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“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. Information Risk Management Strategy for Healthcare Industry Bhaskar Sahay Pre-Sales ConsultantSymantec Company Overview 1
  2. 2. Symantec At a Glance Founded in 1982 $6.2 billion revenue in FY 2011; IPO in 1989 approximately 50% outside of the U.S. Approximately 19,500 employees More than 1200 global patents Operations in more Symantec footprint on more than than 50 countries one billion systems Included on Fortune’s Most #382 on the 2011 Fortune 500 Admired Companies list 100 percent of Fortune 500 Invests 13% of companies are customers annual revenue in R&D* 2* R&D investment is Non-GAAPSymantec Company Overview
  3. 3. Symantec Is – Symantec is a global leader in providing security, storage and systems management solutions to help consumers and organizations secure and manage their information and identities.Symantec Company Overview 3
  4. 4. Industry Recognition Security Leadership • Consumer Endpoint Security (#1 market position1) • Endpoint Security (#1 market position2, Positioned in Leader’s Quadrant in Gartner Magic Quadrant3) • Messaging Security (#1 market position4, Positioned in Leader’s Quadrant in Gartner Magic Quadrant leader5) Storage and Availability Management • Data Loss Prevention Leadership (#1 market position6, Positioned in Leader’s Quadrant in Gartner Magic Quadrant7 )• Email Archiving • SSL Certificates (Positioned in Leader’s Quadrant in Gartner Magic Quadrant14) (#1 market position9)• Core Storage Management Software • Security Management (#1 market position15) (Positioned in Leader’s Quadrant in Gartner Magic Quadrant10)• File System Software • Security Information & Event Management (SIEM) (#1 market position16) (Positioned in Leader’s Quadrant in Gartner Magic Quadrant 11)• Backup and Recovery • Mobile Data Protection (#1 market position17) (Positioned in Leader’s Quadrant in Gartner Magic Quadrant 12 ) Symantec Company Overview 4
  5. 5. Global Intelligence NetworkIdentifies more threats + takes action faster + prevents impact Worldwide Coverage Global Scope and Scale 24x7 Event Logging Rapid Detection Threat Activity Malcode Intelligence Vulnerabilities Spam/Phishing •240,000+ sensors •133M client, server, •35,000+ vulnerabilities •5M decoy accounts •200+ countries gateways •11,000 vendors •8B+ email messages/daily •Global coverage •80,000+ technologies •1B+ web requests/daily Preemptive Security Alerts Information Protection Threat Triggered ActionsSymantec Company Overview 5
  6. 6. 1 Protect the InfrastructureSymantec™ProtectionSuiteEnterprise IT Security Briefing 6
  7. 7. Symantec Protection Suite Backup & Recovery Easy Management Automated Control Messaging & Web Security Endpoint Security Complete Protection Threats
  8. 8. Symantec Protection Suite Backup & Recovery • Backup live desktops & laptops • Restore to any hardware • Take threat-driven backups Messaging & Web Security • Antivirus, antispam, antiphishing, botnet protection Backup & Recovery • Reputation-based spam filtering • Data loss prevention Easy Management Automated Control Messaging & Web Security • Exchange, Domino, Gateway Endpoint Security Endpoint Security • Antivirus, antispyware Complete Protection • Desktop firewall • Intrusion prevention Threats • Device and application control • Network access control
  9. 9. Develop and Enforce2 IT PoliciesSymantec™ • Define risk and develop IT policiesControl • Assess infrastructure and processes • Report, monitor and demonstrate dueCompliance care • Remediate problemsSuiteEnterprise IT Security Briefing 9
  10. 10. Expanding from Compliance to Risk – Considerations Risk Centric Compliance Centric • Driven by external mandates • Internal needs & external context • Focus on pass / fail checkbox • Focus on continuous improvement • Large volume of audit findings • Risk-prioritized issues drive action leads to inaction • More holistic solution needed for • Can get by with tactical point pragmatic view of business risk solutionsSR B24 - The Future of IT GRC 10
  11. 11. Symantec Approach to IT GRC Stakeholders Audit Operations Business PLAN REPORT • Demonstrate compliance to multiple • Define business risk objectives stakeholders • Create policies for multiple mandates • Correlate risk across business assets • Map to controls and de-duplicate • High level dashboards with drill down EVIDENCE ASSETS CONTROLS ASSESS REMEDIATE • Identify deviations from technical • Risk-based prioritization standards • Closed loop tracking of deficiencies • Discover critical vulnerabilities • Integration with ticketing systems • Evaluate procedural controls • Lifecycle Exception Management • Combine data from 3rd party sources EnvironmentSR B24 - The Future of IT GRC 11
  12. 12. Critical System ProtectionOperational: Unauthorized file Virtual, physical and multi- changes OS platform coverage Centrally monitors files, Disruptive application Changes to OS directories, applications and behaviors registry keys other system resources in real-time Detects known and Inappropriate access Inappropriate access unknown threats rights changes and device useBusiness: Quick time to value with out- Suspicious multiple Configuration of-the-box policy templates failed login attempts changes Centralized information across dissimilar platforms Unauthorized network connections Reduced business systems impact via behavior based operation Critical System Protection 12
