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Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

What is New? The Omicron wave is yet another reminder that the uncertainty of this pandemic continues to haunt us but now with tele-health ecosystem getting established, the challenges are less in managing and providing care. The importance of telemedicine for Indian healthcare sector was further stressed by our Union Minister Dr. Jitendra Singh says and he said ‘Tele-medicine Technology is going to be the Main Pillar of India’s Future Health Care System.’ The Consultation Paper on Proposed Health Data Retention Policy that opened out the discussion and asked for suggestions and Recommendations last month was an interesting exercise. We from Tamil Nadu & NCR Chapter of Telemedicine Society of India sent our recommendations to the National Health Authority. It makes interesting reading hence we have enclosed it in the newsletter. Thank You Dr. Sunil Shroff Chief Editor President – TN Chapter – TSI

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Union Minister Dr Jitendra Singh says, Tele-medicine technology is going to be the main pillar of India’s future health care system

Highlights:

• Dr Jitendra Singh launches Tele-digital Health Pilot Program at BHU, Varanasi
• The project starting in three districts of Varanasi, Gorakhpur and Kamjong in Manipur will cover 60,000 patients in the initial phase
• Minister says, project to generate Electronic Health Record (EHR) for Indian population
• Tele-medicine could save India between 4-5 billion US dollars every year: Dr Jitendra Singh

Union Minister of State (Independent Charge) Science & Technology; Minister of State (Independent Charge) Earth Sciences; MoS PMO, Personnel, Public Grievances, Pensions, Atomic Energy and Space, Dr Jitendra Singh today said that Tele-medicine technology is going to be the main pillar of India’s future health care system.

Launching the Tele-Digital Healthcare Pilot Program at BHU, Varanasi, Dr Jitendra Singh said, innovative healthcare solutions like Tele-medicine could save India between 4-5 billion US dollars every year and replace half of in-person outpatient consultations. The Minister said that Prime Minister Narendra Modi’s Digital Health Mission is the next frontier to ensure healthcare delivery is accessible, available, and affordable to all, particularly the poor living in rural and inaccessible terrain. He said, Telemedicine in the country has proven to be cost effective by about 30% less than equivalent in-person visits.

Dr Jitendra Singh said that though Telemedicine technology was in vogue for quite some time in the country, but it got a fillip in post-COVID era and in the wake of PM Modi’s push to Digital Health Ecosystem in India.

Referring to Drone delivery of vaccines in some parts of India, the Minister said, with rapid advancement in technology, Robotic Surgery will also become a reality very soon and future doctors will increasing don the mettle of Tele-Doctors.

Pointing out to very low doctor-patient ratio in India that is about one per 1,457 Indian citizens, Dr Jitendra Singh said, Tele-medicine is no longer an option but a necessity. He said, about 65 percent of India’s population that lives in rural villages, where the doctor-patient ratio is as low as one doctor per 25,000 citizens and therefore they must get best of medical advice from doctors based in towns and metropolitan cities. He said, Telemedicine will not only help the patients save their time and money, but also the doctors who can quickly assist their patients over a call for the same and actively engage in promptly treating patients with major ailments.

Dr Jitendra Singh said, the project starting in three districts of Varanasi, Gorakhpur and Kamjong in Manipur will cover 60,000 patients in the initial phase and it will be scaled up gradually to cover the entire country in the coming years. Technology Information, Forecasting and Assessment Council (TIFAC), an autonomous body of Department of Science and Technology at the Centre has designed a pilot Tele-diagnostics project in collaboration with IIT Madras-Pravartak Foundation Technologies & CDAC Mohali. This will also generate Electronic Health Record (EHR) for Indian population.

The Minister said, the project is a scalable pilot PLUG and PLAY model oriented to provide quality medical care to underprivileged women and children living in remote areas at affordable costs. The key activities include examination of the patients: women/ children with wearable devices, transferring the health data record through the e-sanjeevani cloud to a pool of doctors for analysis, and concurrently for development of EHR. The parameters that would be analysed include: ECG, Heart Rate, Blood Pressure, Lipid Profile, Haemoglobin & Foetal Doppler.

It may be recalled that Dr Jitendra Singh has established tele-consultation facility in his Lok Sabha Constituency of Udhampur-Kathua-Doda from his MP-LAD Fund, in the District Hospital Udhampur with all the Panchayats connected with it and it is being monitored on a regular basis.

Dr Jitendra Singh said that Prime Minister Narendra Modi has given very high priority to the Health Sector and this year’s budget increased the spending on healthcare by 137%, which is in line with industry expectations of 2.5%-3% of the GDP. The Minister informed that India will spend Rs 2.23 lakh crore on healthcare this fiscal including Rs 35,000 crore on Covid-19 vaccines.

The Minister said that various health care schemes launched by Modi Government such as PM Ayushman Bharat Health Infrastructure Mission, Ayushman Bharat Jan ArogyaYojana, Ayushman Health and Wellness Centres, Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) and Ayushman Bharat Digital Mission have made healthcare facilities accessible and affordable to millions of poor people in the country. Read More

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Consultation Paper on Proposed Health Data Retention Policy

Recommendations from Tamil Nadu Chapter & NCR Chapter of Telemedicine Society of India hat was sent to the Joint Director (Coordination),National Health Authority Delhi

2.4 Key Issues for Consultation

1. Whether there is a need for a Health Data Retention Policy and will Indian healthcare ecosystem benefit from such a Universal Data Retention Policy and what should be the key elements of this policy?

