“8th National Biennial Conference on Medical Informatics 2012”

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“8th National Biennial Conference on Medical Informatics 2012” at Jawaharlal Nehru Auditorium, AIIMS New Delhi on 5th Feb 2012,
The organizing committee consisting of Mr. S.K. Meher (Organizing Secretary), Major (Dr.) Anil Kuthiala (Jt. Organizing Secretary) and Ashu (Assistant to the Organizing Secretariat) worked hard and toiled to make the conference a grand success.
The scientific committee comprising of Dr. S.B Gogia, Prof. Khalid Moidu, Prof Arindam Basu, Dr. S Bhatia, Dr. Thanga Prabhu, Dr. Karanvir Singh, Tina Malaviya, Dr. Kamal Kishore, Dr. Vivek Sahi, Spriha Gogia, Dr. Supten Sarbhadhikari, Dr.Sanjay Bedi, Mr. Sushil Kumar Meher actively reviewed all papers for the various scientific sessions.

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“8th National Biennial Conference on Medical Informatics 2012”

  1. 1. Establishing Tele-OphthalmologyCentres in North Eastern States of India Dr M R Surwade Dr S B Gogia SATHI
  2. 2. Need for Telemedicine in North Eastern States of India• Difficult Access to healthcare Services• Lesser availability of specialist doctors• Difficult geographical terrain• Time consuming communication/travel• Higher indirect cost of utilizing healthcare services at district or state level
  3. 3. Responding to the needs• Application of ICT in form of Telemedicine system can provide solution to overcome barriers• Need based strategic approach• Conducive policy environment provides opportunity• Integrating with the Public Health system is necessary as presence of private sector is negligible
  4. 4. The opportunity• Central Government Support – funding and technical• State governments’ willingness and initiatives• Good performance in implementing NPCB• Leadership at state level• Existing Network of CSCs can provide infrastructural base
  5. 5. The situation• 18 million blind people in India• Overwhelming majority are blind due to cataract. 75% cases are avoidable blindness• 9000 Ophthalmologists perform about 1.2 million cataract operations a year• The ratio more skewed in North East ( only 14 ophthalmologists in Nagaland)• 8000 optometrists against 40000 required
  6. 6. Program Objectives• Develop an effective system for delivery of eye care• Cost effective and efficient delivery of eye care services• Easy access to eye care services• Sensitization of rural population regarding eye care
  7. 7. The strategies• Need assessment – prevalence mapping juxtaposed with availability of services• Designing the network of tele- ophthalmology centres• Equipping the centres• Building local capacity – managers of centres and animator frontline workforce• Awareness building at community level
  8. 8. Technology architecture• Appropriate for timely and accurate diagnosis• Effective HMIS• Linkages with Tertiary Care Hospitals with minimum 256 kbps dedicated bandwidth• Application software and database centrally located• Various modules: Video Conferencing, Patient records, Content Portal, MIS with Eye exam and optometry equipment
  9. 9. Operationalization• Program Management Agency: SATHI in collaboration with SPANCO and local bodies• Trained managers of tele-ophthalmology centres• Community mobilization through link workers• Delivery of services through the network and outreach
  10. 10. Role of SATHI• Overall management including monitoring of centres• Collect, distribute and account for medicines and consumables• Operations and maintenance of centres• Ensuring uptime of the network• Availability of power back-up
  11. 11. Building Local capacity• Orientation of state program managers• Identification, selection and training of tele- ophthalmology centre managers• Training of link workers – ASHA, Extension Workers and NGO volunteers• Setting up of tele-ophthalmology network : Central Unit and peripheral centres
  12. 12. Expected Impact• Significantly contribute to well being of rural population• Enhance the capacity of eye care in the state and• Improved access to eye care services• Development of effective, integrated and sustainable model for telemedicine system• Reduce the burden on secondary and tertiary level health facilities• Help achieve the goals of “ Vision 2020 – The Right to Sight”
  13. 13. Current status• 3 centres at Aizwal, Lunglei and Chaphai started• 5 more centres in remaining districts are being set up – installation is in progress• Managers of centres trained• Communications and Social Mobilization Strategy developed• Training modules for centre managers and link workers developed
  14. 14. Ensuring sustainability• Robust hardware and software adapted to the local situation• Trained workforce – Managers at centres and Link workers at community level• Affordable user charges• Support systems: HMIS, Free spectacles, medicines and other consumables, follow-up of patients• Effective community participation• Involvement of all stakeholders
  15. 15. TELEMEDICINE SUPPORTED TOTAL EYE CARE PROJECT Dr Manoj Rai Mehta and Ruchi Agrawal ASTER EYE CARE DM EYECARE (DELHI) PVT LTD 5E/08 B.P. RAILWAY ROAD, FARIDABAD Phone no. 0129-2410231 32 RING ROAD, LAJPAT NAGAR IV, NEW DELHI Phone no. 011 3085337-39
  16. 16. INTRODUCTION Ehealth projects fail more due to Technology (20%) the personnel (40%) rather than Engineering (35%) technology (20%) Business Process Concept of Change Management Change Management Failure is always 100% (40%)  The simplest failures are Luck (5%) the biggest
  17. 17. BACKGROUND Planned tele-ophthalmology project in North East  To be run by Ophthalmic assistants at the periphery  Co-ordination and control by Ophthalmic Surgeons Learning and execution of the personnel key to success Learning required of all aspects  Eye care  Managing Ehealth  General Administration
  18. 18. LEARNINGS REQUIRED Marketing / orientation  of link workers and pts Registering the patient Arranging Tele-consultation Maintaining Equipment
  19. 19. EYE CARE Eye examination (Snellens charts/ Use of Slit Lamp etc) Remove sutures Provision of Specs - Glass grinding Keep and maintain case notes Supply and administer medicines
  20. 20. OBJECTIVES TRAINING IN EYE CARE  Eye examination  Slit Lamp  Vision  Ophthalmoscope  Glass grinding  Streak retinoscope
  21. 21. TRAINING OF IT AND GENERAL ADMINISTRATION IT Hardware/Software Connectivity - TCP/IP Management information Software – Medic Aid Electronic Medical Record keeping Remote Desktop excess – Skype/timeviewer etc Networking and data synchronization
  22. 22. METHODS METHOD - Training come workshopDURATION – 15 days 3 ASSISTANTS - Basic knowledge INCLUDES  classroom lectures  workshops at 2 hospitals  optical center  trip to lenses manufacturing company.
