for equitable access to Healthcare. Dr. Pramod Gaur from USA delivered talk on the re-positioning in Post COVID Health, Prof. D.R. Sahu, Lucknow covered the socio-Technological Dilemma of Future Tele-Health. Ms. Surabhi Joshi from WHO, Geneva, Prof. Isao Nakajima, Japan delivered speech on Digital Technologies in Infectious disease Management particularly for Avian Influenza. Mr. Frank Lievens from Belgium, Prof. Thais Russomano from Brazil, Katarina Hradska from Ostrava Czech Republic shared the experience on the Global Telemedicine & Digital Health. Apart from International, 22 National speakers and 24 abstract presentations were conducted throughout the day.
Inauguration ceremony conducted at the evening where Prof. R.K. Dhiman,Director,SGPGIMS inaugurated the conference as Chief Guest and Prof. Arvind Rajvanshi, Executive Director, AIIMS, Raibareli delivered keynote address. Prof. S.K. Mishra, Chairman, organizing Committee welcome the dignitaries and Prof. P.K. Pradhan, Organizing Secretary delivered the vote of thanks. A total of 600+ delegates from Medical Institutions, IITs, Dental Colleges, Technical Universities were participated in the first days conference in virtual as well physical mode.The Programme ended at 7.00 PM. Subsequently,it was followed with a cultural programme of thematic Kathak dance on ramayan and dinner at hobby center of SGPGIMS,Lucknow.
Third & last day i.e. 14th Nov. 2021, the event again started at 8.00 AM with three parallel Hall under COVID award session which specially designed for the speakers to present their work done during the COVID time. Dr. Gulshan Rai, Former National Cyber Security Coordinator, Govt. of India delivered Key note Lecture on Need of Cyber Security in Health Sector. Dr. Maurice Mars, South Africa, Dr. Luiz Messina, Brazil and Prof. Saroj Mishra from India covered the area of Health 4.0, a vision for Smart Futuristic Healthcare in the symposium session. Prof. R.K. Dhiman, Director, SGPGI delivered the talk on Chronic Disease Telecare, personal perspective with remote monitoring and management of Hepatitis C, Prof. Rakesh Aggarwal, Director, JIPMER, Puducherry emphasize on Digital Health Technologies for the management of public Health Disaster,Prof P K Pradhan shared his experience of telefollow up in thyroid cancer: more than decade long experience and Prof.Sanjay Behari shared his experience of e-CCS in SGPGIMS. Apart from International, 62 National speakers, 36 Moderators and 47 abstract presentation were conducted throughout the day.
Valedictory function conducted at the evening where Prof. Aneesh Srivastava, Dean, SGPGIMS chaired the function though could not attend the function due to medical emergency. Prof. S.K. Mishra, Chairman, organizing Committee welcome the President Col Dr. Aswani Goel, Secretary, Dr. RLN Murthy and other dignitaries. President handed over the Presidential Medallion to President Elect Prof. P.K. Pradhan virtually and Prof. P.K. Pradhan, Organizing Secretary delivered the vote of thanks.
Brief on Conference.
Participants: A total of 700+ delegates from Medical Institutions, IITs, Dental Colleges, Technical Universities were participated in the first days conference virtual as well physical.
Invited Speakers/Chairs/Moderators and presenter; The Scientific Programme consists of 02 Key Note Lectures from Director, IIT Kanpur and Ex Cyber Security Chief, Govt. of India, 15 International Invited Lectures, 10 Symposia, Three Panels and 09 free paper sessions having 54 slots for oral presentations. Besides there are three Poster Presentation Sessions covering 18 posters and 12 Industry presentations highlighting technical solutions for telemedicine & digital health. A total 234 speaker/chairs/panelist taken part in this international conference. Best Oral and Poster presentations award and CME Points for all attendees is provided as per U.P. Medical Council regulations. Two Free paper sessions dedicated COVID-19 on Tele-care and Tele-education practices undertaken during COVID-19 Pandemic.
Industry Participation: A total of 15 industry participated and extend their active support for this event.
