Tag: TSI Tamil Nadu

Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

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

TELEMEDICON 2020
www.telemedicon2020.com

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

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

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

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

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

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

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

Association with entities

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

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

Planned Themes

1. Transforming Telehealth Training for Registered Medical Practitioners in India

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

2. Legal & Ethical Aspects – The Grey Areas

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

3. Challenges in Health Data Integration – National and State

4. 5G and Telehealth – the Larger Impact

5. AI, Block chain and Telehealth

6. Wearables and impact on Tele-health

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

8. History of Telemedicine

a. India
b. International

9. Standards

10. Health Apps in India

11. COVID-19 and impetus to Telehealth

12. Wellness & Telehealth

13. STEMI project in Cardiology

14. ECHO global project

15. Health Insurance and Telehealth

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

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

18. Planned Workshops & Parallel Tracks

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

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

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

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

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

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

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

 

INDIAN TELE HEALTH MARKET TRENDS : MARCH – JUL 2020

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

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

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

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

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

Solution & approaches

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

Key design principles

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

Development approaches

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

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

Technology used

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

Outcome

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

Lessonslearnt

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

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

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

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

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

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

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

(Next Issue – Radio & Marine Telemedicine)

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Telemedicine – News from India & Abroad

India

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

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

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

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

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International

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

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

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

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

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Telehealth Newsletter

Official Newsletter of Tamil Nadu Chapter of Telemedicine Society of India

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

 

Vision Centres

 

Dr. Kim Ramasamy
Aravind Eye Hospitals, Madurai

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

 

 

 

What is TeleICU?

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

What are the various models of care?

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

 What are the advantages?

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

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

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

Are TeleICU services available in India?

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

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

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

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Blockchain Use and Opportunity in Healthcare

 

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

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

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

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

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

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

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

Applications and Studies

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

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

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

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

• Enforcing Human Subject Regulations using Blockchain and Smart Contracts

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

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

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

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

 

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India leads the world in Telehealth Cross-Sector Partnerships

 

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

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

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

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

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

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

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

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

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

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

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

 

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

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

 

 

 

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

“Mr. Watson, come here, I want you.”

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

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

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

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

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