  23. 23. RESULTSWRITTEN ASSESSMENT – 1 hr questionnaire of 60marks + spottingof 40 marks.CONCLUSIONS OF ASSESSMENT – Reviewed for feedback.CONSENSUS – Advance comprehensive course
  24. 24. LEARNING OBJECTIVES Expand formal training in areas of technology applied to healthcare including computer sciences and telecommunication technologies to facilitate the deployment of telemedicine. Understand the basic requirements for the delivery of telemedicine services. Differentiate and apply telemedicine technologies and practices in a variety of health care environments. (With support from out partners) Identify eye problems and provide basic care at the community level
  25. 25. TELEOPHTHALMOLOGY MODULEOBJECTIVE OF THE MODULE –Basic understanding of –  Goals of this course  vision for telemedicine  foundations of telecommunications,  applying telecommunications to health care and ophthalmology  challenges to telemedicine Includes – History, terminologies, types of telemedicine systems, examples of telemedicine in clinical practices etc.
  26. 26. COMMON EYE PROBLEMS AND ITS MANAGEMENT MODULE Refresher on anatomy of the eye ball. Applied physiology related to the eye. Differential diagnosis of red eye and analytical approach. Painful loss of vision. Painless loss of vision. Equipments-OCT/FFA/ slit lamp/Auto refractor/ Applanation tonometer. Surgically managed cases –Cataract, glaucoma and VR procedures Eye in systemic diseases.
  27. 27. MODULE ON SPECTACLE MANAGEMENT AND OPTICAL Focuses on significance of spectacles and contact lenses and their management. Includes understanding of -  Optics of refraction,  Visual acuity  Types of refractive errors  Corrective lenses  Bases of contact lens fitting and types of contact lenses etc
  28. 28. MODULE ON TELEMEDICINE Various IT modules of patient care. Networking Getting online support Services provided through Teleophthalmology Routine and Follow up examinations. Routine and follow up consultation. Clinical Support Services
  29. 29. MODULE ON SOFTWARE FOR PATIENT MANAGEMENT SOFTWARE TRAINING  OPHTHALMIC IMAGES Basic application of teleophthalmic  Capture software.  Manipulation / Compression Methods of data feeding and  Storage retrieving.  Retrieval  ELECTRONIC MEDICAL RECORDS
  30. 30. MODULE ON INFORMATION TECHNOLOGY Focuses on the planning, construction, development and deployment of telemedicine technology systems.  Telemedicine Systems  Connectivity Options  Bandwidth Limitations  Asynchronous vs. Real-time Interactive  Data applications  The World Wide Web
  31. 31. MODULE ON CONNECTIVITY AND COMMUNICATION TECHNOLOGY Audio  Displays Data  Storage Images  Standards Video  Wireless Devices TCP/IP and other types of  Diagnostic Tools and Peripherals Networking  Mobile Telemedicine Telecommunications Processing
  32. 32. GENERAL MANAGMANT MODULE Human Resources Management Financial management Operational management Medical Records management Eye care administration
  33. 33. MODULE ON MARKETTING /COMMUNITY INTERFACE Clinical Acceptance Public Awareness Government officials Community leaders Patient Satisfaction Public and community medicine.
  34. 34. MODULE ON NATIONAL PROGRAMMES Scope, objectives and government aids provided under various national programs. National program for blindness control.