Ans. Yes this is indeed required with advent of digital health and to make it uniform. Though we have had a late start in India, however we can learn from experience of other countries and avoid their errors

The key elements of the policy should be as follows –
Structure

1. Formulate an independent body with reps from govt and non-govt organisations
2. Invite a few stakeholders from some leading countries on the board Focus
3. Interoperability of such data
4. Define data types and subtypes and give each weightage for storage
5. Broadly define acute care vs chronic care – more so with the increasing burden of NCDs. There is a need to store chronic care data for longer

2. How should the guiding principle of this policy be determined for the benefit of stakeholders and ease of adoption by varying sizes of entities deciding to opt in for ABDM?

1. Keep the policy flexible with a review every five years,
2. Storage should be in digital format,
3. Irrespective of size of entity storage time should be the same especially if it means data sharing

3.2 Key Issues for Consultation

1. As per Option 1, it has been proposed that the policy would be applicable to all healthcare entities from health data retention perspective. As per Option 2, the policy will be applicable only to entities participating in ABDM? Which would be a better option for the scope of the health data retention policy?

Ans. This has to be work in evolution. Ideally option 2 should be possible but this can become a nonstarter considering the complexity of the current healthcare infrastructure and digitations and lack of standards

Our recommendation the policy will be applicable only to entities participating in ABDM to start with an objective to integrate other entities in future.

As GoI is going to be both the provider and the payer ( through its universal health insurance schemes) it will not be too difficult to set standards and have a uniform system.

After the initial learnings it can recommend other entities too join.

However an option can be provided to all entities to join without making it compulsory

2. How such a policy should be implemented given limitations in terms of infrastructure, capability, and sufficient understanding of health data in the healthcare ecosystem?

This will take time but then following would be required-

1. Regular seminars and educating healthcare professionals and managers
2. Setting minimum standards requirement and making this a requirement for accreditation for health insurance claims, NABH and NABL

3. As ABDM has a provision for opt-out, in such a scenario what may be the possible implications from the perspective of health data retention?

Ans. This has been answered in the first question. A flexible approach would help stakeholders understand and appreciate the importance of data harmonisation and data retention. It would help avoid fear psychosis, would give time and feedback of what is implemented and make changes in the policies.

Having the payers on the side of the GoI would also help entities to fall in line.

However, where ever the GoI is a stakeholder as a payer and provider – it should be made compulsory and no opt out option should be provided.

4.8 Key Issues for Consultation

This is the most important chapter of the current document. What must remember is that so far the hospitals have followed a physical format of preservation of data. While this has certain advantages in a hospital setting for a follow up system for medical professionals but it adds costs for physical storage, retrieval, classification and maintenance.

This has resulted in many hospitals not having a medical records section at all resulting in patients carrying their medical file from hospital/doctor to another hospital/doctor.

The digitation of records help the whole ecosystem and creates efficiency in the it.

1. Should a blanket retention duration be adopted for all health records in India or different schedules be defined as per a classification? Which is a better approach of retention?

Ans. If blanket retention is followed it would avoid much confusion and discussion.

The number of years for data retention are random and there are no studies that these periods make any sense in the context of data retrieval or other requirements and these are based to lessen the physical storage burden. However, with digitisation of data and the cost of the same coming down, a rethink is required as this is a new paradigm we are addressing and has no comparison to the physical world.

2. How granular should data classification be? Is more granularity required beyond that presented in the sections above? Addressing this aspect of the Health Data Retention Policy would help assess whether minimalist data classification – pertaining only to inpatients and outpatients – would suffice the purpose of health data retention. A minimalist data classification would have both advantages and disadvantages. Please suggest your view in this regard.

And 3. How in your view will a detailed granular data classification enable a better health data retention? Please suggest your view on the classification of health record types as proposed above or if any further granularity is necessary and what are the overarching benefits for different stakeholders?

Ans. Most health data are interlinked from point of patient care and really subclassifying again applies better when there is a physical need of storage of such data.

A new paradigm of data classification will emerge in the digital world. It may be defined as a health condition being cured or not cured. Being acute and cured or acute and not cured or chronic and cured or chronic and not cured.

Again, if blanket retention is followed granularity of data would have not much meaning

4. What should be the ideal duration for these different health data types?

Ans. Different countries follow different timelines and this is random depending on investment in medical record section.

It is generally recommended that the Personal health record should be available for lifetime hence why should other data retention be looked at differently.

UK follows 20 to 25 years. We currently feel this should be the minimum time of retention with a recommendation for it to be ideally for lifetime.

We need to look ahead and serve the new generation borne in the digital age. For a child born today, 10 years of data retention would be meaningless. For someone with chronic care one can’t delete data that goes beyond 10 years.

At this stage as said earlier, the minimum period should be defined as not less than 20 years and recommended for lifetime. A review should be possible in time to come. 10 years is too short a time.

5. While ABDM proposes that all entities opting to join NDHE must be able to retain health data in electronic format, and other entities of the healthcare ecosystem may consider physical or original formats, what options should be made allowable as part of the policy being proposed? Health data records can be only digital, only physical, or combination in any hospital. Accordingly, the question arises whether all the above considerations should fall under one policy or under separate/independent policies?

Ans. Digital format should be compulsory and physical should be optional. A uniform policy would cause less confusion and also be a trigger for the much required change.

6. Should there be a provision for extension of duration or retention of health data under the policy being proposed? What considerations should be made in defining the guidelines, allowing for such an extension?

Ans. Keeping it flexible is the key as time would be required for change. However, at the same time to quicken the process Incentives or a reward system could be created to hospitals, entities, states, cities etc that adopt and implement the change.
In fact, as a starting point all smart cities policies should have this policy as one of the pre-requisites.

