Telecardiology transforming Digital Healthcare

MedPiper Technologies and JournoMed conducted a Webinar Series on “Digital Transformation in Healthcare” in association with IRIA Kerala, Hospex, Indian Junior Doctors Network, ISA Thrissur City Branch, IMA Thrissur and Instaclinik. The fourth-day webinar discussed Telecardiology and Tele-ICU as modern medical approaches. The event was held on 25th August 2022.

Dr Ramesh Babu Pothineni, Cardiologist and Managing Director of Aster Ramesh Hospital spoke about the Significance of Telecardiology in the Healthcare industry, how telecardiology plays a crucial role in saving a person’s life, the impact of Telecardiology in Today’s Medicine, the impact of Golden Hour in Telecardiology, awareness among medical professionals and patients regarding Telecardiology etc. He also spoke about the evolution of Telemedicine across the Globe. 

Healthcare Evolution 

The Healthcare industry evolved in 1784’s when mechanization is still under the developmental stage and more people are waiting for proper diagnosis. There was a huge demand for healthcare, and this strived for transformation in the hospital and the healthcare industries. There was a lack of trained healthcare professionals to meet the patient’s needs. The healthcare industry evolved as 1.0. Slowly in 1870, there started mass production of health equipment and products, the products were streamlined even the electrical equipment got involved in the production. In 1969, the healthcare industry 3.0 still got better with automation and digitalization of industries with the usage of computers and electronics.

Today’s healthcare industry 4.0 is equipped with cyber-physical systems, the evolution of the internet of things and networks. Healthcare is no more service or a profession but it’s a part of the industrial revolution. Every 100 years, there is an evolution in the industrial sector and now there is a transformation in the healthcare industry. Cost-effectiveness and serving the masses is the key to promoting better healthcare. Healthcare is being designed across the globe by implementing various schemes which benefit the patients. Now healthcare is a part of the industrial revolution 4.0. Now with the transformation in healthcare, 80% of diagnosis can be performed without any physical touch. Eventually, patients are receiving better diagnoses than prior. 

Core Elements of Healthcare 4.0

• Assisted Living 
• Rehabilitation 
• Monitoring Physiological and Pathological signals
• Self-management, wellness monitoring and Prevention 
• Medication intake monitoring and smart pharmaceuticals
• Personalized healthcare
• Cloud-based Health information systems
• Tele-medicine, telepathology and Disease Monitoring

Internet of Medical Things 

Internet of Medical things brings a closer network of medical applications online where the patients can get rid of nosocomial infections and other hospital-related allergic infections and can receive a quick diagnosis at their doorstep. Although telemedicine’s utility and advantages are known. People were reluctant to follow any novel advancements concerning healthcare in earlier days. Almost every medical professional now or student is keen to practice the Telemedicine. The literacy knowledge with the advanced medical skills, apart from the functional skills, the technology, communication, safety, hipa compliance are so important while practicing Tele-medicine. In Telemedicine, the management of patients is slightly different from just monitoring and the data gets accumulated with separate clinical flows compared to the physical patient evaluation. This is especially visible in heart patient management discharge and post-discharge management procedures.

Reasons Why Telemedicine is required?

Reasons for Telemedicine implementation

Physician shortage,
Distribution of expertise in hospitals or at healthcare centres,
To reduce the treatment cost efficiency. 

Healthcare Access in Near Future 

According to the American Medical Association, 70% of regular doctor visits and 40% of emergency room (ER) visits can be avoided through Telemedicine 

Telemedicine Significance in Society

• Because of poor infrastructure at healthcare facilities at few centres
• Non-availability of experts (disparate distribution)
• Low doctor-patient ratio (large population)
• Lack of proper medical education 

In the government sector, almost every doctor has to attend to 10,000-20,000 patients i.e., more than 10 times the patients that World Health Organization (WHO) recommended especially in the rural areas, the primary healthcare centres and the community medical centres. So, the demand is huge and applicability if properly understood can save the health of Indian population. 

Telecardiology Significance

The Significance of Telecardiology is it provides primary care support to the practitioners during the patient diagnosis empowering them to manage critical cardiac care with a maximum confidence. Telecardiology implementation depends on the availability of specialized devices such as Electrocardiogram (ECG). Telecardiology is a modern medical approach that utilizes telecommunications for the diagnosis of any heart disease i.e., it can be chronic or acute, arrhythmias, congestive cardiac failures and sudden cardiac arrest.

Applications of Telecardiology

Few Applications where telecardiology is being implemented. 

• Acute chest pain with diagnostic ECG
• Acute chest pain with non-diagnostic ECG
• Chronic chest pain (typical, possibly cardiac and non-cardiac)
• Arrhythmia (Acute Heart Failure)
• Modern Management of chronic heart failure-cited, wearables 
• In hospital tele- monitoring- Emergency room, Outpatient, Cathlab, Non-critical words 
• Post-discharge -Initial 6 weeks of monitoring 
• Optimal control of risk factors – Hypertension (HTN), Diabetes Mellitus (DM), Lipids
• Tele-rehabilitation
• Alarm Fatigue, Quite ICU 

Golden Hour Concept 

As per the golden hour concept, every minute, 65 lives are saved for every 1000 patients treated when the treatment is initiated within the first hour of the symptom onset. Almost all doctors and healthcare professionals are being taught of the golden hour concept. When a patient is observed in an emergency room with acute chest pain. There will be an immediate response from the healthcare team in assisting the patient. Sometimes, there are chances of losing lives while the patient is in transit i.e., from the home to the hospital or an emergency room. Time plays a significant role in a patient’s transition.

Telemedicine 

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 for the continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities. 

Delays in treatment can happen even after hospital admission as there is no proper support from the patients. So, pre-hospital management is also considered, which is very much feasible for a patient sitting at home. All the knowledge and the technology need to be properly utilized so that the patient reaches in time. Another important thing is that people who have heart attacks at the weekend or at nights are 5% more likely to die because of the delay in treatments. Those with serious types of heart attacks are more likely to die if they fall ill outside of normal working hours. This is because of the treatment delay.  

Conclusion 

There is significant variability in in-hospital cardiac arrest (IHCA) survival rate across the hospitals, and this variation persists despite adjustment for the measured patient factors and within hospital subgroups. With telecardiology, cardiac patients can receive the same care in rural areas as those in urban centres. Location is no longer a constraint for cardiac testing and monitoring. Thus, there is a transformation in Telecardiology pratices from the Emergency Management to the Daily Clinical Practice.

Telecardiology Role in Different Fields 

These are different areas where Telemedicine and Telecardiology are being implemented.

In Educational Research: 3D modelling, AI-based platforms, distance education and e-libraries are available, where Telemedicine has paved its path.

In Outpatient clinic: The patient’s data, telemedicine, Rural health and wearables are in more demand.

In Labs: In labs, the patient’s data, biomarkers data, logistics data and billing data are in more demand.

In Pharma: Virtual clinical trials, electronic prescriptions, e-pharmacy, research big data where Telemedicine plays its role.

In Hospital: Electronic Health Records, Medical image data, claims data, Billing and Finance Data has significance of Telemedicine 

In Research and Development: In Next-generation sequencing, Genome-wide association studies, Pharmaco-genetics, Research big data and collaboration, both Telemedicine and Telecardiology has its impact.