  35. 35. PRESENTATION © 2011 Spanco Ltd, All rights reserved
  36. 36. COMPANY PROFILE: INTRODUCTION • Spanco Limited is a company engaged in creating Large scaleGlobal Head Quarter Mumbai, India Technology Infrastructure to help drive governance efficiency across key sectors.Global Presence India, UK, Africa, USA & Middle East • Consistently ranked in ET500 amongst outstanding companies of India Inc. Rev FY10 1182 Cr. • ISO 9001:2008, ISO 27001 and SEI CMMI Level 3 certified • Focused offerings for Government, Telecom, Power and Transport FY 11 (UA)- 1469 Cr. Verticals • Presence e in Four continents with large spread across major cities in Employees 12000+ India Business structure Shareholding Pattern as on March ‘11 Business Verticals Bodies E-Governance SI / Power Service Provider BPO Retail Corporate investor 10% 15% Technology Infrastructure Sector Modernization(NeGP, RAPDRP,USOF Very Large state and Institution 3g/Wimax,AAIM) National Infra Projects investor Promoters 35% 40% Services Infrastructure Government Application Citizen Interface Outsourcing Management Transformation Development © 2011 Spanco Ltd, All rights reserved
  37. 37. COMPANY PROFILE: KEY PROJECTS Smart Card DL/RC SWAN Projects Punjab Disaster Mitigation Maharashtra Andhra Pradesh State State Data Centre Indian Railways Rajasthan - Odisha Passenger Reservation System Key Projects Security Surveillance Airport Authority of India Distribution Franchisee – Nagpur Integrated Border Check post - MPRDC Telemedicine IT Infrastructure CSCs in Maharashtra Anna Centenary Library APDRP Mobile Banking Pension © 2011 Spanco Ltd, All rights reserved
  38. 38. COMPANY PROFILE: AWARDS & ACCOLADES Maharashtra State IT Award for Best IT Company in eGov space for 2010 "UDYOG RATTAN AWARD” & “EXCELLENCE AWARD” by the Institute of Economic Studies (IES) Nominated for the NDTV Profit Business Leadership Awards 2010 – IT Category Consistently ranked in ET500 amongst outstanding companies of India Inc. Ranked amongst top 500 Non Finance Companies by ‘The Business World Real 500’ Ranked 5th BPO Company in the Country by Data quest 2010 Amity Leadership Award 2009. Spanco GKS awarded as best outsourcing solution provided in middle east by Insight (Middle East) for 2010 Spanco BPO Ventures Ltd. ranked in India’s Top 20 ITES and BPO Companies 4 © 2011 Spanco Ltd, All rights reserved
  39. 39. MIZORAM TELEOPTHAMOLOGY PROJECT BRIEF SCOPE • Setting up a system for delivery of Eye care through Tele Ophthalmology • Supply of IT systems, Medical equipment, Power back up connectivity, furniture and physical infrastructure at multiple sites • Identifying Ophthalmic Assistants, Link workers • Training • Operations, Maintenance • Build database of patients • Creating awareness of the project in the rural areas © 2011 Spanco Ltd, All rights reserved
  40. 40. Challenges for Implementation in Mizoram• Difficulty in delivery to State - Permit issues• Difficult Terrain – Long travel time due to road conditions.• Finalization of sites was time consuming because of permissions from department at multiple levels, allocation of space• Lack of availability of Electricity, water connectivity• Availability of Ophthalmic assistants - difficult to get the resources and then move them to remote locations• Link workers - still a challenge (even after approaching several departments). We have finally decided to approach the Church for help• Availability of technical support - difficult to get resources and provide support in remote locations 6 © 2011 Spanco Ltd, All rights reserved
  41. 41. Thank You 7 © 2011 Spanco Ltd, All rights reserved
  42. 42. Community Level Limb Care Through TelemedicineArun Rekha Gogia and Dr S B Gogia S.A.T.H.I. www.sathi.org Telemedicine for Limb care
  43. 43. Treatment Processes (`)Patient with Medical Problem If Treatment not Adequate(Dressing) Local/ Village Practitioner Low Cost (10) Cost of travel (500) But practitioner should have High Cost Treatment (200) the relevant knowledge Doctor in Cost of stay and Relatives (??) nearest town Time off Work for all (??) Still Affordable (50) Upper Classes or those Super having relatives in major Specialist Towns Centre Telemedicine for Limb care
  44. 44. What is Limb careCare of diseases All have common largely localized to Localized Treatment the limbs processesLymphoedema Cleaning and DressingVenous Ulcers Compression BandagingDiabetic Foot ExercizesOther tropical diseases like Yaws and Dracunculosis Drugs 4/15/2012 Telemedicine for Limb care 3
  45. 45. Why Limb Care is ideal for TelemedicineKnowledge of how to care is however missing The condition progresses because of Such neglect Chronic condition -so long term supervision required More of a Social Problem (cosmetic/ odor) Results in Loss of self-esteem, inability to work---may leed to possible depression How many are willing to travel distances or get relatives to take them along? (repeatedly Required Care is easy and possible at the community level 4/15/2012 Telemedicine for Limb care 4
  46. 46. OBJECTIVE Lymphoedema 4th highest cause of morbidity in the worldThe provision of lymphoedema services worldwide variesfrom very well developed care to virtually no provision(e.g.India/Africa).Many patients are not properly diagnosed and there is apervasive impression that the condition israre,causes few problems,is not life threatening and cannot be treated.However, without adequate treatment, lymphoedemacan have major effects, including long-term disability,difficulties with work and emotional problems.