Knowledge partner Institution: Indian Institute of Technology (IIT), Kanpur, Koita Centre for Digital Health (KCDH), Indian Institute of Technology(IIT), Bombay and Technology Information Forecasting and Assessment Council (TIFAC), New Delhi supported this conference as knowledge partner.
Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India
What is New?
This issue covers the highlights of the annual conference of TSI – TELEMEDICON 2021 that happened in Hybrid mode at Lucknow. Most registrations were for the online mode of the meeting.
The annual general body meeting and the elections too took place virtually. The new office bearers of TSI are as foilows –
President – Prof. Prasanta Kumar Pradhan
Immediate Past President – Colonel (Dr) Ashvini Goel (Retd)President
Elect – Dr. Meenu SinghVice President – Dr. R. Kim
Chief Operating Officer – Mr. B.S BediHon.
Secretary – Dr. Murthy Remilla. L.N
Jt. Secretary – Ms. Bagmishika Puhan
Treasurer – Mr. Repu Daman
Executive Members Dr. K. Sudarshan Dr. Umashankar Dr. Uma Nambiar Dr. Suchitra Mankar Ms. Indiritta Singh D’Mello Dr. Sunil Shroff Dr. Krishnakumar
Thank You Dr. Sunil Shroff
Chief Editor
President – TN Chapter – TSI
School of Telemedicine & Biomedical Informatics, SGPGIMS, Lucknow hosted the 17th International Conference of Telemedicine Society of India from 12th Nov. to 14th Nov. 2021. It was an annual conference of the Telemedicine Society of India being held every year in different parts of the country to create awareness, sharing new experiences and learning from each other in the field of telemedicine and digital health.First Day i.e. 12th Nov. 2021, the event started at 9.00 AM with welcome note of the Prof S.K. Mishra, Chairman, Local Organizing Committee, TELEMEDICON2021. First session was devoted only for beginners of Telemedicine where Prof. B.N. Mohanty, Prof. Jayant Mukhopadhya, IIT, Kharagpur, Prof. Meenu Singh, PGIMER, Chandigarh and other 46 National speaker, 20 Chairs & panelist shared their experiences…Readmore
Documentation for Teleconsultations
Anay Shukla
Founding Partner, Arogya Legal – Health Laws Specialist Law Firm Eshika Phadke Associate, Arogya Legal – Health Laws Specialist Law Firm
The legal significance of well-maintained medical records cannot be emphasized enough. Especially for telemedicine where the jurisprudence is still in its primitive stages, it is of utmost important for doctors to maintain detailed records of their teleconsultations.The Telemedicine Practice Guidelines 2020 specify the minimum information that must be documented in a patient’s telemedicine records. In this article, we outline the mandatory information that should be recorded, as well as additional best practices to ensure maximum legal protection….Readmore
Promoting Telemedicine in Tamil Nadu
To promote Telemedicine, a hybrid program, themed “Telemedicine – the Untapped Potential” was organized by the Telemedicine Society of India (TSI) – TN Chapter, at The Tamil Nadu Dr. M.G.R. Medical University in Guindy, Chennai on November 19, 2021. This event was supported by TeleOphthalmology Society of India (TOSI) and Tamil Nadu Ophthalmic Association (TNOA)The online conference commenced with Dr. K. Selvakumar introducing the event and welcoming everyone. This was followed by brief lectures on History and Definition of Telemedicine by Prof. Dr. K Ganapathy; Modes of Communication, Bandwidth by Dr. S Dheeraj Krishnaa; and Mobile Health by Dr. Sheila John.. …Readmore
Telemedicine Practice Guidelines – A Foundation Course for RMPs by TSI
First step towards safer and efficient health records
The world is undergoing a tremendous digital transformation, much accelerated by the COVID-19 pandemic. Similarly, it contemplates providing a seamless flow of information through a digital healthcare infrastructure… Read More
Using Artificial Intelligence to Diagnose Blood Diseases
Artificial intelligence has the potential to boost the method of diagnosing blood diseases using optical microscopes, according to a finding in the journal Blood. Every day, cytologists around the world use optical microscopes to analyze and classify blood cells….Read More
International
New Robotic Device Improves Health Rehabilitation
A robotic device is developed by Inrobics that provides an innovative motor and cognitive rehabilitation service that can be used at health centers as well as at home. The entrepreneurial team has developed a platform made up of four elements…. Read More
Brain Diseases can be Detected by Eye Movements
Using artificial intelligence (AI) to develop an eye tracker that analyzes images from MRI brain scans to recognize patterns that are shared across people is developed by scientists… 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.