7. Who shall have the apex authority to oversee and implement health data retention? Which entity as part of the ecosystem should be rolling out this policy at the macro-level?

Ans. Initially the National Digital Health Authority should be in charge, however creating an independent body with key stakeholders would be ideal under the National Digital Health Authority.

8. How can smaller clinics or centres, both public and private, build capability in a timely and cost-efficient manner to take responsibility of data retention for long time periods?

Ans. The health insurance in the country already has certain requirements and many smaller clinics are slowly adopting some of these requirements. Most will eventually have to fall inline or the larger good.

Hospitals with less than say 25 beds maybe given a longer gestation period for adoption.

9. How can business continuity be ensured in case of fall of the establishment, platform or service providers?

Ans. This is going ot be challenge and requires further deliberation.

In case of closure of an establishment all the data should be transferred to a central repository which can be state or central driven and a mechanism would need to be devised.

Questions to be answered –

• Format of such a body
• If the data is in physical format who would bear the cost of digitisation
• Method of usage of such data

5.5 Key Issues for Consultation

1. Will the governance model as per Health Data Management Policy be sufficient for the retention policy?

Ans. There needs to be audit system by third party that needs to be built in to ensure trust, compliance and accountability

2. How will the policy regulation be enforced and what should be the structure across relevant entities responsible for retaining the health data?

Ans. This would require to be implemented as addendum to many regulations.

Some of these would need to be part of the regulatory structure of PDP Bill on data protection after it is passed by the GoI

3. How should the implementation of the policy be done in case the policy is made applicable for the ecosystem beyond ABDM?

& 4. Is there an alternative model or policy approach which could be considered?

Implementation of the policy will happen if it becomes part of a regulatory requirement.

A start needs to be made and it needs to evolve and change from time to time. There are no perfect policies or perfect implantation and one cannot have all the answers to various questions that crop up.

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A Unique Blended Mental Health Support Delivery Model

Smriti Joshi, MBPsS, M.phil in Clinical Psychology
Advanced Certified Telebehavioral Health Professional (www.telehealth.org) | Lead Psychologist & Member Board of Directors, Wysa

 

In-person mental health support is not replaceable yet it cannot scale enough to address this rapidly increasing need to provide mental health support to this growing public mental health support crisis. (AI)-enabled, empathetic, and evidence-driven conversational agents are now being considered a way to rapidly scale mental health support provision, augmenting existing mental health services. Wysa is one of the world’s leading solutions in this space, with 4 million users served, who have had 485 million conversations in 65 countries.

Wysa was founded in 2016, and I am part of the 5 member founding team.

A. Wysa Introduction & Background
Wysa ‘s service model can be best imagined as a unique 3-layer ‘pyramid of care’, based on an anonymous, text-based app interface that can create custom care pathways. App users get help through –
(1) an emotionally-intelligent AI-CBT delivering chatbot providing 24X7 support,
(2) a library of evidence-based self-help tools and techniques to help build resilience.
(3) online therapy with professional clinical and counselling psychologists.

The model is affordable (cost of triage can be 90% lower), scalable (It can support a 4 million user base with a 70 people team), and flexible to integrate with existing service ecosystems; so it is very suitable for early stage intervention, and support at a population level.

The AI is built inhouse, and tuned for emotional intelligence, delivering evidence-based AI-driven Cognitive Behavior therapy (AI-CBT). Wysa allows for free text input which makes the conversation empathetic allowing for a richer user experience. Wysa’s 100+ NLP models, built on 485 million+ conversations, make its ‘listening’ ability unique and the best in the world today. This AI meets global Clinical Safety standards, are ISO certified, and is explainable using non-generative models that can be audited for clinical safety.

B. Global Leadership
Wysa is a global leader in conversational AI for behavioral health and has already helped improve mental health care for over 4 million individuals across 65 countries. It is the preferred digital behavioral health partner for organizations like Accenture, Aetna, Travelers, and the National Health Service (NHS) in the UK, and the Ministry of Health in Singapore.

Wysa is rated #1 at 93% by ORCHA, the NHS digital app evaluation agency – the highest across all categories – including a 100% on clinical assurance.

It has recently won the NHS NIHR AI Award, aims to accelerate the testing and evaluation of AI technologies in the NHS so patients can benefit from faster and more personalized diagnosis and greater efficiency in screening services.

• NHS Featured App for Covid: link
• NHS ORCHA Best App in Health & Care (ORCHA is the NHS digital health solution evaluation agency): link
• Forbes Top 5 Innovations in Mental Health 2020: link
• Google Play Best App 2020
• CB Insights 25 Technologies Changing the Post-covid World: link
• Cincinnati Children’s Hospital (US) Recommended solution for Covid management: link
• ORCHA 10 Best Apps to Manage Long Covid: link

Wysa’s efficacy for managing depression has been established through a peer-reviewed study published in JMIR, the world’s top e-health journal. We are currently running clinical trials with Harvard Medical School, Columbia, Cambridge, Washington University and the NIHR in the UK: 10 other research papers are underway, and will be published in 2022.

C. My Role & Contributions
The last 6 years of working at Wysa have been the most productive and fulfilling years of my career as there has been immense learning around how AI and machine learning can make healthcare more accessible and scalable and bridge the existing gap in service provision due to various challenges.

Apart from being part of Wysa’s founding team and serving on the Board of Directors, I have set up a 30-people clinical and therapist team that supports clients from India and 30 other countries using Text based and Audio-video counselling and psychotherapy – starting in India, we now have clinical team members in the US and UK. In addition to clinical inputs for product design for our AI platform, the team has also completed more than 10,000 therapy sessions in the past 3 years with a 95% client approval rating.