  47. 47. Filariasis - extent of problemGlobal: 1100 million at risk of infection, 120 million ptsIndia: 553 million at risk, 48 million pts40% of Global disease burden in IndiaIndia is committed to elimination by 2015  261 Districts Endemic  7 States contribute 95% of the burden Lymphoedema occurs after other problems too  Loss e.g congenital,trauma  103 million man days due to acute disease ,Vascular, cancer and  1098 million man days due to chronic disease every year the incidence is  Estimated Annual Loss of 1.5 Billion US $ increasing. Telemedicine for Limb care
  48. 48. Possible SolutionCreating Integrayted lymphoedema service centers that would aim to identifypatients with swelling early so that treatment is timely and effective and enablespatients to remain active and to self-manage their condition.
  49. 49. Limb care in rural areas Creating awareness• Problem of Lymphoedema  Most care is possible locally along with long term follow• and Ulcers requires up and maintenance• Leg washing  Machines and equipment that can be sent• Antibiotics (Penicillin*) • Massage and bandaging can• Physical Massage be taught• Drugs • Appointments for surgery• Heat Treatment after full work up• Pneumatic Compression • Thus patient needs to spend little time outside his village• Nodo - Venous Shunts*• More complicated procedures* * These items require support from clinicians Telemedicine for Limb care
  50. 50. DEFINING THEDESIRED SERVICE Correlating condition severity to level of intervention With Education and awareness 70 to 80% can be self-managed Level I Case Management Includes the provision of intensive therapy top of the Disease specific pyramid (5- 10%) Care/ High Risk Management By paramedics under supervision (10-20%) Self-care support for Level III for 70–80% of long term condition population
  51. 51. The projectThe approach* SATHI Role• Mass creation of treatment and – Supply equipment follow up centres (e.g. in – Train paramedical staff to run collaboration with CSC Providers) the centres• Local health workers provide basic – Engage and train Surgeons in care. surrounding townships – Training and Initial review of – Troubleshooting and further patients Online management from our centre• Local surgeons for monitoring and procedures – Orientation and training Online A demonstrative result * initial MOU with Spanco – (working in coastal Maharashtra)
  52. 52. Range of ProblemsLymphoedema and Processes they needassociated cellulitis DiagnosisDiabetic foot DressingNon Specific Ulcers Bandage Antibiotics/other medicines Physiotherapy and Exercizes Most can be understood through visual or aural means so IT based support possible Telemedicine for Limb care
  53. 53. More DetailsLocal health workers provide Set up franchises with localbasic care on a profit sharing Surgeons formodel e.g. Initial consultation – Identifying patients First dose of Penicillin – Leg washing instructions – Use machines on rental basis Initial care plan – Bandaging Surgical procedures as and – Measurements for garments when required – Issue drugs and antibiotics Local pharmacies to – Follow up and maintenance Sell equipment, bandages etc to the Village level partners Uses IT based support for all centres Direct to patient sales Telemedicine for Limb care
  54. 54. Limb care clinics ?Funding Agency/ (Funds) SATHI AIIMS/GMC (Conceptualization Coordinator Local Hospital and implementation) Hardware Consumables Plastic Surgeon Expert Doctors LOCAL NGO/ Patients VLERange of diseases:Lymphedema/Ulcer/Venous for Limb care Telemedicine problems/Diabetic foot
  55. 55. Current ProgressLymphedema counselingcentre at AIIMS – Around 200 patients given advice (mostly breast cancer) – Support from Rotary for free bandage kits Telemedicine for Limb care
  56. 56. Rotary Counseling Clinic at AIIMS Partners in Healing (RCDS) Assisting and off loading doctors. Repetitive tasks assigned to regular patients Group learning of therapy Improved psychological and social acceptance Compliance due to shock of seeing advance cases About 200+ patients have already been registered in last 12 months Telemedicine for Limb care
  57. 57. Camp at Cardinal Gracias Hospital Vasai (Thane)67 patients seen in 1 day51 given initial dose of penicillin14 planned for surgeryCandidiasis in 49 Telemedicine for Limb care
  58. 58. Vasai ExperienceTelemedicine for Limb care
  59. 59. Telemedicine for Limb care
  60. 60. Rural Centre in SindhudurgTraining and Orientation Setbackscamp done Connectivity slowWide publicity thanks to sPress conference No doctor to administer Penicillin!Machine provided curtseyRCDS Nearest identified and approved hospital is GoaOnline sessions through but a different stateSkype – Telemedicine for Limb care
  61. 61. Goa Medical College51 Patients seen, Lectures and Inquiries for further extensions -two demonstrative surgeries Kerala, Orissa, Tamilnadudone in a 3 day workshop sPlan to set up 3 centres incollaboration with DHS – Telemedicine for Limb care
  62. 62. A Teaching exampleWrong - adding obstruction The correct method Telemedicine for Limb care
  63. 63. To summarize www.sathi.orgLymphedema is common and treatable with or without ulcersTreatment mostly at the community level -requires care of infections and CompressionA community based approach supported by telemedicine has been started48 million pts are suffering Telemedicine for Limb care
  64. 64. Telemedicine for Limb care
  65. 65. Dr. Karanvir Singh MBBS, MS, FRCS (Glasgow) Consultant SurgeonHead of Medical Information Informatics Sir Ganga Ram Hospital
  66. 66.  Data mining ◦ Extracting patterns from large data sets Business intelligence ◦ Analyzing this data with an aim to support better decision making
  67. 67.  Hospital information systems capture huge amounts of data Although reports are available for viewing captured data, analysis is not always possible
  68. 68. Indexing and data mining
  69. 69. Abnash PuriArun KumarAshok KumarChander KantaGouri Ghanshyam How many persons have a K in their name?Gulab DeviGulab Chhikara … or RHarkishan Batra … or SJaya SonowalLalita Singh How many have all three in their name?
