Role of Telemedicine during COVID-19 Crisis of Telemedicine during COVID-19 Crisis.pdf ·...
Transcript of Role of Telemedicine during COVID-19 Crisis of Telemedicine during COVID-19 Crisis.pdf ·...
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Role of Telemedicine during COVID-19 Crisis
Telemedicine Foundation Day Day Lecture, PGIMER, Chandigarh
13th April 2020
Prof. S K Mishra
School of Telemedicine & Biomedical Informatics, SGPGI,Lucknow
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Dedicated to
Prof. B D Gupta, Ex- HoD, Department of Radiotherapy & Founder, Telemedicine
Programme at PGIMER, Chandigarh
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GratitudeProf. S K Jindal, Ex- HoD, Dept. of Pulmonary Medicine, PGIMER
Ex. Professor I/C, PGIMER Telemedicine Programme
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Gratitude to my Almamater
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Agenda1. Introduction
2. Potential of Telemedicine during COVID-19 Crisis
3. Broad areas of application
a. Clinical Care: Acute Care: COVID & Non Covid Emergency; Secondary Care
b. Information, Communication & Education
c. Capacity Building ; HCW Training and Team Management
4. Challenges
5. National & Global Scenario
5. Conclusion
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Covid19 Health Worker Training ProgrammeInaugurated by Cabinet Minister, Shri Suresh Khanna Ji and
Principal Secretary, Shri Rajnish Dubey
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51 Medical College Healthcare Worker Training Programme in ECHO ZOOM Platform
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Faculty Meeting on Preparedness for CoVID 9
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Nursing Staff Training on Covid-19
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Meeting with Hon’ble Anandiben Patel, Governor of UP & VCs - UP
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Total Number Of Training Provided to Health Care Workers- 3,458S.N Training
Date
Participants Training provided by Total number of participants
present during training program
Remarks
1 25.03.20 51 Medical College Cabinet Minister Sri Suresh Khanna Ji
Principal Secretary-Rajneesh Dubey
Director- Prof. R.K. Dhiman
Prof. R.K. Singh
+ 23 Doctors
500-Doctor/Nurses Hon’ble Cabinet Minister-Medical Education,
Sri Suresh Khanna Ji inaugurated training
program
Principal Secretary, Medical Education, Dr.
Rajneesh Dube was available during inaugural
function.
2 27.03.20 27 HOD’s of SGPGIMS Director- Prof. R.K. Dhiman
Prof. R.K. Singh
Dr. Alok Nath, Dr. Soniya
Dr. Amit Agarwal
Dr. S.K. Mishra
+23 Doctor 3 28.03.20 JR, SR, PDCC, DM Of
SGPGI
Director- Prof. R.K. Dhiman
Prof. R.K. Singh 280 Doctor
4 30.03.20 Staff Nurse Of SGPGI Director- Prof. R.K. Dhiman
Prof. R.K. Singh 180 Doctor
5 31.03.20 51 Medical College Director- Prof. R.K. Dhiman
Prof. R.K. Singh 242 Doctor /Nurses
6 02.04.20 HOD’s & Faculty Of SGPGI Director- Prof. R.K. Dhiman
Prof. R.K. Singh 199 Doctor
7 03.04.20 51 Medical College Director- Prof. R.K. Dhiman
Prof. R.K. Singh 650 Doctor /Nurses
8 07.04.20 51 Medical College &
NHM Staff
Director- Prof. R.K. Dhiman
Prof. R.K. Singh 875 Doctor /Nurses 09 Ex-Army, 566 Doctor,300 Staff Nurses
9 10.04.20 51 Medical College &
NHM Staff
Director- Prof. R.K. Dhiman
Prof. R.K. Singh 507 Doctor /Nurses 01 Ex-Army, 450 Doctor,56 Staff Nurses
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Introduction
• COVID-19 Pandemic besides being a public health disaster has annegative impact on socio economical, medical and all service sectorsowing to lock down to ensure social distancing
• All focus being directed to care of COVID patients, quarantine ofHealth Care Workers (HCW), Sanitization and many more publichealth related issues non-COVID medical issues both acute andchronic care has been severely affected
• Telemedicine, a remote care technology which was not so popularwith stake holders is now sought after overnight, but, the healthsystem has never built the capacity neither adopted this form of caredelivery earlier
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Potential of Telemedicine during COVID-19 Crisis
• Imbalances & Shortage of Healthcare Professionals
• Unequal quality and access to healthcare services
• Number and Structure of HCW is changing
• Frontline HCWs have the highest risk of infection, so
telemedicine can minimize the risk by avoiding face to face
interaction
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Broad areas of application 1
1. COVID-19 tele-health usage cases for patients
• Tele-triage
• Self/home isolated patients (self/distant monitoring)
• Patients with mild cases (distant monitoring & treatment)
• Patients after discharge (tele-follow-ups)
2. COVID-19 tele-health usage cases for HCWs
• Clinicians with mild symptoms can still work remotely with patients
• Retired Clinicians
• Second opinion for severe cases
• Cross border experience exchange
• Tele-radiology
• Online training of HCWs
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Broad areas of application 2
Tele-health for Mental Health
• Support tool for patients, HCWs
• To be included in SARS-COV-2 testing process
( e scheduling for clinical and home tests , managing the patient’s waiting time)
