On National Telemedicine Day, republishing this older post from 2016, on the implications of Telemedicine on home healthcare in India.

Healthcare has evolved from a simple physician-patient equation to a highly complex process wherein the entire setup is managed by a team. This becomes all the more true as one moves across the spectrum of primary to tertiary care with the latter being provided in large hospital facilities.

A single patient in the being prepared for surgery for instance can have a cardiologist (to advise about his stent),  an endocrinologist (to set his pre operative Blood Sugar levels to Normal), an anesthetist as well as the surgeon. After the surgery, the care will be continued wherein new members will be introduced eg the Physiotherapist, the dietitian as well as the General physician for follow up as the patient goes home.

The challenge is to merge this disparate care to a holistic approach and hence avoid a blunderbuss of medicines which can cross react and add iatrogenic problems to the existing set being faced by the patient.

In a large hospital, it is a given that all the concerned specialists will be in the same location and will (hopefully) exchange notes on the drugs and protocols to be followed.

However in smaller setups, the caregivers maybe in different locations or significant time gap of their presence may exist. In such a scenario, information exchange is a challenge and Information technology provides the tools to meet these challenges.

IT systems have been shown to help reduce medical errors especially when advanced tools like CDSS (Clinical Decision Support Systems) are included. Many hospitals do use such tools though not yet in India. But even where they are used, such tools would be expensive in disparate locations, not only in terms of money but also in the break in and learning period of using such systems effectively.  Most hospitals would be expected to provide uniform IT systems wherein transfer of data becomes easy although it is rarely the rule as purchases have mostly been done by different departments and also at separate time for separate locations wherein even a version change may disallow transfer of data.

In Home care, which is now felt to be a growing need as the elderly population is increasing rapidly, many tools, gadgets and even Robots have been shown to improve care provision to the patient. They provide a supplemental (although that is getting to be very comprehensive especially for robots) role and have to be monitored through electronic means creating the new field of Home based Telecare.

Data interchange and sharing in such a situation becomes even important. This interchange would expectedly have to cross many locations and also problems of disparate systems. The problem of Healthcare IT standards have to be solved for this. Herein proper, connectivity, conformity of data structure and uniform messaging has to be in place. The basis has to be a common EHR structure.

Once uniformity allows seamless access to data across different locations, telemedicine becomes a living reality and as simple as any patient management process wherever and whatever the distance separates the patient from the care provider. However the machines and other tools whichever use any sort of electronics can be converted to provide digital output so that the data is streamed to various locations. It goes without saying that the same sort of uniformity would be required.

 While this is an ideal world situation, large sections are already happening – ECGs were among the first to be referenced using Tele-Medicine. Holter monitoring started even before the internet was commonplace.  The patient carries around a portable device that records his ECG continuously and especially when possible angina occurs.

A special device allows a patient to  send his (single lead) ECG by phone. He just calls the number and places the devices close to his chest – the ECG signals are transmitted as audio signals.

Recently in a study,  EEG data of 1782 patients were sent from a tertiary care hospital in Tanzania to neurologists in India for analysis and interpretation. The EEG’s were recorded in digital format and placed on web server to be ready by clinical neurologists. This is done using ECHOSpa software and email but a backup system was established using other system with suitable encryption. A total of more than 1000 EEGs were reported in between April 2014 to Dec 2015 for patients of all ages. All cases were reported within 24 hrs of recording. The back-up system was used in 60 cases.. Quantitative EEG characteristics were classified into various categories hemodynamic parameter, Type of surgical operation, Bio spectral characteristics, Type of cases (Normal/Abnormal). Their sensitivity, specificity and accuracy in determination of depth of anesthesia were yielded by comparing them with the recorded reference signals in awake, sleep anesthesia,and the frequency of waves were recorded.

It was found that the Tele-Medicine could be used effectively for diagnosis and getting a second opinion. But at the same time care had to be given to the security of patient data as well as the encryption of the systems being used.

The detailed study can be found on this ink.

About the author

Purva Gupta is a graduate in Hospsital and Health Management from IIHMR Delhi. Please direct all questions and comments on this article to purvagupta456@gmail.com .

(Note to readers: Healthcare India has not checked the validity and authenticity of this research. This article has been published on statements from the author on its originality and authenticity. Healthcare India is not liable for any misrepresentation in this article.)

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