  13. 13. Security Information Manager Central Visibility to Reduced Number of Prioritization Critical Threats Alerts Prioritized Reports Incidents RemediationData Normalized into Common Formats Aggregation and Correlation Network Access Intrusion Firewall Control Prevention Multiple Data Millions of Unprioritized Sources Device and Application Events Control Antivirus …Other log data 13Symantec Security Information Manager
  14. 14. Incident and Event Log Correlation OS Antivirus  Firewall breaches Database Corporate  Infected systemsAdditional Intelligence on: Network  Virus outbreaks Malicious IPs Mail and Groupware  Privileged user activities Firewalls Botnet IPs Worm IPs  Other internal events… Syslogs IDS/IPS Other sources… Comprehensive Vulnerability Scanners VisibilitySymantec Security Information Manager 14
  15. 15. 3 Protect the InformationSymantec™Data LossPreventionEnterprise IT Security Briefing 15
  16. 16. 3 Protect the InformationSymantec™ • Discover where sensitive informationData Loss resides • Monitor how data is being usedPrevention • Protect sensitive information from lossEnterprise IT Security Briefing 16
  17. 17. How It Works DISCOVER MONITOR PROTECT2 3 4 • Identify scan targets • Inspect data being sent • Block, remove or encrypt • Run scan to find sensitive • Monitor network & • Quarantine or copy files data on network & endpoint events • Notify employee & endpoint manager MANAGE • Enable or MANAGE • Remediate and 1 customize policy 5 report on risk templates reductionSymantec Data Loss Prevention 17
  18. 18. Symantec’s Complete Encryption Platform Full Disk Encryption (FDE) • PGP® Whole Disk Encryption • Symantec Endpoint Encryption (EE) FDE Device and Media Encryption • PGP Portable • SEE Removable Storage Edition (RSE) • SEE Device Control FTP/Batch and Backups • PGP® Command Line File/Folder/Shared Server Encryption Management • PGP® NetShare Central Management of Gateway Email Encryption Encryption Applications • PGP® Gateway Email PGP® Universal ™ Server End-End Email and IM Encryption • PGP® Desktop Email Key Management Smartphone Solutions PGP® Key Management • PGP ® Viewer for iOS Server (KMS) • PGP® Mobile • PGP® Support Package for BlackBerry®Symantec Encryption 18
  19. 19. 4 Manage SystemsAltiris™ ITManagementSuitefrom SymantecEnterprise IT Security Briefing 19
  20. 20. 4 Manage SystemsAltiris™ IT • Implement secure operatingManagement environments • Distribute and enforce patch levels • Automate processes to streamlineSuite efficiency • Monitor and report on system statusfrom SymantecEnterprise IT Security Briefing 20
  21. 21. Altiris IT Management Suite Client IT Asset Service Desk Management Server ManagementAltiris IT Management Suite – Sales Enablement 21
  22. 22. Symantec Security Recognized as A Leader inGartner Magic Quadrants* Network Access Control1 Endpoint Protection Platforms2 Security Info & Event Mgmt3 Content-Aware DLP4 PC Lifecycle Config Mgmt5 E-Mail Security Boundaries6 Enterprise IT Security Briefing 22*MQ source and disclaimer information at the end of the presentation
  23. 23. Protect Your Data BACK UP RECOVER Tier availability by application Reduce downtime risks STORE MANAGE Do more with your existing Realize the promise of storage investments virtualization 23 Data Protection Solution ©2009 Symantec. All Rights Reserved.
  24. 24. Complete Protection for Your InformationDriven Enterprise Dedupe Everywhere, Closer to the Source Drive down infrastructure costs – improve performance Simple and Complete Virtual Machine Protection Remove virtualization roadblocks – lower costs Better Disaster Recovery with Global Data Protection Lower complexity and improve business continuity Centralized Global Management and Reporting Reduce operational overhead and gain control
  26. 26. Symantec Has Defined and Lead Today’s Backup &Archive Market for Over a Decade… Leading Customer Validation… 1.5 Million savvy 99% of the Fortune 90% of the Global small / medium 500 2000 businesses #1 Backup #1 Archiving 10 of 10 leading 10 of 10 leading 10 of 10 leading telecommunication healthcare financial services Market Share Market Share companies companies companies Leading Analyst Recognition… Leading Leading Backup Archiving Vision Vision 26
  27. 27. Email Security Email Anti Spam Email Anti Virus Email Image Control Email Content Control Email Management Boundary EncryptionSymantec.Cloud Policy Based Encryption Email Archiving Email ContinuityPre-integrated Web & IM Security Web Anti Virus & Anti Spyware applications Web URL Filtering Web Roaming User Secure Enterprise IM IM Security Endpoint Security Endpoint Protection 27
  28. 28. Thank you! © 2010 Symantec Corporation. All rights reserved. Symantec and the Symantec Logo are trademarks or registered trademarks of Symantec Corporation or its affiliates inthe U.S. and other countries. Other names may be trademarks of their respective owners.This document is provided for informational purposes only and is not intended as advertising. All warranties relating to the information in this document, either express or implied,are disclaimed to the maximum extent allowed by law. The information in this document is subject to change without notice.
  29. 29. Dr Pramod D. Jacob (MBBS, MS- MedicalInformatics),Consultant,Healthcare Information Technology .Email:
  30. 30. Topics covered About HIMSS GETF for EHR Core Comparisons of EHR across countries National EHR initiatives in the UK, Canada and the US Comparisons in Funding , Governance and Standards Key Lessons
  31. 31. Mission Statement for the HIMSS Global Enterprise Task Force (GETF)‫‏‬for EHR The United States lags behind other industrialized nations for implementing Electronic Health Record ( EHR ) systems. Chartered in 2006 The mission of the Task Force has been to examine the reasons for this lag and the opportunities available to close that gap.