• Rescue during Lock down to prevent abuse in family, tele-care / counseling for
pre-existing psychiatric illness
• Counseling for COVID scare in the family and society
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Broad areas of application 3 Clinical Care: Non Covid Emergency; Secondary Care
• For non-covid emergency (mostly trough telecommunication): Access to National Ambulance Service, pre-hospital logistics, selection of hospitals
• Secondary care (semi emergency): Teleconsultation, hospitalization justification, counseling, facilitation of appointment
Can be carried out through telecommunication/ social media tools
• NCDs can be managed through telecommunication/ social media based tools: Assurance, drug refill, sporadic events, Drug dosage readjustments e.g. INR based anticoagulants therapy
• Remote-monitoring for some ailments can be carried out through same tools as above
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Broad areas of application 4Information, Communication & Education
SGPGI COVID Web URL : https://www.covid19sgpgi.com/
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Broad areas of application 4 Contd. COVID-19 Educational Videos
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Broad areas of application 5: Capacity BuildingOn going training on COVID-19 for 51 UP State Medical Colleges for Doctors and Nursing & Paramedical Workers from SGPGIMS, Lucknow
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Challenges
• Limited / No Internet in many rural areas
• Affordable & high quality Broad Band Access
• System Scalability , capacity of HR and systems are critical
• Integration of medical digital devices with tele-health solution
• Secure exchange and storage of data in compliance with the standard regulations e.g.
a. GDPR Regulation
b. Hosting health data regulation
c. Information Security requirements
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Global Scenario
Faciltation of telehealth adoption through legislation thus removing regulatory and financial barriers
USA: March 27, 2020 : Coronavirus Aid, Relief, and Economic Security Act (CARES Act)(H.R.748
• The CARES Act signals strong support for telehealth and recognition from congress that expanding access to virtual care is critical to defeating COVID-19– American Telehealth Association (ATA)
• Relaxation on HIPPA compliance, Insurance coverage for services by Medicare and Medicaid, Trans state border services
• Number of Teleconsultations have increased many folds post-COVID
EU & Nordic countries: relaxed regulation governing trans-border services
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National Scenario
• Telemedicine Practice Guidelines approved by MOH&FW on 25th March 2020
https://www.mohfw.gov.in/pdf/Telemedicine.pdf
• Telemedicine Practice Guidelines for Ayurveda, Siddha and Unani Practitioners (2020)
https://www.ccimindia.org/pdf/CCIM_Telemedicine_Guidelines_08-04-2020.pdf
• Telemedicine Guidelines Approved for Homoeopathic Practitioners on World Homeopathic Day (2020)
https://pib.gov.in/newsite/PrintRelease.aspx?relid=201171
https://nmcn.in/pdf/public-notice-telemedicine-practice-guidelines.pdf
• Guidelines for Telemedicine Services in Ayushman Bharat Health & Wellness Centres (HWCs) (2019)
https://nmcn.in/pdf/Guidelines%20TeleMedicine%20HWCs.pdf
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Launch of COVID-19 National Teleconsultation Centre (CoNTeC) AIIMS, New Delhi on Saturday, 28th March, 2020.
Inaugurated by Hon’ble Health Minister Dr. Harshvardhan followed by interaction with NMCN Nodes across the country
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COVID Training at Medical Colleges
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Online classes using telemedicine
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eICU at Rajdhani COVID-19 Hospital, SGPGI, Lucknow
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Remote monitoring and Decision Support COVID Hospital
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Conclusion 1
• WHO Policy on Strengthening the Health System Response to COVID-19 – “Within the optimizing service delivery action, telemedicine should be one of the alternative models for clinical services and clinical decision support”
• Telehealth can directly influence the curve of demand on health system world wide slowing transmission and spreading incidence over long time period
• The COVID-19 pandemic is a challenging test for all solutions to prove how reliable and agile they are in the new circumstances
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Conclusion 2
• CDC is calling for healthcare facilities to adopt telemedicine to protect patients and staff
• The Digitally-Enabled Health System is the future of care, can reduce the burden on secondary care
• Countries with mature telehealth system in place e.g. USA, Israel, France, UK, Nordic countries and their cumulative experience is helping them to respond to current situation
• Telemedicine hasn’t traditionally been used in response to public health crisis but that is changing with COVID-19
• Sharing best practices and implemented solutions from around the globe is the need of the hour
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Thank you for Kind Attention