Guidelines for submission to TN TSI Newsletter-
Report can be from 500 to 600 words
Report Should be relevant to Telemedicine or Medical Informatics
No promotion of self or any product
Avoid plagiarism
All references should be included
Provide any attributions
Visuals are welcome including video links
Send full authors name, degrees, affiliations along with a passport sized photograph of good resolution. If multiple authors only main author photo to be sent.
Submission may be sent to – tsigrouptn@gmail.com Editors reserve the rights for accepting and publishing any submitted material.
Editor in Chief – Dr. Sunil Shroff Editors – Dr. Senthil Tamilarasan & Dr. Sheila John Technical Partner- www.medindia.net
Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India
What is New?
The next annual conference of Telemedicine society of india – the 17th TELEMEDICON2021 will be held in hybrid mode at Lucknow from 12th to 14th November 2021.
TELEMEDICON this year takes special significance as it coincides with the 21st anniversary of our society which was formed in Lucknow in the year 2001. Prof. S. K. Mishra is the Chairman and Prof. P.K. Pradhan the Organizing Secretary for the meeting. You should register for the meeting by visiting https://www.telemedicon2021.com
The big event this month was the launch of the Health card by the GoI on 27th Sept, by our Prime Minister, Mr. Narendra Modi under Pradhan Mantri Digital Health Mission (PM-DHM). During the launch he said: “The drive to strengthen the health facilities of the country, in the last 7 years, is entering a new phase today. This is not an ordinary phase. This is an extraordinary phase.”
Under this scheme, now every citizen in India will have a separate health ID. The Health ID will have a unique 14-digit health identification- for every citizen that will also work as their health account. This would help give a big boost to the ‘Digital Health’ in India. The key objectives are as follows:
The national Health ID will be a repository of all health-related information of a person. The health ID will enable access and exchange of longitudinal health records of citizens with their consent.
Healthcare Professionals Registry (HPR) and Healthcare Facilities Registries (HFR) that will act as a repository of all healthcare providers across both modern and traditional systems of medicine.
This health account will contain details of every test, every disease, the doctors visited, the medicines are taken, and the diagnosis. This information will be very useful as it will be portable and easily accessible even if the patient shifts to the new place and visits a new doctor.
The personal health records will be linked and viewed with the help of a mobile application;
Ayushman Bharat Digital Mission Sandbox, created as a part of the Mission, will act as a framework for technology and product testing that will help organizations, including private players, intending to be a part of National Digital Health Ecosystem become a Health Information Provider or Health Information User or efficiently link with building blocks of Ayushman Bharat Digital Mission.
This Mission will create interoperability within the digital health ecosystem, similar to the role played by the Unified Payments Interface in revolutionizing payments. Citizens will only be a click-away from accessing healthcare facilities
Thank You Dr. Sunil Shroff Chief Editor President – TN Chapter – TSI
History of Telemedicine @ Apollo Hospitals India
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: https://kganapathy.in |Email: drganapathy@apollohospitals.com
Chronicle of events
Sep 16th 1996 – The compiler of this chronicle delivered an Institute Lecture @ IIT Kanpur at 8pm. . Prof K. Srivathasan then HoD EE introduced him to the word Telemedicine and persuaded him to jointly prepare a project report from 10.30pm to 4am immediately after the lecture !!!….Readmore
Informed Consent for Telemedicine
Anay Shukla
Founding Partner, Arogya Legal – Health Laws Specialist Law Firm Eshika Phadke Associate, Arogya Legal – Health Laws Specialist Law Firm
The Telemedicine Practice Guidelines specify that consent may be implied when a patient initiates a teleconsultation; however, there are certain situations wherein a doctor is legally required to obtain consent from the patient… Readmore
Problems that exists in Rural India to Adapt Telehealth
Telemedicine has recently emerged and gained popularity as a new hope to remove the bottlenecks in the healthcare seeking. While telehealth technology and its use are not new, widespread adoption among patients, especially in rural areas, beyond simple telephone correspondence has been relatively slow…Readmore
Telemedicine Practice Guidelines – A Foundation Course for RMPs by TSI