In addition, I have been the company’s senior representative at Swasth Alliance, an public-private partnership between the Ministry of Health & Family Welfare, Govt of India, and a consortium of startups in the Indian ecosystem coming together to serve the country during Covid. I am also part of the leadership team driving Wysa’s response to the mental health challenge brought upon by India’s third Covid wave, through a partnership with ACT Grants (a multiparty donor consortium) and the Govt of India.

The burden of care on health care professionals is immense. While setting up a team for remote delivery services, especially during the recent covid-19 waves, where psycho-therapy providers themselves were struggling with covid-19 related concerns, I developed a keen interest in an area often neglected by practitioners themselves- compassion fatigue and burnout in health care providers.

Ensuring my team’s well being and building team resilience became my key focus and I ensured that this work was carried out via an action based research effort at Wysa.

We are creating new models of tele-therapy that combine human support with AI-led CBT, that are cutting-edge and unique and our unique culture, ethos and spirit of service are being recognised in clinical and practitioner communities within tele-therapy globally. I have been invited to offer mentoring and support to aspiring psychologists from across the world via this https://www.therapistsintech.com/ to assist them in their phase of transition from making a shift from in person clinical practice or academia to delivering services via online modalities and also helping platforms build resilient remote service delivery teams, especially in the wake of covid-19. These efforts were acknowledged by this international platform and I was awarded with “The outstanding mentor in tech award for 2021”.

https://wysabuddy.app.link/dwwysa – Download Wysa Link

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A model for sustainable, partnership-based telehealth services in rural India: An early process evaluation from Tuver village, Gujarat

Shoba Ramanadhan ¹, Krishnan Ganapathy ², Lovakanth Nukala ², Subramaniya Rajagopalan ³, John C Camillus ⁴

Prof. Krishnan 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

 

Abstract

Background: Telehealth can improve access to high-quality healthcare for rural populations in India. However, rural communities often have other needs, such as sanitation or employment, to benefit fully from telehealth offerings, highlighting a need for systems-level solutions. A Business of Humanity approach argues that innovative solutions to wicked problems like these require strategic decision-making that attends to a) humaneness, e.g., equity and safety and b) humankind, or the needs and potential of large and growing markets comprised of marginalized and low-income individuals. The approach is expected to improve economic performance and long-term value creation for partners, thus supporting sustainability.

Methods: A demonstration project was conducted in Tuver, a rural and tribal village in Gujarat, India. The project included seven components: a partnership that emphasized power-sharing and complementary contributions; telehealth services; health promotion; digital services; power infrastructure; water and sanitation; and agribusiness. Core partners included the academic partner, local village leadership, a local development foundation, a telehealth provider, and a design-build contractor. This early process evaluation relies on administrative data, field notes, and project documentation and was analyzed using a case study approach.

Results: Findings highlight the importance of taking a systems perspective and engaging inter-sectoral partners through alignment of values and goals. Additionally, the creation of a synergistic, health-promoting ecosystem offers potential to support telehealth services in the long-term. At the same time, engaging rural, tribal communities in the use of technological advances posed a challenge, though local staff and intermediaries were effective in bridging disconnects.

Conclusion: Overall, this early process evaluation highlights the promise and challenges of using a Business of Humanity approach for coordinated, sustainable community-level action to improve the health and well-being of marginalized communities.

Publish or Perish

The Oxford Dictionary of Phrase and Fable, describes ‘publish or perish’ as an attitude or practice existing within academic institutions, whereby researchers are put under pressure to produce journal publications to retain their positions or to be deemed successful, The phrase is attributed to Coolidge who enunciated this theory in 1932. Successful publications draw attention to scholars and their sponsoring institutions. This , helps getting funds for research projects. However the pressure to publish also causes poor work being submitted to academic journals.

Publications in Telehealth have increased exponentially in the last 2 years. The author personally reviews at least one article a week from several international journals. Journals are measured by their impact factor (IF), which is the average number of citations per article published in that journal. Not many Indian journals have an impact index of even more than 2.5 .Neurology India for example has an IF of 2.7 . New England Journal of Medicine has an IF of 92 !! What is an author’s impact ?. This is traditionally measured using the number of citations a single article has received. Today this information can be obtained in real time. The impact of a publication can also be determined by the number of times a free access article has been downloaded.

The author’s first paper in a Pubmed indexed journal was as an MBBS student in 1972. https://pubmed.ncbi.nlm.nih.gov/4402191/. Since then one book has been edited, 20 chapters contributed and 79 papers published in indexed journals. Most of the 30 odd papers dealing with telehealth have been downloaded in large numbers. An article “ Distribution of neurologists and neurosurgeons in India and its relevance to Telemedicine ” https://www.neurologyindia.com/articleStatistics.asp?issn=0028-3886;year=2015;volume=63;issue=2;spage=142;epage=154;aulast=Ganapathy;aid=ni_2015_63_2_142_156274 has been downloaded 17,500 times and also often cited.

Publishing a paper in a well known journal is time consuming and labor intensive. In academic institutions a good library, secretarial help and residents are available to help the faculty to put together a paper. As mentioned earlier it is part of their job profile and is essential for survival. Interestingly more services in various aspects of telehealth are offered in the private sector. Here the story is different. In large private institutions a P&L driving CEO has concerns, and rightfully so, in making available “confidential” data in the public domain. Top journals insist on full access to nitty gritty. There is a conflict of interests. Paper publication takes a back seat. HR are dedicated to managing the operations. They generally do not have a Paper publishing background. Not being a part of their KPI it is extremely difficult to make them do extra work.

