Uncategorized

Remote Patient Monitoring Significance

 

TELEMEDICON 2022 is an annual meeting organized globally. It’s the 18th International Telemedicine Conference in Kerala organized by the Telemedicine Society of India (TSI). “Strengthening Health Systems through Sustainable Telemedicine and Digital Health” is the theme for this year with the objectives of building platforms involving healthcare regulators, health funding authorities, service providers and international experts, exploring emerging telehealth models and breakthrough technologies. Examining new telehealth models, entrepreneurship, cutting-edge technology and the socioeconomic impact of telehealth implementation on healthcare access and equity will also be highlighted. The event was held on 10th November 2022. 

Mr Bijoy MG, Organizing Secretary spoke about Telemedicon 2022, an International Annual Conference of the Telemedicon Society of India (TSI). The three-day scientific conference includes the scientific sessions from 10-12th November 2022 at Amritha Hospitals, Kochin. It would involve the global speaker’s participation and World Health Organization (WHO) support. There are 4 credit hours applicable for doctors who are attending the Telemedicon Conference

Dr Uma Shankar, Principal of Padmashree School of Public Health, Bangalore; an executive member of the DSI Committee and Telemedicine Society of India (TSI), Kerala Chapter spoke about “How to implement Telemedicine in Daily Life.”

Learning Objectives of Telemedicine

  • Definition of Telemedicine 
  • Tools of Telemedicine application 
  • Various Telemedicine models in daily practise 

India is one of the fastest-growing, emerging economies in the World. It is the second most populous country. Despite rapid development in other fields, the performance based on healthcare parameters remains poor. One of the dominant discourses in the public health domain within the context of the provision of Universal Health Coverage is the shortage of an adequate number of qualified medical and healthcare professionals in India.

There is an abundant requirement for technologies because India is diversified as urban and rural areas.

India’s Doctor Population Ratio

The Minister’s version in the Parliament assumes that there is 80% availability of registered allopathic doctors and 5,65,000 ayurvedic, Unani, Siddha and homoeopathic doctors. This data was obtained by the Union Ministry of Health and Family Welfare, on April 5th, 2022.

It is very much difficult to provide quality care to people. The efficiency and effectiveness in managing the problems may not be good. So, to reduce that kind of and even due to doctors’ scarcity the usage of technology became the preferred solution. The technology chosen is “Telemedicine”. 

Telemedicine Definition

“The delivery of healthcare services where distance is a critical factor, by all the healthcare professionals using information and communication technologies for the exchange of valid information for the diagnosis, treatment and prevention of disease and injuries, research and evaluation, and the continuing education of the healthcare workers, to advance the health of individuals and communities.”

Most Telemedicine practitioners might have practised Telemedicine without the knowledge of Telemedicine.

Telemedicine Practice 

Telemedicine practice is as simple as a doctor consultation over mobile. It may be a junior doctor conversation with the senior specialist or a senior discussion about the complicated robotic surgery case that doctor had observed and the steps to be performed while undergoing surgery.

If the patient is somewhere and when the doctor is elsewhere, there is a wide spectrum of Telemedicine. So, in this wide spectrum of Telemedicine which possesses a major scope of practice. 

Telemedicine Services for Teleconsultation Practised in India 

Tele Radiology, Tele Consultation, Tele Ophthalmology, Tele Pathology, Tele Dermatology, Tele Cardiology and Tele ICU. These are all how Telemedicine is practised. But when it started with space, it started with Telepsychiatry. Today scope is the artificial intelligence, and machine learning evolving more deeper and deeper. Any specialist can use teleconsultation. In every specialization and system of Medicine, telemedicine is applicable. Telemedicine is a tool, depending on how one uses it. 

Telemedicine 

Primary Telemedicine: It is the place where one provides primary care to the patients, where there is no doctor, the primary care is provided. There is a direct connection between the patient and the doctor. 

Secondary Telemedicine: It is usually between two doctors. There may be a specialist, general physician, junior doctor or who is referring the senior doctor on how to do and what to do. Taking a report and acquiring a consultation etc. 

Tertiary Telemedicine: It may be surgical telesurgery, where most of the tertiary care is provided. 

It is very simple of looking at Telemedicine in these three layers. Generally, in the Indian health system, there are all three tiers.  

