Healthcare with IT Enabled PPP

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HCIT Enabled PPP Oct 2015 – Bengaluru

Health Care Information Technology Enabled PPP

K. GANAPATHY President

Apollo Telemedicine Networking Foundation

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Public Private Partnerships in Health in India

JV for health projects, PE to set up hospitals for Govt.

Qualified providers through contract mechanisms in rural areas

↑ capacity, ↓ financial burden of Govt. expenditure on tertiary care, ↓ geographical disparity in access, reaching remote areas, targeting specific group of populations, improving efficiency through evolving new management structures

Incentives for desired geographic distribution of health facilities

Develop strategies to utilise untapped resources & strengths of private sector

Outsourcing management of clinical and non-clinical services

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PPP Modalities & Trends

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Integration of ICT for improving health services in Govt. Hospitals is different in different states

ICT has been effectively used to improve emergency ambulance services, health insurance, help lines, call centres, e appointments & commencement of EMR in the Govt. sector Though deployment of ICT is lowest in the health care industry as compared to banking, automobile, aviation and most other industries there has recently been a wake up call in the pvt. sector who are now looking at HCIT as a major transformational agent ICT firms willing to deploy HCIT as CSR activity & Govt’s. willing to seek new collaborations & try new innovations can go a long way to bridge the urban rural pvt - Govt. divide

Health Care Information Technology enabled PPP

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Parameters to Evaluate PPP Projects in Healthcare

Incentive Mechanism

Projects cannot succeed if human capital is not compensated for their work. A clear incentive mechanism results in success in partnership projects.

Responsibility Division

Before the start of the project, responsibility of each partner should be clear in terms of service / maintenance / ownership

Sources of Fund/Budget

Clarity in financing of project contributes to sustainability

Risk Sharing Risk – sharing is essential component of partnership. It makes partners equally liable for the project

Sustainability It is a composite parameter that may contain measures likeperformance measurement etc.

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Parameters to Evaluate PPP Projects in Healthcare

Grievance redressed

Feedback, quality, disputes, resolution, argument, clash & negotiations

Strong MIS Online system, electronic upload, Governance, audit & monitoring.

Referral System

Recommended, framework, turnaround, protocols & referring

Political/Leadership Motive

CM, Minister, State, Secretary, Director, Jurisdiction & authorities

Pro Beneficiary/Coverage

BPL, Tribal, underprivileged, affordable & cashless

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Health Care Information Technology enabled PPP

Under the project, Sanjeevani-108 (Emergency Medical Ambulance Service(EMAS)) has been integrated with a fully functional centralized call centrereceiving 25000 calls per day handling 1800 emergencies daily Assam Tele Radiology Project of NRHM, PPP with HealthFore

Technologies Ltd Vision centre April, 2007, WHO & International Agency for Prevention of Blindness (IAPB). 3.7 million people in remote areas, in Tripura. 44 Tele-ophthalmology Centres in a phased manner

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Interim Report on 6 months OperationsProf. K. Ganapathy - Principal Mentor

Dr. Chandra Medical officer - HP ATHS ProjectPremanand - AVP and Project in chargeArunabh Sharma - Project Manager

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Project Design and Conceptualization

MoU with ATHS signed in January 2015The scope of work includes innovating a healthcare delivery model to improve access to quality multi-specialty health services for over 33 thousand population in one of the remotest districts of India; Lahaul and Spiti (Keylong and Kaza)

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Robust Hands-on Training @ Chennai ApolloFeb 7, 2015 – Mar 24, 2015

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ATHS team in action - not in Job Profile of Executives & Managers !!!

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Tele auscultation - Digital Stethoscope

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TELE – SPIROMETRY THROUGH WIRELESS SPIROMETERPulmonary Function Capacity

Displayed

No. of PFTs done through TeleHealth Services:20

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Tele- ECG from KeylongTransmission of real –time ECG for quick assessment & monitoring @ ER, Apollo

Hospitals, Chennai

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The coordinator focusing camera at the site of pain to facilitate tele- examination by tele-consultant

Otoscopic examination revealing tympanic membrane rupture and ear bleed in a road traffic accident patient. Picture was sent to Tele-Emergency Consultant

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3yr old child with non remitting fever, treated at RH Keylong had Tele consultation-

HAND-FOOT-MOUTH disease diagnosed, appropriate medicines

prescribed and cured

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65 Yr. male (Mr. RS- RM01.0000001035), came to Telemedicine OPD, CHC- Keylong on Saturday, 8th August around 3.45 PM with severe chest discomfort. Coordinators recorded:Pulse-45, BP: 110/60, ECG taken immediately reviewed by ER Specialist at Chennai at 4.02PM. Vitals checked again- PR – 57/Min, BP 90/60mm HgLocal doctor asked to look for signs of failure & start IV fluids followed by Disprin 325mg stat, T.Atorva 80mg, T. Clodipogrel 300mg stat & Tramadol 50 mg slowly with Emeset. PR – droped to 46/min, SPO2 -94% . Repeat ECG showed ST elevation in Leads II, III & aVF with reciprocal changes in chest leads suggestive of Inferior Wall MI. After ruling out contraindications, immediate Thrombolysis with Streptokinase was planned followed by stabilising the patient and shifting to higher center for further management

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An Illustration of How Tele - Emergency Saves Lives! Contd…

Due to further deterioration Dopamine infusion (200mg in NS 500ml was started at 10-12 drops/min) using syringe pump. Thrombolysis was started with Streptokinase 15lakh IU in 100ml NS over one hour at 5pm. Around, 5.45pm, Patient’s oxygen saturation fell to 78%, high flow oxygen via AMBU bag was advised, BP & SpO2 was monitored every 3 mins with continuous monitoring of patient’s clinical status. At 6pm, the patient’s saturation improved to 97% with 5 liter Oxygen and BP was 120/80mm Hg Pulse was still low at 64 and patient became drowsy. The Tele-consultant envisaged impending intubation and urged the coordinators to arrange for shifting the patient immediately to higher center and to monitor vitals till the patient is moved out. At 6.45pm patient was moved from RH, Keylong to ZH, Kullu. As the local doctor was subsequently not available, the rest of management was taken care by Tele-coordinator Ms.Sonam- a trained ICU nurse. The ER specialist at Chennai made a final diagnosis of myocardial infarction with cardiogenic shock and pulmonary edema.