Publishing papers in national / international journals in the field of Telemedicine do have a RoI. Unfortunately this takes considerable time. It is not a low hanging fruit. From a purely personal growth perspective, every time one writes a paper, one becomes a little more knowledgeable. Literature review ensures that we are up to date. Defining the problem, spelling out exact aims and objectives, documenting observations , extrapolating inferences, writing a discussion and making conclusions when repeatedly done becomes part of one’s DNA. Writing an article makes one see the Big Picture. Getting an article accepted for publication is an art and a science. : https://www.neurologyindia.com/text.asp?2021/69/6/1547/333463. Adopting a scientific approach means more business !

India is indeed a paradox. In terms of numbers we probably provide more teleconsultations every single day than most countries on this planet. It is often stated that the sheer volume of work prevents us from meticulous documentation and follow up which is the sine qua non of doing any impact study. Interestingly even politicians and administrators want hard core scientific evidence that our remote intervention is cost effective resulting in significant difference in the ultimate health care outcome. The only way to get this evidence is to plan a paper for the NEJM and be patient for 3 years !! A prospective multi institutional well designed and funded study resulting in multiple papers alone will enable India to take a leadership role in the comity of nations. Improbable Yes. Impossible No. Do hope the Next Generation will take this seriously and not treat it as the rumblings of a septuagenarian. 22 years after the birth of Telehealth in India we should no longer follow high standards. We must set them. We should not be talking of achieving world class. The world should talk about achieving India class. We have the potential to bring out at least 40 papers every year in journals with an IF of > 2.5 . Doing qood quality work alone is not enough. The world should know about it !!

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Handling Sensitive Situations through Telemedicine

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

 

The legalisation of telemedicine has been a boon for access to healthcare. However, the increased reliance on telemedicine has also been accompanied by unintended consequences: doctors may receive requests during consultations that are of a risky or highly sensitive nature, that they may not be comfortable handling.

For instance, a doctor may be consulted by a patient for a matter that requires an in-person examination, or it may be that the medication that the patient requires for their condition cannot be prescribed through telemedicine, but the patient refuses to visit a clinic or hospital and insists on receiving treatment through a teleconsultation only. In such a case, the doctor must inform the patient that a diagnosis cannot be arrived at or treatment cannot be commenced through a teleconsultation, and should meticulously record the patient’s refusal to seek a physical consultation. The doctor should inform them of the risks of not seeking proper treatment, and should record that the patient has been informed of the risks and is still refusing to seek proper treatment. Essentially, the doctor should capture that the patient was fully informed of the situation, and that he/she acted against medical advice.

In more extreme situations, a doctor may be consulted in an emergency situation where the patient requires urgent care. The doctor should advise the patient or caller to call an ambulance or rush to a hospital immediately. If required, the doctor may also inform the caller of the first aid measures that must be carried out.

There may be situation wherein a patient is verbally abusive or behaves inappropriately, perhaps even to an extent where the doctor feels uncomfortable or at risk. In such a situation, the doctor may advise the patient to consult with another doctor, end the consultation, and record his/her reasons for doing so. Depending on the severity, the doctor may also file a complaint with the police. If the doctor is consulting through a telemedicine service provider, he/she should also inform the management so that they can take appropriate actions.

If a patient is incoherent and appears to be either of unsound mind or inebriated, the doctor should ascertain whether there is a caregiver or trusted person whom the doctor may speak to for clarity and to give further instructions to. Doctors should exercise great caution while administering advice to a person who does not appear to be lucid.

A patient may display suicidal tendencies or even outrightly express that they intend to hurt either themselves or another person. In such situation, as with regular consultations, the doctor must promptly inform the authorities. Similarly, if the patient confides in the doctor that he/she is the victim of abuse or has been assaulted, the doctor should consider whether the authorities ought to be notified. Note that, to the extent that it is practical, guidelines for medicolegal cases should be adhered to for cases that are of a medicolegal nature.

Such situations are not specific to telemedicine, and may also occur with in-person consultations. Doctors should ensure that they apply at least the same level of prudence and professional judgment for remote consultations, and should ensure that they maintain meticulous records of such interactions (including any complaints made to authorities in relation to such interactions). Wherever possible, they should attempt to ensure that the records also reflect that the patient was made aware of the situation, and the patient concurs with what is being recorded in the doctor’s notes.

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Telemedicine – News from India & Abroad

 

New Device Helps Measure Blood Pressure and Other Vitals

New ‘finger clip’ device has been designed to measure and monitor blood pressure consintuously, reveals a new study.Monitoring a person’s blood pressure on a regular basis can help health care professionals with early detection of various health problems such as high blood pressure…..Readmore

Artificial Intelligence (AI) Helps Improve Patient and Doctor Communication

Understanding between a patient with low health literacy and doctors can be improved with the help of artificial intelligence (AI) as per a study at the University of California – San Francisco, published in Science Advances.The study team performed a computer analysis of 250,000 … Read More

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

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

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TN – TSI invites all the TSI Chapters and Members to submit information on their upcoming Webinar or Events (50 words), News related to Telemedicine (200 words) or short articles (500 words) for the monthly e-newsletter. Guidelines for submission to TN TSI Newsletter- Report can be from 500 to 600 words Report Should be relevant to Telemedicine or Medical Informatics No promotion of self or any product Avoid plagiarism All references should be included Provide any attributions Visuals are welcome including video links Send full authors name, degrees, affiliations along with a passport sized photograph of good resolution. If multiple authors only main author photo to be sent.

