French telemed 22 jan15 v2

Contact:

[email protected]

Website:

www.taurusglocal.com

CONFIDENTIAL AND PROPRIETARY TO THE PARTIES IN DISCUSSION.

1

Background Notes

Indo-French Dialogue on Telemedicine in Healthcare

New Delhi, 22 January, 2015

WHAT IS TELEMEDICINE

Telemedicine is a Bundle of existing

technology and business applications:

Video: Video chat, F2F Webconference e.g.

Skype, High resolution Videoconference,

Sharing Endoscopy video film, USG

Image: DICOM format e.g. X-Ray, CT,

Patient’s pictures e.g. JPG/GIF format

Voice: VOIP Phone to Phone, Computer to

Phone, Computer to Computer

Text: Chat Sessions, Electronic Medical

Records, Messenger Apps e.g. WhatsApp

Business Applications: Primary Care,

Second Opinion, Remote Monitoring etc.

2

WHY TELEMEDICINE

Promise of fulfilling gaps:

HR Crisis:

Shortage of Doctors,

Shortage of Nurses,

Shortage of Technicians,

Shortage of ANM, ASHA

Ability: Skill obsolescence of medical staff in

rural and remote areas

Access: Little Medical facilities in Rural and

Geographically Remote areas

Affordability:

80% of India’s population lives in villages,

2% of Indian population falls below the poverty

line every year due to medical expenses

3

TELEMEDICINE CHALLENGES Business Issues:

Collection of payment from rural and remote areas

Cash based economy,

Very little penetration of Plastic money,

eMoney, eBanking not prevalent

HR:

Medical Staff not trained on IT,

Old School resistant to IT,

Senior Doctors reluctant to visit rural areas,

Younger Doctors not going to primary care

High touch Culture:

Indian culture looks for Tangibility

Touch, Feel, Smell play vital role

Doctors practice runs on personal relationships

4

PROMISE OF TELEMEDICINE

Chain of Clinics:

Urban Main Hub: Having Specialist Doctors

Semi-Urban Local Hub: Having Primary Care

Physicians

Rural Spoke: Nurse, ANM, ASHA in rural and

remote areas

Staff from higher centers regularly visit lower

centers to handle Hi-Touch culture

Remote Monitoring:

Elderly Care, Home Care, Hospice,

Rehab,

Difficult Pregnancies,

Chronic Disease Management

eLearning

Bundle Telemedicine with eHealth and mHealth:

EMR for patient history and orders

Internet of Things: Integrate self monitoring

devices to mobiles for reporting on health status

Smart Mobile Apps acting as devices e.g.

Pedometer, ECG, Temperature, HR, BP monitors 5

TELEMEDICINE IN INDIA

Some Projects:

National Telemedicine Network

National Knowledge Network

Apollo Telemedicine Network

SGPGI Lucknow – Telemedicine CoE

PHC- District Telemedicine Pilot programs

Tripura Telemedicine Program

Issues:

Pockets of Success but not Scalable

Rural penetration issues

Internet penetration: 2G < 3G < 4G

Power Situation unpredictable

Rural Telephone Network issues

> 900 Million Mobile Phone users in India

6

Contact:

[email protected]

Website:

www.taurusglocal.com

CONFIDENTIAL AND PROPRIETARY TO THE PARTIES IN DISCUSSION.

7

GOVERNMENT OF INDIA POLICY ON

TELEMEDICINE

EHR Standards notified. Available on

MoHFW website.

MDDS Standards draft approved.

Available on MoHFW website

Telemedicine Guidelines published.

Digital India > eKranti > eHealth

Services > Telemedicine

DEITY > NeGP > MMP > Health

National eHealth Authority [NeHA] in the

works.

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V I S I O N S T A T E M E N T S I N H L E G A N D B A C K G R O U N D N O T E S

Overarching goal is a health

information network that links

all service providers in public

and private sector and also

generates the aggregate

figures for policy and

management decision

A system based on universal

registration and biometrics

which is dynamic health

record of every citizen,

portable and accessible to

service providers and

patients

Generates the alerts for disease

surveillance

I M M E D I A T E N E E D S A S I D E N T I F I E D I N W O R K I N G G R O U P P A P E R S

BRIDGING THE GAP

Need to Integrate

Births and Deaths

Service Delivery data

from HMIS

National Disease/ Program

Monitoring

Disease Surveillance

Epidemiology GIS

Nutrition Surveillance

Emergency Response Support

Public Information

HR and Financial

Management

Hospital Information

Systems, EMR, PHR

Medical Education

and Research

Regulatory Support

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LEAPING FORWARD FOR INDIA

State2 Health

Information

Exchange

State1 Health

Information

Exchange

State3 Health

Information

Exchange

1. Build the eHealth Authority

2. Setting Standards

3. Get the architecture right

4. Integration across systems

5. ICT for quality of care

6. Capacity Building

National

Health

Information

Network

Standardized

Technical

Architecture

Standardized

Interfaces

Standardized

Data Structures

Standardized

Vocabularies,

Code Sets

Standardized

Functional

Architecture

Disability

I/O Standards

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Physician/Hospital

Pharmacy

HIE Call Centre

Patient Ambulance

Lab/ Rad

Corp Employer Rep And Insurance

Health Information

Exchange for

Chronic Disease

Management

Convincing all the stake holders to share the data on a cloud is

the biggest challenge in building a health information exchange

11

Contact:

[email protected]

Website:

www.taurusglocal.com

CONFIDENTIAL AND PROPRIETARY TO THE PARTIES IN DISCUSSION.

12

DEFINITION OF TELEMEDICINE

Telemedicine is defined by the Telemedicine Information Exchange (1997) as the

"use of electronic signals to transfer medical data (photographs, x-ray

images, audio, patient records, videoconferences, etc.) from one site to

another via the Internet, Intranets, PCs, satellites, or videoconferencing

telephone equipment in order to improve access to health care."

Reid (1996) defines telemedicine as "the use of advanced telecommunications

technologies to exchange health information and provide health care services

across geographic, time, social, and cultural barriers."

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HISTORY OF TELEMEDICINE

The practice of medicine through telecommunications, or telemedicine, began in the early

1960s when the National Aeronautics and Space Administration (NASA) first put men in

space. Physiological measurements of the astronauts were telemetered from both the

spacecraft and the space suits during NASA space flights. These early efforts were

enhanced by the development of satellite technology which fo stered the development

of telemedicine.

NASA funded telemedicine research projects in the late 1960s and early 1970s.

In 1974, NASA conducted a study with SCI Systems of Houston to determine the minimal

television system requirements for accurate telediagnosis. A high-quality videotape was

made of an actual medical exam conducted by a nurse but supervised by a physician

watching on closed-circuit television. These videotapes were systematically

electronically degraded to less than broadcast quality. The original and degraded videos

were then shown to randomly selected groups of physicians who attempted to reach a

correct diagnosis (Telemedicine Research Center, 1997).

In 1989, NASA conducted the first international telemedicine project, Space Bridge to

Armenia/Ufa, after a powerful earthquake struck the Soviet Republic of Armenia in

December 1988. An offer of medical consultation was extended to the Soviet Union by

several medical centers in the United States. Telemedicine consultations were

conducted under the guidance of the US/USSR Joint Working Group on Space Biology

using video, audio, and facsimile between a medical center in Yerevan, Armenia and

four medical centers in the United States. 14