At Kullu, the patient was in ICU for 12 days and following recovery he was discharged with advice to do angiography as early as possible. Telephone call follow up on 23rd Sept, 15 confirmed that patient was doing well and will be going to Shimla/Chandigarh for further evaluation. Close follow is being continued by Telemedicine coordinators.

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Tinea Capitis in Monasteries of Kaza

2 monks aged, 9 and 11 were diagnosed with Tinea Capitis on a routine Tele-Dermatology OP. In subsequent Tele-dermatology Ops, more young monks affected by same condition were identified leading to suspicion of endemic focus of infection in the Monastery

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Tinea Capitis -Telemedicine Team visit to Monasteries in Kaza

Sr. no UHID NO Name Age Sex1 RM01.0000000990 Master. Nawang Tenzin 10 M2 RM01.0000001106 Master. Nawang Funchok 10 M3 RM01.0000001120 Master. Nawang Lotey 10 M4 RM01.0000001121 Master. Thinlley Choppel 11 M5 RM01.0000001027 Master. Nawang Ringzin 11 M6 RM01.0000001033 Master. Tanzin Sonam 11 M7 RM01.0000000989 Master. Nawang Rapsel 10 M8 RM01.0000000991 Master. Tashi Shingon 13 M9 RM01.0000001119 Master. Nawang Takpa 11 M

10 RM01.0000001104 Master.Thinley Namgial 10 M12 RM01.0000000990 Master. Nawang Tenzin 10 M13 RM01.0000001106 Master. Nawang Funchok 10 M14 RM01.0000001120 Master. Nawang Lotey 10 M15 RM01.0000001121 Master. Thinlley Choppel 11 M16 RM01.0000001027 Master. Nawang Ringzin 11 M17 RM01.0000001033 Master. Tanzin Sonam 11 M18 RM01.0000000989 Master. Nawang Rapsel 10 M19 RM01.0000000991 Master. Tashi Shingon 13 M20 RM01.0000001119 Master. Nawang Takpa 11 M21 RM01.0000001104 Master.Thinley Namgial 10 M

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Tinea Capitis in Monasteries of Kaza –Microbiological Confirmation

Hair shafts and scalp scrapings of lesion were sent from Kaza to Apollo Main Hospitals and microbiological examination confirmed

diagnosis of Tinea Capitis

Fungal culture report to ascertain the causative species is awaited

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MilestonesAs on 21st Sep 2015

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Clinical Spectrum - 21st April to 21st Sep, 2015 – Keylong & Kaza

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Clinical Spectrum - 21st April to 21st Sep, 2015 – Keylong & Kaza

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Himachal Pradesh Teleconsults Project

Clinical Audit_ Review MeetingAll case records reviewed with representative tele consultants

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Example of Clinical audit

Photo of swelling could have been attached to the case record - before advising biopsy Oral surgeon’s opinion/ specialist could have been obtained by the MRC family physician. Could be an innocuous vascular angioma bleeding may not be controlled – no facilities for HPE

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Apollo Coordinators reaching the community to explain services

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Social Health Education to promotehealth seeking behaviour

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Mid Course InitiativesMedicines1.Request to Tele-consultants to prescribe generics 2.Request to State to procure the essential branded drugs commonly prescribed across specialties 3.Dispensing medicines through TM staff (Qualified pharmacist)

Laboratory facilities 1. Deployment of POCT devices

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Voice of customer-Patient feedback

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VoC Analysis of complete responses from 105 patients

Savings for the 105 respondents Rs. 8,63,100This is purely subjective based on each respondent’s individual assessment, but gives a general indication.

Detailed objective analysis of a larger number will be done

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Panel of Tele Consultants

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August August 2015,2015,157 157 residentresidents of s of Lahul Lahul and Spiti and Spiti had had travelled travelled 7892.5 7892.5 kms kms (average (average 50.3 km 50.3 km each) to each) to get get specialisspecialist t consults consults -55% -55% womenwomen

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http://nrhm.gov.in/component/content/article.html?layout=edit&id=509

http://nrhm.gov.in/component/content/article.html?layout=edit&id=509

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Rural Health care Future through CSCsChange the delivery of health care solution to rural India through

telemedicine…

Through this new model of Apollo Tele-consultation service, patients in locations that have no access to even primary healthcare facilities can now connect to a doctor.

With Remote patient monitoring devices like Control-H one can monitor basic vitals and maintain patients’ health information electronically all under one platform – Apollo Medeintegra.

This Telemedicine service is poised to service over 360 million people in the next 5 years.

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Process Flow at CSCs

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Inauguration of Govt. of India Central Asia e Network by Hon Prime Minister of India. Complex Cardiac problem teleconsult from Osh city in Southern Kyrgyzstan, with doctors in the capital Bishkek and with super specialists @ Apollo Hospital New Delhi on 12th July 2015

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Healthcare with IT Enabled PPP

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