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Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

What is New? This issue reports the highlights of the annual conference of Indian Society of Lifestyle Medicine. A society that will play stellar role in the development of tele-health space. Tele-health is ideally placed to treat most of the Non-Communicable disease that now makes up the major reason for morbidity and mortality of our global population. TSI itself is now undertaking the amendment of its constitution after 20 years, all members should contribute to this endeavour by sending their recommendations to our hon secretary. We finish another year of uncertainty with the Omicron variant. From the editors of this newsletter our best wishes for a safe and happy holiday season and a very happy and healthy 2022 to all TSI members. Thank You Dr. Sunil Shroff Chief Editor President – TN Chapter – TSI

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‘A Paradigm Shift in Healthcare’ theme of the Second annual conference of Indian Society of Lifestyle Medicine

Dr. Ravi Modalli
Treasurer, Indian Society of Lifestyle Medicine

 

 

The second International Conference i.e. ISLM2021 was conducted on the 27th and 28th November 2021 by Indian Society of Lifestyle Medicine (ISLM – www.islm.org.in). Under the conference theme ‘A Paradigm Shift in Healthcare’, deliberations of ISLM2021 established the value of Lifestyle Medicine in bending the trajectory of healthcare towards positive health and well-being among physicians, their patients & people in general.

Dr. Ravinder Mamtani, MBBS, MD, MSc, FACPM, FACOEM, ABoIM, DipABLM, Prof of Population Health Sciences, Weill Cornell Medical College, NY, USA, in his key note message extended his full support to ISLM leadership & highlighted that reforms of modern healthcare must hold it’s progressive path by adopting lifestyle medicine approaches to control the burden of lifestyle diseases and reduce the incidence of premature deaths. Lifestyle medicine offers a breath of fresh air. Providing patient-centred evidence based lifestyle medical care, when warranted, is a step in the right direction. He summarised saying ‘This year’s ISLM2021 conference on changing the paradigm of healthcare will shed light on how lifestyle medicine can positively impact healthcare delivery in India.

Ms. Preetha Reddy, Executive Vice Chairperson, Apollo Hospitals Group, in her key-note message commended the organisation of ISLM2021 and prompted the entire medical fraternity to champion the healthy way forward and mitigate the burgeoning threat of lifestyle related chronic diseases, thereby contributing to the making of a healthy economy.

Dr. Sheela Nambiar, President, ISLM, presented the conference theme of ISLM2021 highlighting ISLM’s approach to reduce burden of the already overloaded healthcare system & making care systems more conducive to wellbeing and quality life for physicians and their patients.

She spelt ISLM’s 8 point vision:
1. To educate medical students on principles and practices of Lifestyle Medicine
2. To motivate and inspire young physicians to adopt health promotion & personal protective practices including preventive medicine using lifestyle modifications
3. To create strategic alliances between healthcare systems and other organizations, corporates, communities, companies and interested individuals to help the cause of ‘health promotion’, ‘disease prevention & control’ and improved longevity using the principles of Lifestyle Medicine.
4. To continue collaborating with senior physicians in India who are integrating lifestyle medical protocols in their clinical practices.
5. To establish standards of education and service protocols for Lifestyle Health Management.
6. To amass more indigenous research, improving the understanding of our own population and better control of lifestyle related diseases.
7. To take social responsibility by educating people on healthy choices & empower control on their personal health.
8. To make India a forerunner to contend with global movement of Lifestyle Medicine in lines with Sustainable Developmental Goals

Over 40 speakers including Padmashrees, Padmabhushans, Academicians & Practitioners of International repute shared evidence on alignment of Lifestyle Medicine with over 22 topics of mainstream clinical disciplines like Endocrinology, Gastroenterology, Gynaecology, Paediatrics, Oncology, Cardiology, Neurology, Psychiatry, Adolescent Medicine, Obesity, COVID19 care, Sleep medicine, etc.

Dr. Sunil Shroff, Renowned Urologist, Transplant Surgeon & President, TN – Telemedicine Society of India, enlightened on the prospects of delivering lifestyle medical care through tele-health & tele-medicine especially on reaching the masses, keeping people engaged in personal health & also enabling long-term treatment follow-ups. Tamil Nadu Medical Council permitted CME credit hours for the conference.

The conference also featured two workshops on Stress Management and Culinary Medicine. Participants enjoyed the morning exercise sessions. Series of virtual networking meets allowed attendees to interact with the faculty, discussing topics of interest like Telemedicine, Mindfulness, Principles of Lifestyle Medicine, Nutrition, Obesity, Positive Psychology. A panel discussion on Lifestyle Medicine in Clinical Practice brought forth the experiences of leading Lifestyle Medicine Physicians in India.

Thirty physicians and licensed dietitians appeared for the certification examination conducted by the International Board of Lifestyle Medicine through ISLM. Scores of researchers participated in the research presentations highlighting the adoption of principles of lifestyle medicine in mainstream healthcare.

Lifestyle Medicine, being a vital clinical area of work promoted by the Indian Society of Lifestyle Medicine, the new members joining ISLM enjoy continued learning opportunities through the monthly academic & research activities of ISLM.

A world full of compliments for ISLM2021, sponsors messages, abstracts, recipes are captured in the form of a souvenir that is accessible at www.islm.org.in

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ISO 13131 Certification for Telehealth Services

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.

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The Use of Fitness Trackers for Telemedicine

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

Fitness trackers are increasingly being relied upon by people to monitor factors such as temperature, pulse rate, respiration rate, blood oxygenation, sleep patterns and exercise levels. Concurrently there has been a significant rise in remote consultations between patients and doctors. As a result, data from patients’ fitness trackers are making their way into telemedicine. However, doctors must proceed with caution while placing reliance on vitals that have been obtained from a fitness tracker.

