Last month the Medical Council of India along with Niti Aayog had released the guidelines on telemedicine in India. The move which was almost 7 years plus incoming has created a new paradigm in the delivery of remote patient care.
While many technology solution providers have started offering this as a platform, the Telemedicine Society of India has started a program to register all platform providers for Telemedicine.
The best way to do so is to register in this google forms document. Link is provided here.
Bharat Gera, EX CIO St Johns Hospital Bangalore has been leading this study and evaluation. According to the study the main objective is
“Purpose of the study is to put together a repository of telemedicine solution providers and evaluate their suitability for healthcare providers in India aligned with TPG and NDHB”
The categories are
TELE-CONSULTATION-needed immediately to avoid patients visiting OPD during Covid19 and avoid exposure to infection amongst healthcare workers as well as between patients. These can be doctor-to-patient, doctor-to-caregiver, doctor-to-doctor, and doctor-to-paramedic etc.
TELE-ICU AND OTHER TELE-SERVICES AT THE HOSPITAL to minimize exposure of healthcare workers to Covid19 cases and optimize the usage of experienced staff.
REMOTE PATIENT MONITORING AND COUNSELLING as patients are unable to leave their homes, many chronic patients will require remote monitoring of their condition by a clinical team and as far as possible care at home.
SPECIALIZED TELESERVICES USING DEVICE AND NETWORKS services such as teleradiology, telecardiology, telepathology, telepsychiatry, etc. that enable remote diagnostics and therapeutic support and interventions like these will improve the capacity to handle load of patients and access to specialized clinicians.
Telemedicine is a key component of the India Healthcare story, it remains to be seen how this would grow and fill the big need for care especially in rural parts of the country.
Telemedicine Registry and Evaluation in India, April 2020 by Bharat Gera
One of the perplexing questions that have baffled technologists for long is why the regulators have not approved the use of teleconsultation for doctors. In the past, I have felt the need for Tele-Consultation or Telemedicine, tremendously to improve care in India.
Here are my reasons
As a doctor, I used to see the 8 hours of works heavily imbalanced. I was free for the first 5 hours of the day but loaded towards the evening. The last three hours and especially the weekends would be packed and I would be overworking at that time. If I had to balance that time well, was If I could equally load the patients throughout that 8 window period. But as I would have to meet the patients and they might require someone to bring them to the clinics.
Our health infrastructure, both in terms of people, beds and devices, is based in the cities. Our rural areas are underserved and they need to make the trip tot he cities for any healthcare service. Sometimes even to take a blood test or an X-Ray. While they might need to make the trip to avail of lab facilities, through Tele Medicine, this problem should be solved.
India needs cheap access to care. Most consultations are expensive as they take into account the investments in infrastructure, rent, etc. With Telemedicine, one has to only pay rent for platform and bandwidth charges. The overall cost of consultation should come down.
While I have argues for this for long, the regulations until recently did not allow for telemedicine or teleconsultation.
The breakout of Covid19 has changed everything. With social distancing emerging as the best defense against Covid19 it is obvious that the next step was the guidelines for telemedicine from the Medical Council of India.
On 25th March 2020, the Medical Council of India along with Niti Aayog has released the Telemedicine Practice Guidelines. The document can be found here
In summary, these are the key areas covered by the document.
Guidelines for Telemedicine in India Elements specific to Telemedicine
Appropriateness of Telemedicine
Identification of RMP and the patient
Appropriateness of technology/Mode of Telemedicine
Patient Consent · Patient Evaluation · Patient Management: Health education, counselling and medication Duties and responsibilities of RMP in general
Medical Ethics, Data Privacy & Confidentiality
Documentation and Digital Records of Consultation
Fee for Telemedicine
2) Framework for Telemedicine
Patient to Registered Medical Practitioner
Care Giver to Registered Medical Practitioner
Patient to RMP through Health Worker at a Sub Center or any peripheral center
Registered Medical Practitioner to another RMP / Specialist
3) Guidelines for Technology Platforms enabling Telemedicine
I would recommend that everyone should read these guidelines. It’s a great read for startups and technology providers planning to build these platforms and healthcare providers planning to develop their telemedicine services.
As always questions and clarifications are welcome.
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.
Purva Gupta is a graduate in Hospsital and Health Management from IIHMR Delhi. Please direct all questions and comments on this article to email@example.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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Healthcare ecosystem in India is still evolving. Considering the diverse landscape in India, various technologies have been considered for increasing access and improving the care outcomes. In this context Telemedicine continues to be a relevant discussion and one that many feel will ultimately solve our issues with care specially in the rural parts of the country. But has Medicine delivered on its potential? Or does more need to be done to harness the benefits of this technology. To get the answers for these questions we spoke to Dr Harsha Rajaram, Vice President, Telemedicine, Columbia Asia Hospitals Pvt. Ltd. Below are some snippets from the discussion.
Digital has transformed health care and made geographic boundaries hazy. As part of the E-health initiative, the Telemedicine program at Columbia Asia Hospitals, extends expertise of its renowned physician from India to meet the needs of Patients across the globe. This is a good example of how digital has managed to create new care models.