  70. 70. K R SAbnash Puri Ö ÖArun Kumar Ö ÖAshok Kumar Ö Ö Ö How many persons have a KChander Kanta Ö Ö in their name?Gouri Ghanshyam Ö Ö … or RGulab DeviGulab Chhikara Ö Ö … or SHarkishan Batra Ö Ö ÖJaya Sonowal Ö How many have all three in their name?Lalita Singh Ö
  71. 71. …before the questions are asked
  72. 72.  The HIS will index only what is essential to its daily functioning. If you want to analyze data in detail, you need to create indexes externally.
  73. 73.  Speedminer is our data mining and business intelligence software. It copies all HIS data on a separate server and indexed everything we want to analyze. By Hesper, Malaysia, but implemented and supported in India
  74. 74. Internal process monitoring Clinical data analysis Financial analysis
  75. 75. ◦ Episode.avi
  76. 76.  Looking up patients with Diabetes and Hypertension ◦ Diagnosis_2.avi Operation diagnosis analysis ◦ Operation Diagnosis analysis.avi
  77. 77.  Dashboards interact with users. They can accept input parameters and display results Key Performance Indicators (KPI) C_Section.avi Lab income.avi
  78. 78.  Garbage In = Garbage Out Data Mining can only be as accurate as the data that is captured in the HIS The HIS needs to have ‘granular’ fields. Once deployed, it is difficult to change field types
  79. 79.  What gets measured gets managed. Historically, hospitals have been data rich but information poor. IT investment had done little to enhance the strategic use of data, till BI came along. HIS is just a milestone BI is the next milestone - it is what provides a ROI on HIS investment
  80. 80. .
  81. 81. Role of Knowledge Based Expert Medical Systems in improving Quality of Healthcare NCMI 2012 – Paper submission 64 DR SHRUTI GADGIL, MBBS, IAMI Life member31-Jan-2012 Dr Shruti Gadgil 1
  82. 82. Paper Details Introduction  What is “Knowledge Based Expert Medical Systems”  Current situation in Indian Healthcare system Vs defined framework of Quality Of care in developed countries. Method  Knowledge Based Medical Systems using Data Mining techniques and Concurrent Chart Abstraction for improving quality of care. Discussion  Healthcare Quality Measurement – need in India31-Jan-2012 Dr Shruti Gadgil 2
  83. 83. What is Knowledge Based Expert System? These are the variants of Clinical Decision Support Systems (CDSS) that use knowledge based techniques to support clinicians in decision making, learning, action and can also be used to measure & monitor quality of care. Based on various data mining techniques and patient’s parameter specific validations. Functional Types –  Concurrent –  Work at the time of patient care  Non concurrent –  Post patient discharge processing 31-Jan-2012 Dr Shruti Gadgil 3
  84. 84. Clinical Workflow & CDSS • Patient’s Demographic Details Inputs to 1. Patient’s age, sex • Patient’s Insurance Details CDSS 2. Insurance Health PlanPatient Registration • History of present illness 1. Chief complaints • History of known medical conditions & Inputs to 2. Allergies allergies CDSS 3. Vital SignsInitial assessment by • Family History, Social History 4. Genetic preponderance Medical assistant • Recording of Vitals • Summary of positive medical History 1. Signs general (clinical) • General Examination Inputs to 2. Signs system specific (clinical) • Systemic Examination CDSS 3. Differential Diagnosis Consultation (part 1) with • Assessment and Plan Physician for assessment • Documentation of provisional Diagnosis • Documentation of provisional Diagnosis 1. Orders • Orders for necessary investigations Inputs to 2. Medications Prescribed • Prescription based on Provisional Diagnosis CDSS 3. Follow upConsultation (part 2) • Follow up instructions 4. Patient’s experience of episode of with Physician for plan of action care 31-Jan-2012 Dr Shruti Gadgil 4
  85. 85. Measurement Of Quality Of Care – A keyDriving Factor Physician Performance Monitoring Measurement of Quality of Care Improvement in Quality of Care and Reduction in the cost of Healthcare31-Jan-2012 Dr Shruti Gadgil 5