  32. 32. GETF- Task Force Objectives Identify and describe significant healthcare information solutions being pursued in countries globally. Identify aspects of a solution that differs from one nation to another and to determine, through ROI in finance and quality, which represents “best practices.”
  33. 33. GETF- Task Force Objectives Identify the common threads in national EHR adoptions that led to success or failure. Understand the funding, architecture, and delivery systems of solutions in other countries, including network models and central versus local data repositories.
  34. 34. GETF- Task Force Objectives Incorporate “best practices” into a road map for the development of a successful solution in the United States and other countries embarking on implementing EHR at a national level To avoid the pitfalls that have had negative impact in past implementations.
  35. 35. GETF- Task Force Objectives Join and communicate with other nations of the world to help promote common goals in the global adoption of Electronic Health Records.
  36. 36. Immediate Observations Comparison objects were huge, i.e.. There were so many data elements identified we had to narrow the elements so we could provide an “apples to apples” comparison.
  37. 37. Sample of comparison data• EHR applications selected – Different in several countries.• Legal and regulatory process: – Terms on which providers, health plans, public health authorities and researchers participate. – Privacy and rights of individual whose information is held in EHR’s, Compliance with Federal laws regarding privacy and security. – Liability of providers participating in EHR’s. – Technology products and services licensing agreements. – Data use agreements.
  38. 38. Sample of comparison data EHR Architecture: Standards Employed  Centralized vs. distributed - HL7 v3 RIM (ISO  Information model 21731)  User authentication - SNOMED  Security model - ISO TC 215  Services model - ICD 9 or ICD 10  Messaging model - LOINC  Transport - DICOM (communications) - Other  Clinical data (moved)
  39. 39. Sample of comparison dataTotal cost Modules employed – Software cost – Hardware cost – Clinical – Practice management – Implementation cost – E-prescribing – Training cost – Scheduling, billing – Infrastructure cost – Other – Operation cost Who pays – Clinical users – Private funding – System funding – Federal/regional/state/local
  40. 40. Core Comparisons Overview of healthcare system of country National EHR Program - National IT/ICT status and strategy - National/Regional EHR Approach EHR Governance - Legal/Regulatory - Healthcare policy - EHR Financing
  41. 41. Core Comparisons Technology Adoption Outcomes - Benefits - Implementation Experiences Next steps for each country
  42. 42. Expected functions of EHR/EMR• Review of encounters, problem list, medication list• Clinical Documentation like progress notes• Order entry such as for medicines, lab tests and procedures, results of tests• Alert systems like drug-drug inter action• Supports clinical decision ability such as correction of dosage in case of renal insufficiency.
  43. 43. HIMSS GETF white paper Title : Electronic Health Records: A Global Perspective 2nd edition- Aug, 2010 Website link:
  44. 44. England EHR program NHS has ongoing project known as National Program for IT (NpfIT) from 2002 The Spine is a national central database for patient summary records (Summary Care Record (SCR)) - Comprises a central health record repository , access control, messaging hub and a portal for clinical users Services being implemented by four categories of external suppliers
  45. 45. England EHR program Four categories of external suppliers :--National Infrastructure Service Providers (NISP) :- delivering National Network for the NHS (N3) and NHS mail.- National Application Service Providers (NASP) :- providing services such as the EHR initiative called the NHS Care Records Service (NHS CRS) and e-prescribing
  46. 46. England EHR program Four categories of external suppliers :-- Local Service Providers (LSP):- responsible for systems such as GP systems, new hospital systems and a new diagnostic application.- GP Systems of Choice (GPSoC):- introduced 2008 to provide a greater level of choice to the primary care sector in selecting the products to run within a practice and funded as part of the NPfIT.
  47. 47. England EHR program• EHR initiative is NHS Care Records Service (NHS CSR):- Two elements - Detailed records (held locally)‫‏‬ - Summary Care Record (held nationally)‫‏‬• Detailed records securely shared between different parts of the local NHS like one GP practice to another (GP2GP)
  48. 48. England EHR Program Summary Care Record- summary of patients important health information available to authorized NHS staff anywhere in NHS in England. Patient can access their summary records through secure web portal “HealthSpace” Summary Care Record stored in the Spine central database.
  49. 49. England EHR Program Status:- -June 2011- Major Projects Authority (MPA) substantial achievements such as the Spine, N3 Network, NHSmail, Choose and Book and PACS. However, the National Program for IT has not and cannot deliver its original intent.- Recommend that dismember the program and reconstitute it under new management and organization arrangements.
  50. 50. Canada EHR Program Canada Federal Government established an organization called Canada Health Infoway Inc (Infoway) in 2001 to support and accelerate the development and adoption of interoperable EHR solutions across Canada. Infoway is a not for profit organization whose goal is that by 2010 , each province and territory will benefit from new health information systems that will modernize healthcare.
  51. 51. Canada EHR Program 3 key factors of national Health network led by Infoway1. Strategic Investor- Infoway collaborates with federal/provincial/ territorial authorities, healthcare organizations and IT vendors to identify investments. Once investment decisions made, public sector partners lead implementation with Infoway providing strategic direction.