CoWIN develops API to track COVID vaccination status in India First unveiled in January, the CoWIN portal has now launched a new feature called Know Your Customer’s Vaccination Status (KYC-VS). Spotted by Republicworld, the new tool was announced by the Union Health Ministry of India on September 10. It will now enable companies to check the vaccination status of individuals via the official CoWIN portal. … Read More
Kotak, IISc to set up AI, machine learning centre in Bengaluru Kotak Mahindra Bank and the Indian Institute of Science (IISc) on Thursday announced a partnership to set up an Artificial Intelligence & Machine Learning (AI-ML) Centre at the IISc campus in Bengaluru… Read More
94% Indian healthcare leaders want to invest in AI technologies: report NEW DELHI : At least 94% of Indian healthcare leaders would most like their hospital or healthcare facility to invest in Artificial Intelligence (AI) technologies in the near future, the Future Health Index (FHI) 2021 India Report released by the Royal Philips a global player in health technology on Thursday, said… Read More
International
World’s First AI Developed to Treat Covid-19 Patients Worldwide Artificial intelligence (AI) has been used by Addenbrooke’s Hospital in Cambridge along with 20 other hospitals from across the world and healthcare technology leader, NVIDIA, to predict Covid patients’ oxygen needs on a global scale… Read More
AI Algorithm to Treat Psychiatric Illness, Stroke Google and Mayo Clinic researchers partner to develop new artificial intelligence (AI) algorithms to improve brain stimulation devices to treat people with psychiatric illness and direct brain injuries, such as stroke… Read More
Study shows success of hybrid in-person, telemedicine model of vitreoretinal care A hybrid model of patient care, combining telemedicine and traditional face-to-face visits, may offer the best of both worlds, minimizing the risk for disease transmission while maximizing practicality and patient safety… 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.
Guidelines for submission to TN TSI Newsletter-
Report can be from 500 to 600 words
Report Should be relevant to Telemedicine or Medical Informatics
No promotion of self or any product
Avoid plagiarism
All references should be included
Provide any attributions
Visuals are welcome including video links
Send full authors name, degrees, affiliations along with a passport sized photograph of good resolution. If multiple authors only main author photo to be sent.
Submission may be sent to – tsigrouptn@gmail.com Editors reserve the rights for accepting and publishing any submitted material.
Editor in Chief – Dr. Sunil Shroff Editors – Dr. Senthil Tamilarasan & Dr. Sheila John Technical Partner- www.medindia.net
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
Thank You. Dr. Sunil Shroff
Chief Editor
President – TN Chapter – TSI
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.
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
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.
Telemedicine Practice Guidelines – A Foundation Course for RMPs by TSI
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
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
TN – TSI invites all the TSI Chapters and Members to submit information on their upcoming Webinar or Events (50 words), News related to Telemedicine (200 words) or short articles (500 words) for the monthly e-newsletter.
Guidelines for submission to TN TSI Newsletter-
Report can be from 500 to 600 words
Report Should be relevant to Telemedicine or Medical Informatics
No promotion of self or any product
Avoid plagiarism
All references should be included
Provide any attributions
Visuals are welcome including video links
Send full authors name, degrees, affiliations along with a passport sized photograph of good resolution. If multiple authors only main author photo to be sent.
Submission may be sent to – tsigrouptn@gmail.com Editors reserve the rights for accepting and publishing any submitted material.
Editor in Chief – Dr. Sunil Shroff Editors – Dr. Senthil Tamilarasan & Dr. Sheila John Technical Partner- www.medindia.net
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
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.
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.
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)
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.
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
TN – TSI invites all the TSI Chapters and Members to submit information on their upcoming Webinar or Events (50 words), News related to Telemedicine (200 words) or short articles (500 words) for the monthly e-newsletter.