  86. 86. Knowledge Based Medical System -Benefit to All Benefit to Patients –  Most appropriate treatment according to set protocol  Better care at reduced cost Benefit to Clinicians  Clinical analysis results reports –  Failure of adherence to a clinical protocol for a physician or nurse.  Physician specific lines of treatment etc.  Study Population identification  Identify specific type of patients in the database based on the clinical parameter.  Research /Publications  Excellent opportunity for the physicians to generate physician specific reports that can be used for their publications, research and even clinical trials.  Statistical data to prove the facts is easily available.  Analyzing the outcomes and cause/effect relationships is made easy.  Medico legal Cases –  Consolidated data available to support the decisions made.31-Jan-2012 Dr Shruti Gadgil 6
  87. 87. Knowledge Based Medical System - Benefit to All – cont…. Benefits to Administrators  Process checks  Excellent data points to track the process improvements and performance reviews for Hospital Administrator and Quality Department. (ADT analysis)  It can measure efficiency based upon timely action by clinical staff.  Admission, transfers and discharges can be analyzed to determine how efficiently patients are moved in & out or within the organization.  Benchmarking of performance indicators is possible with use of such systems.  Analyzing the outcomes and cause/effect relationships is made easy.  Costs  Alerts to inform administrators of performance trends that have crossed a threshold.  Lowers the cost for management systems by consolidating data from disparate systems and eliminating staffing and maintenance cost.  Medico legal Cases - follow up is easy  Provides input for the Insurance Organizations while establishing or renewing the service contract with the Hospital. 31-Jan-2012 Dr Shruti Gadgil 7
  88. 88. Knowledge Based Medical System -Benefit to All – cont….31-Jan-2012 Dr Shruti Gadgil 8
  89. 89. Knowledge Based Expert Systems – Need in India – Clinician’s perspective Lack of standardization in Quality assessment criteria. Monetary benefit to the physician is independent of the measurement of quality of performance. Rapid penetration and spreading Insurance network. Medical Tourism – pushing the cost of care up. Increasing cost of Healthcare. 31-Jan-2012 Dr Shruti Gadgil 9
  90. 90. Knowledge Based Expert Systems – Needin India – Clinician’s perspective –cont… Lack of appropriate legislations for noncompliance. Increased gaps in affordability of Socio economic strata. Lack of trained medical staff /physicians in rural areas. Lack of awareness of Human rights and superstitious approach towards healthcare provider.31-Jan-2012 Dr Shruti Gadgil 10
  91. 91. Knowledge Based Medical System -Benefit to AllThank You!31-Jan-2012 Dr Shruti Gadgil 11
  92. 92. EVALUATION OF COMPUTER USAGE IN HEALTHCARE DELIVERY AMONGPRIVATE PRACTITIONERS OF NCT DELHI ORAL PRESENTATION Ganeshkumar P* Arun kumar sharma O.P.Rajoura Assistant professor, Department of Community Medicine, SRM University, India.
  93. 93. BACKGROUND AIMS METHODOLOGY RESULTS CONCLUSION SCOPE BACKGROUND • Indian health system - increasing cost and demand pressures and a shortage of skilled health care workers till the root • Poor integration of information - between the health sectors - incapable to handle public health issues & lack of proper evidence in public health decisions • 70% of the population use - private sector -not integrated with the govt. system & often not regulated. • Ehealth strategy – proven solution ; remains incompetent in pvt. sector – never documented or little initiatives to assess the utilization of ICT by the private health care delivery systems in India. NCMI 2012 , Ganeshkumar - 26 2
  94. 94. BACKGROUND AIMS METHODOLOGY RESULTS CONCLUSION SCOPE AIMS AND OBJECTIVES 1.To evaluate the usage and the knowledge of computers and Information and Communication Technology (ICT) in health care delivery by private practitioners. 2.To understand the determinants of computer usage by the private practitioners. NCMI 2012 , Ganeshkumar - 26 3
  95. 95. BACKGROUND AIMS METHODOLOGY RESULTS CONCLUSION SCOPE METHODOLOGY Cross-sectional study – Nov’ 07 – Dec ’08 – 3 districts of Delhi state – 600 clinic based private practitioners . • Inclusion criteria: only modern medicine practitioners; practicing for 1 year in same location Software USAGE Hardware KNOWLEDGE Internet NCMI 2012 , Ganeshkumar 26 4
  96. 96. BACKGROUND AIMS METHODOLOGY RESULTS CONCLUSION SCOPE KNOWLEDGE SOFTWARE – 60% MEDIAN COMPOSITE HARDWARE – 10% SCORE INTERNET – 30% 15 POTENTIAL BARRIERS 60 Patient Technical Logistic Financial related 7 & 28 3 & 12 3 & 12 2&8 SA A N D SD NCMI 2012 , Ganeshkumar 26 5