  52. 52. Canada EHR Program3 key factors of national Health network led by Infoway2. Gated funding – Infoway provides 75 % funding with provinces and territories funding balance. Gated funding model where funding given on attaining specific implementation milestones3. Interoperability- Infoway promotes use of common architecture and standards to ensure systems can interoperate. Established Infoway Standards Collaborative.
  53. 53. Canada EHR Program The Electronic Health Record Solution (EHRS) Blueprint provides an overall architecture for a national system, that guides development of the whole and individual parts. The architecture is technology neutral – does not mandate use of a particular technology, product or vendor. It just describes how the system should work. Any application selected by provinces or local jurisdictions must be complaint with the blueprint.
  54. 54. Canada EHR Program This principle along with the use of standards based applications reduce cost and risk, which is Infoways business strategy
  55. 55. Canada EHR ProgramInfoways EHR Solution (EHRS) Blueprint Flexible business and technical design framework allowing solutions , components and business rules to be reused by multiple applications in health IT. Ensures all EHR solutions can exchange patient health information across healthcare organizations in a seamless and secure manner.
  56. 56. Canada EHR ProgramInfoways EHR Solution (EHRS) Blueprint Addresses business, conceptual and logical architecture, deployment models and potential applications for healthcare IT.
  57. 57. Canada EHR ProgramStatusGoal : - By 2010 fifty percent of Canadians on EHR - By 2016 hundred percent Achieved :- By March 2009 reached seventeen percent- By March 2010 reached thirty eight percent
  58. 58. USA EHR initiative Feb 2009 American Recovery and Reinvestment Act (ARRA) with the HITECH Act being the Healthcare Information Technology component. Budget of $ 20 billion ( $ 36 billion) Through the Medicare/Medicaid programs
  59. 59. USA EHR plan General principles :-- Carrot and stick for physicians /providers/ hospitals to adopt EHR systems- Setting up of Health Information Exchange initiatives like RHIO- Setting up national HITRC and Regional Extension centers
  60. 60. USA EHR planCarrot and stick for providers- Each will receive about $ 44000 over five years if implement EHR by 2011 and 2012. Decreasing if after; no subsidy if after 2014.- If do not show “ Meaningful use of EHR” after 2014, will get decrease in payment from Medicare and Medicaid and no annual increase for services.
  61. 61. USA EHR planHealth Information Exchanges initiative- Amount of $ 300 million to establish health information exchange (HIE) initiatives across regions and states-(RHIO) to hook up to a National Health Information Network (NHIN)
  62. 62. USA EHR planHealth Information Exchanges initiative- Use of standards for inter operability and exchange of data between hospitals and clinics.- Further funds available for the network and increasing broadband capability.
  63. 63. USA EHR planHITRC and Regional Centers- Setting up 70 Regional Extension centers with a central Health Information Technology Resource Center (HITRC)- Regional Extension centers- assistance to providers through education, outreach and technical help in selecting and implementing the EHR
  64. 64. USA EHR planHITRC and Regional Centers- Form a collaborative network that is facilitated by the HITRC.- About $ 600 million for regional centers.
  65. 65. USA EHR planStatus :-- By Nov 2011:- 20,000 providers and 1,200 hospitals achieved Stage 1 meaningful use and received payment- By end of 2012 expected to reach 100,000 providers achieving Stage 1
  66. 66. Asia EHR initiatives Hong Kong Singapore Malaysia
  67. 67. Comparing EHR in differentcountriesNext few slides will compare- Funding- Governance Models- Standards and Interoperabilitybetween different countries
  68. 68. Funding Central Government -England, Germany, France, Netherlands, Sweden, South Africa, Denmark, New Zealand. Private Sector -India, Israel, Japan. Central, Local and Private -Canada, Hong Kong, USA. Central and Local -Australia
  69. 69. Governance Models Governance Model Countries Centralized England, New Zealand Private Sector United States Distributed Germany, Denmark
  70. 70. Standards and InteroperabilityParochial Standards France, Sweden, Netherlands, DenmarkInternational (such as England, South Africa,HL7)‫‏‬ New Zealand, AustraliaInteroperability-Driven England, United States, New Zealand, AustraliaMultiple Systems Israel
  71. 71. Key Lessons Requires a commitment from high levels of government and private sector. Flexibility and configurable applications Data standards for Interoperability needs to be implemented . Physicians/Clinicians must be involved. Training is a essential piece that must be funded and subsidized. Change management crucial.
  72. 72. Thank you Dr Pramod D. Jacob (MBBS,MS- Medical Informatics), Consultant, Healthcare Information Technology. Email: Tel: (+91) 9370715571
  73. 73. 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.