First and foremost, even though fitness trackers offer medical device-like functionalities, they may or may not actually be medical devices. While a medical device is subject to regulatory scrutiny and has to undergo extensive clinical testing to ensure it’s accuracy before it is launched in the market, a fitness tracker does not undergo similar testing. Fitness trackers are, as the name would indicate, meant to track fitness levels and are targeted at healthy individuals. The manufacturers consciously elect to not pursue the medical device route, and do not intend for the device to be used to monitor vitals in a “patient”. They contain an explicit disclaimer on the packaging itself stating that the product is not a medical device and is not intended to be used for the diagnosis, treatment, cure or prevention of any disease. In addition, unlike a medical device, the health data of individuals collected by these trackers can be accessed by the manufacturer, and therefore while choosing a fitness tracker, doctors and patients should make an informed choice from data protection perspective on use of such health data by the manufacturer.

Second, the fitness trackers are not subject to conform with any uniform quality standards in India, and every fitness tracker uses a different technology and algorithm for tracking data and thus, hardly ever will two fitness trackers report similar numbers.

Further, fitness trackers are highly susceptible to human error and external conditions, and individuals are generally unaware of how to use the function correctly, so the data derived from a fitness tracker is not reliable. The reading would be affected by where the person is wearing it, how tight or loose the strap is, whether the person is wearing accessories that may hinder the sensor, whether the person is perspiring, whether they are correctly positioned, movement, the charge or the device, etc.

Therefore, while the utility of these devices is undeniable, their utility in medicine warrants abundant caution. The responsibility of a doctor to exercise great caution and professional discretion increases while discharging their professional services via telemedicine due to lack of physical contact with the patient. If a patient does use a fitness tracker and relays information from it to a doctor during teleconsultation, the doctor should refrain from taking the reading at face value or basing decisions solely on them. That being said, they may take it into consideration in combination with other symptoms and the patient’s history. The doctor could also peruse historical data from these devices to identify any patterns in the patient’s readings.

If a doctor does rely on any data that the patient obtained from a tracker, they should also note down the make and model of the device in their notes, if possible, so that they can also verify whether the tracker is a medical device or not. If it is, the doctor should also confirm with the patient that they used the device as per the manufacturer’s instructions.

Irrespective, before commencing a treatment plan on the basis of a information that had been obtained from a patient-operated device the vital signs of a patient should direct the patient to visit a doctor for and have their vitals measured and verified on a reliable device.

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Telehealth and Medicine Today (TMT) Journal

Tory Cenaj
Founder and Publisher, Partners in Digital Health

Telehealth and Medicine Today (TMT) is an open access international peer reviewed journal examining the value of telehealth and clinical automation, its use and scalable developments, business process guidance, market research and the economic impact of digital health innovations in an evolving health technology sector. A world-class review board includes constructive commentary through rapid and rigorous peer review.

TMT’s audience includes leadership at hospitals and medical research centers, universities, payor organizations, IT/IS, healthcare providers, consultants, companies (early and more established), entrepreneurs, developers & start-ups, life sciences and device companies, pharmacy, NGO, government, and policy leadership around the globe.

For a complimentary subscription, register at:
https://telehealthandmedicinetoday.com/index.php/journal/user/register

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

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

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Telemedicine – News from India & Abroad

India

Vyomanauts
Dr. Ganapathy strongly believes that the ultimate in Telehealth where the sky is no longer the limit (pun intended) will be a reality even in India in the next decade. The MoS Space has announced that India’s first International Space Station will be launched in 2030. ISRO hopes to launch our own Vyomanauts in 15 to 18 months from now. It is therefore not surprising that the ever future ready IIT Alumnus Club invited Dr. Ganapathy to give a talk on Extra terrestrial Healthcare. Profusely illustrated this talk gives several examples of technology transfer – tools planned to withstand microgravity and irradiation have resulted in better less expensive armamentarium for health care providers on earth. The full talk is available @….Readmore

Artificial Intelligence Helps Doctors With Patient Diagnoses
Artificial intelligence (AI) can facilitate a faster, automated route in decisions doctors need to take, ultimately meaning quicker answers and patient recovery….Readmore

 

International

British Man Receives World’s First 3D-Printed Eye
World’s first 3D-printed eye has been fitted to a middle-aged man in the UK, as part of a trial. reports media. Doctors at Moorfields Eye Hospital in London fitted the first ever 3D-printed eye… Read More

Machine Learning Predicts Death Risk in Heart Disease Patients
A new machine learning/artificial intelligence score provided an accurate forecast of the likelihood of patients with suspected or known coronary artery disease dying within 10 years…. Read More

 

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TN – TSI invites all the TSI Chapters and Members to submit information on their upcoming Webinar or Events (50 words), News related to Telemedicine (200 words) or short articles (500 words) for the monthly e-newsletter. Guidelines for submission to TN TSI Newsletter- Report can be from 500 to 600 words Report Should be relevant to Telemedicine or Medical Informatics No promotion of self or any product Avoid plagiarism All references should be included Provide any attributions Visuals are welcome including video links Send full authors name, degrees, affiliations along with a passport sized photograph of good resolution. If multiple authors only main author photo to be sent.

Click Here to Download PDF Version

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

What is New? 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

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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

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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

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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

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Telemedicine Practice Guidelines – A Foundation Course for RMPs by TSI

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

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Telemedicine – News from India & Abroad

India

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

 

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TN – TSI invites all the TSI Chapters and Members to submit information on their upcoming Webinar or Events (50 words), News related to Telemedicine (200 words) or short articles (500 words) for the monthly e-newsletter. Guidelines for submission to TN TSI Newsletter- Report can be from 500 to 600 words Report Should be relevant to Telemedicine or Medical Informatics No promotion of self or any product Avoid plagiarism All references should be included Provide any attributions Visuals are welcome including video links Send full authors name, degrees, affiliations along with a passport sized photograph of good resolution. If multiple authors only main author photo to be sent.