  97. 97. BACKGROUND AIMS METHODOLOGY RESULTS CONCLUSION SCOPE RESULTS • 85.5% - males and the mean age of all - 45.46±5.52 years • 77% - own computer - but only 10.5%(63) – using in clinic • 22% - had known about EHR – but only 8.8% - using in clinic • Male and super speciality practitioners - more knowledgeable PRESENCE OF EHR COMPUTER PRACTICE IN THE CLINIC KNOWLEDGE SCORE SPECIALTY N(%) (MEAN ± SD) General practice 20(5.7) 2.26±1.05 General surgery 1(3.6) 2.48±1.04 Internal medicine 11(17.2) 2.42±1.07 Super speciality 16(24.6) 3.1±0.98 Others (Paeds,O&G) 5(5.3) 2.43±1.03 Statistical test X2: 32.22 df:4 p<0.000 SSB:40.02 df:3 p<0.000 MIE 2011, Ganeshkumar 26 6
  98. 98. BACKGROUND AIMS METHODOLOGY RESULTS CONCLUSION SCOPE• Practitioners who attended a computer course were 13.8 times [OR: 13.8 (7.3 - 25.8)] more likely to have installed an EHR in the clinic• Most (86.3%) thought - lack of time was the major barrier and nearly 50% – disagreed that cost is not a barrier• Data entry - a cumbersome process - reasons for not installing a computer in their clinic POTENTIAL DETERMINANTS ADJUSTED ODDS RATIO P VALUE Speciality practice 1.9(1.15-3.12) 0.011 Super speciality practice 8.18(2.57-5.99) 0.000 Presence of computer 3.93(1.67-9.26) 0.002 professional in the social circle Female practitioners 0.493(0.27-0.87) 0.016 NCMI 2012 , Ganeshkumar 26 7
  99. 99. BACKGROUND AIMS METHODOLOGY RESULTS CONCLUSION SCOPE CONCLUSIONS • Computer in clinical practice – low usage – low understanding – low priority • Existing knowledge by training influences more positively in practicing a new technology in their clinical practice • Limitation - cross sectional study - difficult to establish temporal assoc. between knowledge and usage • Major perceived barriers - technical related issues • Significant determinants of usage – Practice speciality, – income, – presence of a computer professional in the family and – gender - significant determinants of usage NCMI 2012 , Ganeshkumar 26 8
  100. 100. BACKGROUND AIMS METHODOLOGY RESULTS CONCLUSION SCOPE SCOPE • Educating & training the doctors and a step forward - the students in medical school • Encouragement by government for using computers in clinic – policy design • Regulations for mandatory maintenance of electronic records • Involving professional bodies in govt. programs – Public private partnership – ehealth • More research into the usability – patients & doctors – potential determinants – diffusion of technology in practice NCMI 2012 , Ganeshkumar 26 9
  101. 101. THANK YOU FOR YOUR ATTENTION DR.P.GANESHKUMAR MD SRM UNIVERSITY ganeshkumardr@gmail.com +91 98406-40483 NCMI 2012 , Ganeshkumar 26 10
  102. 102. WISHING YOU ALL MERRY CHRISTMASAND A VERY HAPPY NEW YEARCOMPURX INFOTECH WELCOMES EVERYONE IN THE GATHERING ANDINTRODUCES ITSELF AS AN UNIQUESOFTWARE DEVELOPMENT COMPANYDEDICATED SPECIALLY TO HEALTHCAREGIVING YOU A BRIEF INTRODUCTION TOITS ACTIVITIES AND PRODUCTS WITHYOUR KIND PERMISSION
  103. 103. PRESCRIPTION PAD VER – 3 A PRESCRIPTION WRITING SOFTWAREA TOOL TO WRITE 100% SAFE, ERRORFREE & FIRST RATE PRESCRIPTION
  104. 104. Why Prescription Pad ? HOW MANY TIMES You have yearned to get complete details of a drug especially when some near & dear is sick ? You had to strain to remember the safety profile of a drug ? You have diagnosed a disease but dont remember its recent treatment / drug dosage ? You wanted to see previous prescriptions / records of a patient which he has lost or has forgotten to bring ? Has the chemist dispensed wrong medicine due to ineligible writing in the prescription ? You depend on chemists choice for a substitute in the prescription which he doesnt have because you fail to remember any alternative brand ? You have felt that there should be some way to avoid rewriting a frequently encountered diseases prescription to save time ?
  105. 105. Statistical Analysis of Prescription Pad 2.0 Diseases Details (with Advised Investigations) 1500 Brands (Trade Name) with Complete Prescription Details 45000 Complete Drug Monographs 2500 Drugs with Complete Pharmacological Information and Drug Safety Parameters 2500 Handouts (for Diet, Exercise, Diseases etc) In English / Hindi 600 Drug Interaction (with Complete Interaction Details) 55000 Investigations - (with Complete Details) 700 Pharmacological Groups of brands 950 Special Precautions 400 Procedures / Surgery 1700 WHO Standard Vaccination Schedule Total text information in the software cosists of (pages) 50,000 And Much More with the Flexibility to Add Endless No of Records.