  74. 74. 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
  75. 75. 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
  76. 76. 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
  77. 77. 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
  78. 78. 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
  79. 79. 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
  80. 80. 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
  81. 81. 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
  82. 82. THANK YOU FOR YOUR ATTENTION DR.P.GANESHKUMAR MD SRM UNIVERSITY +91 98406-40483 NCMI 2012 , Ganeshkumar 26 10
  83. 83. POST GRADUATE TEACHING POST GRADUATE TEACHING & CADAVERIC DISSECTION WORKSHOPWORKSHOP & CADAVERIC DISSECTION IN HEAD & NECK SURGERY - 2010 IN HEAD & NECK SURGERY - 2012Dept of ENT-HNS, Army Hospital (R&R) & Dept of Anatomy Army College of Medical Sciences Foundation for Head – Neck Oncology Supported by ICMR, MCI
  85. 85. POST GRADUATE TEACHING POST GRADUATE TEACHING & CADAVERIC DISSECTION WORKSHOP & CADAVERIC DISSECTION WORKSHOP IN HEAD & NECK SURGERY - 2010 IN HEAD & NECK SURGERY - 2012Lunch Break - 01 hour - Lunch is laid out in the canteen downstairs - Cadaver dissection starts at dissection hall, Anatomy Dept at 1330 hrs - Please reach Dissection Hall 10 mins before
  87. 87. POST GRADUATE TEACHING POST GRADUATE TEACHING & CADAVERIC DISSECTION WORKSHOPWORKSHOP & CADAVERIC DISSECTION IN HEAD & NECK SURGERY - 2010 IN HEAD & NECK SURGERY - 2012• Workshop Dinner Date: 21 Jan 12 Time: 1945 hrs Venue: Officers Mess, AHRR All faculty, Delegates and Observors are requested to attend.
  89. 89. PRESENTATION © 2011 Spanco Ltd, All rights reserved
  90. 90. 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
  91. 91. 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
  92. 92. 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
  93. 93. 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
  94. 94. 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
  95. 95. Thank You 7 © 2011 Spanco Ltd, All rights reserved
  96. 96. electronic patient records in sri lanka hospital health information management systemdenham pole MDconsultant in medical informatics
  97. 97. subjects covered overview of health care in sri lanka early attempts at ePR initiatives from the private sector problems faced by the red cross how were they solved overview of hhims softwaredenham pole MD 2 04 February 2012
  98. 98. health care in sri lanka state health care for 60% 230 state hospitals with beds out-patients ++ private curative services for 40% 45 private hospitals with beds family practitioners ++denham pole MD 3 04 February 2012
  99. 99. early attempts at ePR in south asia ePR is in its infancy even manual record-keeping is rudimentary WHO advocates for improved records 2003 – several MOH initiatives started 2005 – WHO uses tsunami mandate to install ePR systems none of these systems had long-term successdenham pole MD 4 04 February 2012
  100. 100. early attempts at ePR 2003 MOH: polonnaruwa, kurunegala, anuradhapura 2005 WHO: karapitiya, matara, ampara, trincomalee, batticaloadenham pole MD 5 04 February 2012
  101. 101. why early systems failed databases too complex resistance from clinical staff infrastructural and environmental problemsdenham pole MD 6 04 February 2012
  102. 102. private sector initiatives austrian / swiss / norwegian red cross – proprietary software • currently 26 hospitals running sri lanka government (ICTA) – open-source software • 5 hospitals running, 6 more in planningdenham pole MD 7 04 February 2012
  103. 103. recent developments • proprietary software 2006-9: austrian / swiss / norwegian red cross (27 hospitals in east) • open-source software ICTA: 10 hospitals in 4 provinces • lunar technologies 4 hospitals in 3 provincesdenham pole MD 8 04 February 2012
  104. 104. problem faced by red cross clinical staff refused to use ICD to code diagnoses health ministry insisted on ICD for statistics free-text input not a viable alternativedenham pole MD 9 04 February 2012
  105. 105. ICD 10 daggers and asterisksdenham pole MD 10 04 February 2012
  106. 106. daggers and asterisks explaineddenham pole MD 11 04 February 2012
  107. 107. how was it solved concept groups allowed appropriate terms to be selected – event, findings, disorder, procedure synonyms user-friendly for staff whose mother- tongue was not english cross mapping to ICD 10 codes satisfied official requirementsdenham pole MD 12 04 February 2012
  108. 108. snomed – ctdenham pole MD 13 04 February 2012
  109. 109. royal college of physicians individual patient care care of populations – epidemiology cost – effectivenessdenham pole MD 14 04 February 2012
  110. 110. simplicitydenham pole MD 15 04 February 2012
  111. 111. portable/mobile solutions iPhone accessdenham pole MD 16 04 February 2012
  112. 112. what can hhims do patient registration simple OPD/Clinic record-keeping admission records public health statistics infectious disease notifications appointment system laboratory ordering/reportingdenham pole MD 17 04 February 2012
  113. 113. what are the benefits of using hhims clinical staff: better informed, easier to do administrative work hospital administrators: medical record management, stock control, performance indicators central ministry / WHO: better public health information patients: better documented record, better care, possibilities of telemedicinedenham pole MD 18 04 February 2012
  114. 114. patient overviewdenham pole MD 19 04 February 2012
  115. 115. ODP visitdenham pole MD 20 04 February 2012
  116. 116. admissiondenham pole MD 21 04 February 2012
  117. 117. snomed look-updenham pole MD 22 04 February 2012
  118. 118. out patient registration new patients are first registered before seeing the doctordenham pole MD 23 04 February 2012
  119. 119. paperless registration desk registering a patientdenham pole MD 24 04 February 2012
  120. 120. admission desk nurse admits the registered patientdenham pole MD 25 04 February 2012
  121. 121. paperless OPD – large hospital some doctors’ tables are paperlessdenham pole MD 26 04 February 2012
  122. 122. paperless dispensaries some dispensaries are also paperlessdenham pole MD 27 04 February 2012
  123. 123. paperless OPD – small hospitals smaller hospitals benefit from improved documentationdenham pole MD 28 04 February 2012
  124. 124. paperless wards some wards are also paperlessdenham pole MD 29 04 February 2012
  125. 125. paperless wards smaller hospitals benefit from improved documentationdenham pole MD 30 04 February 2012
  126. 126. admission desk new patients are first registered before seeing the doctordenham pole MD 31 04 February 2012
  127. 127. OPD paperlessdenham pole MD 32 04 February 2012
  128. 128. OPD paperlessdenham pole MD 33 04 February 2012
  129. 129. OPD paperlessdenham pole MD 34 04 February 2012
  130. 130. OPD paperlessdenham pole MD 35 04 February 2012
  131. 131. manual records before ePRdenham pole MD 36 04 February 2012
  132. 132. Lunar Technologies (pvt) Ltd. 15B, Fullerton Estate II, Gamagoda 12016, Kalutara, Sri Lanka.