Guidelines for submission to TN TSI Newsletter-
Report can be from 500 to 600 words
Report Should be relevant to Telemedicine or Medical Informatics
No promotion of self or any product
Avoid plagiarism
All references should be included
Provide any attributions
Visuals are welcome including video links
Send full authors name, degrees, affiliations along with a passport sized photograph of good resolution. If multiple authors only main author photo to be sent.
Submission may be sent to – tsigrouptn@gmail.com Editors reserve the rights for accepting and publishing any submitted material.
Editor in Chief – Dr. Sunil Shroff Editors – Dr. Senthil Tamilarasan & Dr. Sheila John Technical Partner- www.medindia.net
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
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.
(L) Dr. Rebecca Punithavalli, CMO, IITM Institute Hospital with the Doctor app. (R) Team member at the hospital with the Patient app.
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.
(L) Team members Selva and Ramashankar assisting the patients with app installation and user registration. (R) The Blockchain network running behind the application makes the entire system decentralized and secure.
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.”
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.
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.
When was the Term Telemedicine first used?(History and Evolution of Telemedicine – 8th 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.
Telemedicine Practice Guidelines – A Foundation Course for RMPs by TSI
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
TN – TSI invites all the TSI Chapters and Members to submit information on their upcoming Webinar or Events (50 words), News related to Telemedicine (200 words) or short articles (500 words) for the monthly e-newsletter.
Guidelines for submission to TN TSI Newsletter-
Report can be from 500 to 600 words
Report Should be relevant to Telemedicine or Medical Informatics
No promotion of self or any product
Avoid plagiarism
All references should be included
Provide any attributions
Visuals are welcome including video links
Send full authors name, degrees, affiliations along with a passport sized photograph of good resolution. If multiple authors only main author photo to be sent.
Submission may be sent to – tsigrouptn@gmail.com Editors reserve the rights for accepting and publishing any submitted material.
Editor in Chief – Dr. Sunil Shroff Editors – Dr. Senthil Tamilarasan & Dr. Sheila John Technical Partner- www.medindia.net
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
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 Todayhttps://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 issuehttps://telehealthandmedicinetoday.com/index.php/journal/issue/view/20
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.
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
Space Travel and Telemedicine (History and Evolution of Telemedicine – 7th 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.’
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
TN – TSI invites all the TSI Chapters and Members to submit information on their upcoming Webinar or Events (50 words), News related to Telemedicine (200 words) or short articles (500 words) for the monthly e-newsletter.
Guidelines for submission to TN TSI Newsletter-
Report can be from 500 to 600 words
Report Should be relevant to Telemedicine or Medical Informatics
No promotion of self or any product
Avoid plagiarism
All references should be included
Provide any attributions
Visuals are welcome including video links
Send full authors name, degrees, affiliations along with a passport sized photograph of good resolution. If multiple authors only main author photo to be sent.
Submission may be sent to – tsigrouptn@gmail.com Editors reserve the rights for accepting and publishing any submitted material.
Editor in Chief – Dr. Sunil Shroff Editors – Dr. Senthil Tamilarasan & Dr. Sheila John Technical Partner- 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.
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
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
eSanjeevani – India’s National Telemedicine Service
Sh. Lav Aggarwal1, Dr. Sanjay Sood2 & Dr. P.K. Khosla2 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).
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.
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/
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
Submission may be sent to – tsigrouptn@gmail.com Editors reserve the rights for accepting and publishing any submitted material.
TN – TSI invites all the TSI Chapters and Members to submit information on their upcoming Webinar or Events (50 words), News related to Telemedicine (200 words) or short articles (500 words) for the monthly e-newsletter.
Editor in Chief – Dr. Sunil Shroff Editors – Dr. Senthil Tamilarasan & Dr. Sheila John 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.
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 !
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
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.
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.
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.
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
Submission may be sent to – tsigrouptn@gmail.com Editors reserve the rights for accepting and publishing any submitted material.
TN – TSI invites all the TSI Chapters and Members to submit information on their upcoming Webinar or Events (50 words), News related to Telemedicine (200 words) or short articles (500 words) for the monthly e-newsletter.
Editor in Chief – Dr. Sunil Shroff Editors – Dr. Senthil Tamilarasan & Dr. Sheila John Design – Sankara Nethralaya Technical Partner- www.medindia.net
Prof. K. Ganapathy