Tools of Telemedicine available for any Practitioner

One can use a normal telephone line or a video consultation. Nowadays, most of us during covid have utilized the chat platforms like WhatsApp. Some of them have used Facebook and many other platforms to consult their patients. So, one can have various devices connected to the systems. One can have an additional stethoscope, ECG or otoscope, at any point of care device can be in use. Today, there is an availability of a lot of mobile apps or internet-based digital platforms which confirm Telemedicine. The practitioners can use any of the systems available. There are various tools available. Irrespective of the communication tools, the main moto is to provide care to the patients and the core principles of telemedicine practice remain the same. There are both pros and cons to the usage of Telemedicine services. The consultation services are usually done through chat services i.e., through what’s app. With all these telemedicine services, the government of India, the Ministry of Health and Family Welfare came out with Telemedicine guidelines. It is good that the government has kept it vast open so that technology usage becomes available. Always look at ease that is available for both patients and doctors and start selection. One needs to look for the options available, connectivity available and acquired facilities. Most of the time, the practice can be done at home or by travelling. That’s the beauty of Telemedicine practice. Even while travelling, one can provide a consultation. 

Telemedicine Applications Classification 

Mode of communication: It can have text-based (chat/ platforms) audio-based (Phone, VOIP, Apps) or video-based (Apps, video on chat platforms, skype or face time). The positions might be remade once take a consultation. One needs to take a second opinion from a specialist. So, it can be done text-based.

Timing information transmitted: Based on the timing information transmitted, it can be real-time (video/audio/text interaction). Asynchronous exchange of relevant information where the patient information can be sent to the doctor, and the doctor examines the reports and respond. Here the time constraints remain crucial.

Purpose of consultation: It can be an emergency consult for immediate assistance or first aid. Telemedicine can be used in emergencies. 

One needs to be very partial, and one should not be managing patients in an emergency. In a non-emergency consult, the first consult with any remote health practitioner (RHP) for diagnosis/ treatment/ health education/counselling. Follow up with RHP. 

Interaction between the individuals involved: Teleconsultation can be between the patient and the doctor directly. It can be a caregiver; the patient is not able to do, or one may have their parents. It can be from home care where the patients and doctors are at different locations. There are health costs and telemedicine costs that are coming up where it is fixed in various places, where one can go to various places and start consultations based on the interaction, there are different types of telemedicine. Telemedicine applications can be one of the major four. 

Types of Consultation: 

First Consultation: The patient is consulting with the RMP for the first time. The patient consulted with the RMP earlier, but more than 6 months have elapsed since the previous consultation. The patient consulted with the RMP earlier, but for a different health condition. 

Follow-up Consultation: The patient is consulting with the same RMP within 6 months of his/her previous in-person consultation and this is for the continuation of care for the same health condition. However, it is not considered a follow-up if there are:

  • New symptoms
  • RMP does not recall the context of previous treatment and advice.

    Patient Management: Health Education, Counselling and Mental Stress

If the condition can be appropriately managed via telemedicine, based on the type of consultation, then the RMP may proceed with a professional judgement, the medicines can be prescribed, provide health education as appropriate in the case, and provide counselling related to a specific clinical condition.

Telemedicine Delivery Models: Six Scenarios

There are various technologies and platforms available for us. A public platform is available, where one can get the details of it. Because most of us make a mistake in selecting the appropriate platforms or appropriate scenarios for each technology. There are appropriate technologies for each of the scenarios. It is where most of us fail. Some people might recommend that Telemedicine doesn’t work. The problem is telemedicine arises because one hasn’t raised an appropriate tool for Telemedicine. The other way is most of the doctors commute to different areas so instead of patients travelling, the patient can set up rural telemedical centres wherever happening. There can be a doctor or nurse available who is locally trained. Instead of the system placed travelled everywhere and the other one is where the patient does not reach as the hospitals are very far away. Mobile telemedicine can be used, where the van can reach different places with all the equipment. The other one is the doctor-to-doctor consultation with another specialist. 

Model 1: A patient to RMP Doctor Directly:  It can be a consultation i.e., either the patient can be at home or a hospital and can reach the known doctor. There are platforms where doctors are listed, the patients can go to any of the hospitals or any specific doctors where there are concerned according to their language, name and specialization. However, there are various facilities available, one scenario or model where one can practise telemedicine.

Model 2: Home Healthcare to RMP: A lot of life expectancy has increased in India. Also, have a lot of non-communicable diseases, and the patients are bedridden at home, and it is unnecessary that the patient needs to travel every time. Unless and until they need a procedure, the patient may require a doctor in person. In some situations, the patients can manage their treatment at home. So, in-home healthcare, there are few pieces of equipment and one can monitor the vital parameters.