  133. 133. thank you denham pole MDconsultant in medical informatics lunar technologies sri lanka
  134. 134. Foto: Fröken Fokus Telemedicine for Developing Countries Jeremiah Scholl, Senior Researcher, Health Informatics Centre, Karolinska Institutet, Stockholm Sweden Presented by Dr.Shabbir Syed-Abdul Taipei Medical University and National Yang Ming University, Taipei, Taiwan.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  135. 135. Foto: Fröken Fokus About Jeremiah • From Denver, Colorado • PhD in Media Technology, Luleå University of Technology (2000-2005). • Norwegian Centre for Integrated Care and Telemedicine. Tromsø, Norway (2005-2010). – WHO Collaborating Centre for Telemedicine – Research Manager is Richard Wootton (lots of experience with Telemedicine for Developing Countries). • Health Informatics Centre at Karolinska Institutet since January 2010.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  136. 136. Foto: Fröken Fokus Overview of presentation • Clinical use for second opinions – Overview of systems – Challenges to widespread adoption – Some successes in India – Looking to the futureHealth Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  137. 137. Foto: Fröken Fokus Clinical useHealth Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  138. 138. Foto: Fröken Fokus Obtaining second opinions • There are quite a few different networks, some of which have evolved into large scale. • There is some evidence of positive impact. – 34 articles reporting clinical experience. – All studies except 1 reported benefits for Telemedicine. • Possible publication bias. – Methodology often poor. • Sometimes they don’t even include the total number of patients.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  139. 139. Foto: Fröken Fokus Obtaining second opinions Some well established International networks 1. Partners Healthcare, Boston, USA 2. Tripler Army Medical Centre, Honolulu, USA 3. iPath Association, University of Basel, Basel, Switzerland 4. Swinfen Charitable Trust, Canterbury, UK 5. Institute of Tropical Medicine HIV/AIDS Telemedicine network, Antwerp, BelgiumHealth Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  140. 140. Foto: Fröken Fokus Partners Healthcare, Boston, USA • Date of first operation: 2001 • Mechanism: Email • Referring sites: Rovieng Health Centre, Cambodia; Rattanikiri Hospital, Cambodia • Expert sites: Sihanouk Hospital, Phnom Penh; Harvard Medical School, Boston • Description: Email consultations are used to support health workers at a rural clinic in northern Cambodia. The email advice comes from specialists at a tertiary hospital in Phnom Penh and from the Massachusetts General Hospital in Boston. In 2003, a second site at a small hospital in northern Cambodia began referring cases.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  141. 141. Foto: Fröken Fokus Tripler Army Medical Center, Honolulu, USA • Date of first operation: 1997 • Mechanism: Web • Referring sites: US-associated Pacific islands • Expert sites: Tripler Army Medical Center, Hawaii • Description: A web-based teleconsulting system is used by the main US Army hospital in Hawaii to support referrers in hospitals (mainly military hospitals) around the Pacific.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  142. 142. Foto: Fröken Fokus iPath Association, University of Basel, Basel, Switzerland • Date of first operation: 2001 • Mechanism: Web • Referring sites: Several (mainly telepathology), e.g. Cambodia, Solomon Islands, Bangladesh Also more recent teleconsultation work, e.g. Ukrainian Swiss Perinatal Health Project • Expert sites: Mainly Swiss, European • Description: The iPath software was originally developed for telepathology case conferences (for which it is an excellent tool, and several tens of thousands of case conferences have now been conducted — technically by a number of different organizations who all use the same software). More recently the software has begun to be used for general teleconsulting (i.e. non-pathology work).Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  143. 143. Foto: Fröken Fokus Swinfen Charitable Trust, Canterbury, UK • Date of first operation: 1999 • Mechanism: Email and Web • Referring sites: Global • Expert sites: 513 consultants in 68 countries • Description: A simple email teleconsultation system was established at a single hospital in Bangladesh by a UK-based charity. Specialist opinions were obtained from a small panel of volunteer consultants. The operation has now grown to service over 100 hospitals around the world, with a panel of more than 500 consultants. An automatic message handling system is employed, supplemented by a more recent web- messaging system.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  144. 144. Foto: Fröken Fokus Institute of Tropical Medicine HIV/AIDS Telemedicine network, Antwerp, Belgium • Date of first operation: 2003 • Mechanism: Email and Web • Referring sites: Global (40 countries as of 2009) • Expert sites: 20 experts (Antwerp and others) • Description: Internet-based decision support service to assist health-care workers in the management of difficult HIV/AIDS cases. Available to physicians working in resource-limited settings. Queries are handled by a coordinator that forwards them to a network of specialists, based at the ITM and at other institutions.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  145. 145. Foto: Fröken Fokus Utilization Operator Cases (as of 2008- Years 2009) Partners 900 6 Healthcare Tripler 3000 10 iPath 500 5 SCT 1500 9 ITM HIV/AIDS 950 6Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  146. 146. Foto: Fröken Fokus Utilization • Despite there being… – A number of services. – Years of experience. – Free! • Overall utilization seems extremely low in comparison to potential demand. – Consider that: • Developing world contains 5400 million people in 127 countries. • Suppose 1/10 people sees a health-care professional each year. • Suppose in 1/100 of these interactions, the health-care professional concerned would like to seek a second opinion. • This would imply 5 million referrals each year.