  106. 106. BRAND DETAILS ENTRY SCREEN
  107. 107. DRUG DETAILS ENTRY SCREEN
  108. 108. DRUG MONOGRAPH SCREEN
  109. 109. FIND OPTION IN DRUG MASTER
  110. 110. ABD. GIRTHPATIENTS INFORMATION ENTRY SCREEN
  111. 111. PATIENTS HISTORY SCREEN
  112. 112. DISEASE ENTRY SCREEN
  113. 113. DISEASE RELATED INFORMATION SCREEN AFTER DISEASE ENTRY
  114. 114. DISEASE DETAIL INFORMATION SCREEN
  115. 115. BRANDS WRITING AREA
  116. 116. ADVANCED SEARCH OPTION
  117. 117. EXAMPLE OF DRUG SAFETY MESSAGE
  118. 118. EXAMPLE OF DRUG SAFETY, DISEASE WISE
  119. 119. DRUG INTERACTION POP UP SCREEN
  120. 120. DRUG DUPLICATION WARNING SCREENDRUG DUPLICATION WARNING
  121. 121. EXAMPLE OF PRESCRIPTION GENERATED BY THE SOFTWARE
  122. 122. EXAMPLE OF INVESTIGATIONREPORTS THROUGH THE SOFTWARE
  123. 123. GRAPHICAL PRESENTATION
  124. 124. EXAMPLE OF HAND OUTS OF THE SOFTWARE
  125. 125. CARDIAC RISK CALCULATING UTILITY
  126. 126. CHILD GROWTH CALCULATING UTILITY
  127. 127. SNAPS COMPARING UTILITY
  128. 128. READYMADE PRESCRIPTION
  129. 129. DIFFERENT TYPES OF REPORTSGENERATION UTILITY
  130. 130. ACCOUNTS HANDLING SCREEN
  131. 131. APPOINTMENT LIST
  132. 132. LEDGER MAINTAINING SCREEN
  133. 133. REMINDER UTILITY
  134. 134. ARTICLE IN THYROCARE MAGAZINE
  135. 135. News item in HINDU PAPER
  136. 136. NEWS ITEM IN HINDU PAPER
  137. 137. DOCTOR, IF YOU AREINTERESTED IN THESOFTWARE FOR YOURPRACTICE THEN CONTACTUS AT THE COUNTER FORMAXIMUM ON SPOT DISCOUNT
  138. 138. Thank You for your Kind Attention
  139. 139. CLOUD COMPUTING FORMEDICAL RESEARCH ANDHEALTHCAREYu-Chuan (Jack) Li, M.D., Ph.D., FACMIGraduate Institute of Biomedical InformaticsCollege of Medical Science and TechnologyTaiwan Medical University
  140. 140. Taiwan • 23 Million people • GDP: $30,000 USD • 80% IC Chips, 70% Notebooks and PDA, 60% LCD screens ... • 500 hospitals and 17,000 clinics  high IT adoption rate since 1996
  141. 141. Taipei Medical University (TMU)• Top private medical university in Taiwan• 6000 students, 620 faculty members, 7 colleges• Closest to the world’s highest building – Taipei 101
  142. 142. TMU Healthcare Group• Largest JCI-Accredited teaching hospitals in Taipei• 3,150 beds• Over 10,000 Out-patient visit per day 北醫附醫 萬芳 雙和 4
  143. 143. Taipei Medical University 7 Colleges13 Departments Students: 6,059 16 Graduate Alumni: 31,214 Institutes 3 TMU Hospital s Full-timeInstructor 428 Total Faculty Part-time 6,102Instructor 649 5
  144. 144. College of Medical Science and Technology - TMU• Department of Biomedical Informatics • 80 master and Ph.D. students• Department of Medical Technology • 60 master and Ph.D., 300 undergraduate students• Department of Cancer Biology and Drug Discovery • Ph.D. only• Department of Neuro-regenerative medicine • Ph.D. only
  145. 145. Wellness Medical Cloud Cloud 國民電子 健康記錄 Care Cloud Long-term Care
  146. 146. NIST Definition v.15• Cloud computing is a model for enabling convenient, on-demand network access to a shared pool of configurable computing resources (e.g., networks, servers, storage, applications, and services) that can be rapidly provisioned and released with minimal management effort or service provider interaction.
  147. 147. Five Characteristics of Cloud• On-demand self-service• Broad network access• Resource pooling• Rapid elasticity• Measured Service “the kind of service that dry-lab biomedical researchers would always wanted…”
  148. 148. Other Terms related to Cloud• Service Model • Cloud Software as a Service (SaaS) • Cloud Platform as a Service (PaaS) • Cloud Infrastructure as a Service (IaaS)• Deployment Model • Private cloud  TMUH as an example • Community cloud • Public cloud • Hybrid cloud

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