Model 3: Health worker to RMP: Health workers such as Aasha workers have a kit and can go to various places and connect to try to provide healthcare at the doorsteps. Healthcare workers can carry a digital stethoscope. They can have an ECG, an otoscope, and simple laboratory equipment. All those things can be carried in a suitcase like in a hospital kit so that is another model that comes in use. 

Model 4: RMP to RMP (a doctor to a specialist): It is necessary that I have to refer the patient for an opinion. One can send documents to a senior consultant, or a specialist or one can perform a video call and finish the consultation based on the doctor’s availability. Also, immediate consultation is possible. 

Model 5: There can be the availability of a mobile ICU, once the ambulance is picked up at the hospital, the emergency physician can guide the patient and the care can start the moment the patient is in an ambulance. So, emergency care can be provided. Even the diagnostics can be done, the patients can be consulted. Even mobile hospitals go around different cases. The person that gets in a hospital including the labs, x-ray machines, and even the diagnostics can be done, and they can consult the doctors.

Model 6: The health Kiosks can be various places, if there is no health worker too, the patient goes to the kiosks and those who know a little bit about computers. The basic details need to be entered. Then the kids start operating. There are various systems and models which are used in our day-to-day life. The technology is advanced so much that even medicines can be prescribed using this kind of kiosk.

Consultation between Patient and RHP through a caregiver 

The caregiver could be a family member, or any person authorized by the patient to represent the patient. There could be two possible settings. 

A patient is present with the caregiver during the consultation. A patient is not present with the caregiver. 

Equipment for Telehealth Workers

Basic hardware such as a laptop with a web camera. A medical device needs to be attached i.e. Stethoscope, Thermometer, BP apparatus, ECG, Otoscope, Ophthalmoscope, SPO2, Pulse oximeter, Basic lab investigations or point of care advice such as glucometer, haemometer etc. are carried out by a telehealth worker. 

Consultation between a Health Worker and a Remote Health Practitioner

A health worker could be a nurse, allied health professional, mid-level health practitioner, ANM or any other health worker designated by an appropriate authority. 

Emergencies 

A remote medical practitioner should exercise their professional judgement to decide whether a telemedicine consultation is appropriate in a given situation or whether an in-person consultation is needed in the interest of the patient. 

Mobile/ Emergency Telemedicine 

The remote medical practitioner based on his/ her professional discretion may

  • Advise first aid 
  • Counseling
  • Facilitate referral

In all cases of emergency, the patient must be advised for in-person interaction with a remote medical practitioner at the earliest. 

Telemedicine in Rural Areas 

Telemedicine can be used for any medical condition provided it is not an emergency, provided the patient and the doctor need not be in person for any kind of procedure. Other than that telemedicine can be used, it has to be used judiciously. Any tool cannot be used appropriately. There are a lot of experts available today who are aware of all these facilities. There are various technologies available that are particularly reachable. It all depends on the connectivity. There are a lot of apps available but patients in rural areas cannot use the apps available. So, for them, it is always better if they can go to a centre where the health worker works. There are technologies, that one needs to select and is apt in every situation.

Equipment at Rural Health Centres 

  • basic hardware such as a laptop with a webcam

    A medical device to be attached 
  • Stethoscope
  • Thermometer
  • BP Apparatus
  • ECG
  • Otoscope
  • Ophthalmoscope
  • SPO2
  • Pulse oximeter
  • Basic lab investigations/ Point of care device such as glucometer/ thermometer etc
  • Mini pharmacy
  • Facility for dressing minor injury 

If there is a big super speciality hospital, one can connect to the rural network, remote tele ICU or provincial hospital, where the super speciality hospital may be intensified. The intensiveness can be monitored remotely. The intensivist can manage 30-40 patients remotely as the technology is so advanced. That’s the way, one is moving forward towards digitalization. 

Conclusion:

Capitalize on the potential of telemedicine practice as per the Telemedicine Practice guidelines. Telemedicine is a useful tool if used appropriately. Telemedicine is the right solution which can deliver the right healthcare, the right patient, the right time and the right remote medical practitioner. If practised well, even the efficiency would be good and one can attain more money by practising Telemedicine. A lot of patients can be managed single-handedly by moving the patients from one place to another. 

 

 

 

Show More

Related Articles

Leave a Reply

Check Also
Close
Back to top button