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  147. 147. Foto: Fröken Fokus Why is utilization so low? • Evidence of the following challenges – Cultural problem of asking for help. – Referrers too busy. – Perceived loss of control. – Lack of communication infrastructure.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  148. 148. Foto: Fröken Fokus Cultural problem of asking for help • SCT: About half of requests are by ex-pats. – Malawi: 50% of doctors registered in Malawi are Malawian. • This indicates it may not be a major problem. • One report from India however states that patients might loose trust in a doctor that uses Telemedicine.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  149. 149. Foto: Fröken Fokus Referrers too busy • Doctors would like a second opinion. However they are too busy to ask for one. • An experiment with medical students on elective time in developing countries increased usage of Telemedicine. • Thus, there is some evidence for this.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  150. 150. Foto: Fröken Fokus Perceived loss of control • SCT. Asia-pacific region. Country making about 30 referrals a year. 2004 new health minister with nationalistic tendencies: Referrals stopHealth Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  151. 151. Foto: Fröken Fokus Lack of connectivity • Existing connectivity options all have limitations.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  152. 152. Foto: Fröken Fokus Advantages and disadvantages of various connection technologies. • Satellite – Advantages: Can go anywhere. – Disadvantages: Expensive and requires government help. • Internet – Advantages: Cheap and (sometimes) fast service – Disadvantages: Not always available in rural areas. Telecom companies must make a profit to be there. Only as reliable as fixed infrastructure. • Mobile phone – Advantages: Quite widely available. Inexpensive for low bandwidth (sms, audio) – Disadvantages: Not available in all rural areas (especially Africa). Low bandwidth, and/or expensive for data. (I.E. Not ideal for routine video conferencing usage or large data transfers).Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  153. 153. Foto: Fröken Fokus Lack of connectivity • Experiments in South India show large increase in Telemedicine by using point- to-point WiFi. • Recent Study indicates interest in connectivity with DTN to improve adoption of Telemedicine. • Thus, this can be overcome.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  154. 154. Foto: Fröken Fokus Awareness? • How much is awareness a problem? – How many of you are aware that Swinfen Charitable Trust provides free access to specialist advice via Internet?Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  155. 155. Foto: Fröken Fokus Where to go from here? How do we develop a? • Within country networks. • Demonstratable health outcomes. • Shown to be cost-effective and sustainable. • Acts as a model for other countries to copy.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  156. 156. Foto: Fröken Fokus Within country Telemedicine Networks Indian ExperienceHealth Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  157. 157. Foto: Fröken Fokus Telemedicine Networks in India 1. Apollo Telemedicine Networking Foundation. 2. Indian Space Research Organization (ISRO). 3. Aravind Teleophthalmology Network.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  158. 158. Foto: Fröken Fokus Apollo Telemedicine Networking Foundation • First telemedicine centre in Aragona in 1999. • Wide spread international network. • Provide a wide range of Telemedicine services. – Tele-Radiology, Tele-Dermatology, Tele- Pathology, Tele-Cardiology, Remote ICU Monitoring, Ambulance Monitoring, Mobile Telemedicine Unit, Electronic Health RecordHealth Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  159. 159. Foto: Fröken Fokus Apollo Telemedicine Networking Foundation • Details of their services not extensively published much in medical literature. • Thus, it is difficult to generalize their experiences.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  160. 160. Foto: Fröken Fokus Indian Space Research Organization (ISRO) • Providing Telemedicine services since 2001. • Uses satellite link. • 60 remote hospitals connected to 20 super-specialty hospitals.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  161. 161. Foto: Fröken Fokus Dealing with Connectivity Problems. • Aravind Teleophthalmology Network. • Built on customized point-to-point Wifi.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  162. 162. Foto: Fröken Fokus Aravind Eye Care SystemHealth Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  163. 163. Foto: Fröken Fokus Aravind • Largest eye-care provider in the world by volume • 5 hospitals: – Madurai, Theni, Tirunelveli, Coimbatore, and Pondicherry • 2006-2007 – 2.3 million patients – 270,000 surgeries – most for cataracts 4Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  164. 164. Foto: Fröken Fokus New Model: Vision centres – Doctor stays at urban hospital – Interacts with patients via Telemedicine. – Technician operates the ophthalmic equipment and PC – Counselor follows up with patients based on the diagnosis provided by tele-doctorHealth Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  165. 165. Foto: Fröken Fokus Some key challenges to sustainable Telemedicine system in developing countries 1. Financial self-sufficiency 2. Operational self-sufficiency • Challenging in areas without good communication infrastructure. • Do not want to rely on outside donors to pay for bandwidth forever etc. • New techniques allow custom point-to-point WiFi connectivity to be set up. • Audio, Video, Email, Web etc.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  166. 166. Foto: Fröken Fokus Financial self-sufficiency • Sustainable deployment must be cash- flow positive. • Positive monthly cash flow is easier to achieve than profitability (including recovery of capital investments). • Limits aid to start-up $, but not ongoing operations.