Click Here to Download PDF Version

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

What is New? 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

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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

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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

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Problems that exists in Rural India to Adapt Telehealth

Ms. Saranya Gupta
Mentor: Manvee Bansal / Abhimanyu Rathore
Pathways World School, Aravali (IB)

 

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

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Telemedicine Practice Guidelines – A Foundation Course for RMPs by TSI

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

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Telemedicine – News from India & Abroad

India

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

 

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TN – TSI invites all the TSI Chapters and Members to submit information on their upcoming Webinar or Events (50 words), News related to Telemedicine (200 words) or short articles (500 words) for the monthly e-newsletter. Guidelines for submission to TN TSI Newsletter- Report can be from 500 to 600 words Report Should be relevant to Telemedicine or Medical Informatics No promotion of self or any product Avoid plagiarism All references should be included Provide any attributions Visuals are welcome including video links Send full authors name, degrees, affiliations along with a passport sized photograph of good resolution. If multiple authors only main author photo to be sent.

Click Here to Download PDF Version

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

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

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Webinar on ‘Ethical Issues in Telehealth Practice’

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

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

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

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Confidentiality and Data Protection in Telemedicine

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

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

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

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

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

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

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

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

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

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

References:

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

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

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

Preamble

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

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

Beginning

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

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

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

Telemedicine Implementation

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

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

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

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

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

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

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

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

Outcome of ISRO’s Initiative:

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

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

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Telemedicine Practice Guidelines – A Foundation Course for RMPs by TSI

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

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Feedback for Telemedicine Practice Guidelines Course

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

A snapshot is presented a below:

1. Did you find the live interaction useful?

 

 

 

 

 

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

 

 

 

 

 

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

 

 

 

 

4. Overall rating

 

 

 

 

 

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Telemedicine – News from India & Abroad

India

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

International

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

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

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

 

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TN – TSI invites all the TSI Chapters and Members to submit information on their upcoming Webinar or Events (50 words), News related to Telemedicine (200 words) or short articles (500 words) for the monthly e-newsletter. Guidelines for submission to TN TSI Newsletter- Report can be from 500 to 600 words Report Should be relevant to Telemedicine or Medical Informatics No promotion of self or any product Avoid plagiarism All references should be included Provide any attributions Visuals are welcome including video links Send full authors name, degrees, affiliations along with a passport sized photograph of good resolution. If multiple authors only main author photo to be sent.

Click Here to Download PDF Version

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

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

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Tele Rehabilitation : The Time has come

 

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

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

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

Introduction to Telerehabilitation Services

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

Advantages and Barriers in TeleRehabilitation

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

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

Tele Rehabilitation potential in India

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

Tele Rehabilitation; A peep into the Future

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

Conclusion

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

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

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

 

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

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

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

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

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

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

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

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

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

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Medical Negligence in the Telemedicine Era

 

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

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

 

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

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

Standard of reasonable care

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

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

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

Documentation and Consent

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

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

Delay in seeking treatment

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

Incorrect mode of teleconsultation

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

Prescriptions

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

REFERENCES

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

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

 

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

 

 

 

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

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

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

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

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

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

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

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

Reference

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

 

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Telemedicine Practice Guidelines – A Foundation Course for RMPs by TSI

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

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Telemedicine – News from India & Abroad

India

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

International

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

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

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

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

 

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TN – TSI invites all the TSI Chapters and Members to submit information on their upcoming Webinar or Events (50 words), News related to Telemedicine (200 words) or short articles (500 words) for the monthly e-newsletter. Guidelines for submission to TN TSI Newsletter- Report can be from 500 to 600 words Report Should be relevant to Telemedicine or Medical Informatics No promotion of self or any product Avoid plagiarism All references should be included Provide any attributions Visuals are welcome including video links Send full authors name, degrees, affiliations along with a passport sized photograph of good resolution. If multiple authors only main author photo to be sent.

Click Here to Download PDF Version

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

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

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Towards Blockchain Based Secure Healthcare Information Systems

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

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

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

Key outcomes from this project are:

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

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

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

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Teleophthalmology Adoption – Barriers and Solutions

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

 

 

 

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

Teleophthalmology is done through the following modalities:

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

This article mostly covers the Teleconsultation part of Teleophthalmology.

Acceptance by Ophthalmologists and Patients

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

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

Dependence on Diagnostic Tests and Equipment’s

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

High Cost of Equipment’s and Poor Quality of Images

Other challenges

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

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

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

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

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

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

 

 

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

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

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

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

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

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

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

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

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

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

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

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

 

 

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

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

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

The cited article was dated December 29, 1927.

 

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

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

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Telemedicine Practice Guidelines – A Foundation Course for RMPs by TSI

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

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Telemedicine – News from India & Abroad

India

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

International

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

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

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

 

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TN – TSI invites all the TSI Chapters and Members to submit information on their upcoming Webinar or Events (50 words), News related to Telemedicine (200 words) or short articles (500 words) for the monthly e-newsletter. Guidelines for submission to TN TSI Newsletter- Report can be from 500 to 600 words Report Should be relevant to Telemedicine or Medical Informatics No promotion of self or any product Avoid plagiarism All references should be included Provide any attributions Visuals are welcome including video links Send full authors name, degrees, affiliations along with a passport sized photograph of good resolution. If multiple authors only main author photo to be sent.