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  167. 167. Foto: Fröken Fokus Capital expenditures • Some can be framed as a monthly cost. • PC that costs $600 and lasts five years. – $10 per month without interest . – $14.70 per month with interest (8%). – $11.76 per month with salvage value of 20%.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  168. 168. Foto: Fröken Fokus Operational self sufficency • Ongoing system maintenance and support. – power, hardware, software, expansion and new installations. • Local groups do not start out with the ability to handle this. Thus the system has: – component robustness – easy-to-use management tools for local staff – tools for remote management by expertsHealth Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  169. 169. Foto: Fröken Fokus Incremental approachHealth Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  170. 170. Foto: Fröken Fokus Incremental approach 1) Moved 4 vision centeres to their high speed wireless 2) Added 5 more vision centres. • May 2007 -December 2007 – Average of 3,632 patients per month. – 75% new patients, 25% follow-up – 9,835 patients diagnosed with severe cataract or refractive errors – 90 percent (8,814) got their sight backHealth Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  171. 171. Foto: Fröken Fokus Results • 50,000 telemedicine examinations so far • 3600 per month • Expanding to 50 centers in next 3 years – 500.000 examinations expected per year.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  172. 172. Foto: Fröken Fokus Limitations • Apollo: – For Apollo network. – Seems good but its unclear how others in India can benefit from their success. • ISRO: – Expensive satellite system. – For use by a few public clinics. • Aravind – Very specific for use with their clinics. – Provides good model of developing custom connectivity and service! – But not all questions others need to deal with are answered.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  173. 173. Foto: Fröken Fokus Limitations • The vast majority of clinics in India are private clinics that are not part of the Apollo network or Aravind network. • Many are small with only a few patient beds. • It is unclear how to apply these experiences to these clinics.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  174. 174. Foto: Fröken Fokus Challenges with further development of Telemedicine in India • Lack of economic incentives for private clinics. – Local clinics are often run as businesses by the medical practitioners. – Common source of revenue at these clinics is % of the fees collected from patients they refer to hospitals. • If they use telemedicine instead of send the patient, they would miss out on this revenue. • Potential negative impact on the doctor-patient relationship. – Patient perspective: Physician treats them immediately, or refers them to a hospital for additional care. • Why does this doctor need to ask an outside network for help? Maybe (s)he is not so good? • Lack of awareness of potential. – How many people are aware that SCT can provide free specialist advice to physicians? • Lack of adequate infrastructure in some rural areas. – Aravind model could help.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  175. 175. Foto: Fröken Fokus ConclusionsHealth Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  176. 176. Foto: Fröken Fokus Conclusions • Telemedicine holds a lot of promise to improve healthcare systems in developing countries. – Improved access to care, help to overcome lack of resources. • There are many international Telemedicine networks that offer support. – There are some challenges with their use: Patients may be skeptical; Referrers may be too busy; Loss of control; Lack of infrastructure – They seem underutilized. • Awareness also may be a problem. • There is some success with within country Telemedicine networks – Ukraine: Success with teleconsultation for trauma and orthopedics. – India: 1. Apollo 2. Space 3. Arvind eye care system • It is possible to overcome lack of infrastructure.Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  177. 177. Foto: Fröken Fokus Conclusions • Challenges for Telemedicine in India – How to create economic/organizational alignment between clinics and specialists? • Comprehensive insurance programs? – Apollo and Aravind show that connecting clinics and hospitals financially enables Telemedicine. • Government run Telemedicine centres and increased awareness among patients about benefits to them from Telemedicine? – What if Telemedicine becomes a known service provided by government hospitals? Perhaps patients will accept and trust this. – How to make patients comfortable with Telemedicine usage by doctors? • If patients understand that doctors ask Telemedicine centres to save the patient expensive trips to hospitals, then maybe they will trust their doctor more? – Improve awareness for those that would like to use international networks. • Why not use SCT?Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  178. 178. Foto: Fröken Fokus References • “Telemedicine support for the developing world”, R. Wootton - Journal of Telemedicine and Telecare, 2008 • “Deploying a rural wireless telemedicine system: Experiences in sustainability”, S. Surana, R. Patra, S. Nedevschi… - IEEE Computer, 2008 • “In what circumstances is telemedicine appropriate in the developing world?”, R. Wootton and L. Bonnardot - JRSM short reports, 2010 • “Experience with low-cost telemedicine in three different settings. Recommendations based on a proposed framework for network performance evaluation”, R. Wootton, A. Vladzymyrskyy, M. Zolfo, L. Bonnardot- Glob Health Action, 2011 • “Study on the potential for delay tolerant networks by health workers in low resource settings”, S. Syed-Abdul, J. Scholl, P. Lee, W.S. Jian, D.M. Liou – Computer Methods and Programs in Biomedicine, 2012Health Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI
  179. 179. Foto: Fröken Fokus Thanks! jeremiah.scholl@ki.seHealth Informatics Centre, Dept. of LIME and Dept. of Medicine (MedSolna), KI