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

Dedicated to

Prof. B D Gupta, Ex- HoD, Department of Radiotherapy & Founder, Telemedicine

Programme at PGIMER, Chandigarh

GratitudeProf. S K Jindal, Ex- HoD, Dept. of Pulmonary Medicine, PGIMER

Ex. Professor I/C, PGIMER Telemedicine Programme

Gratitude to my Almamater

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

Covid19 Health Worker Training ProgrammeInaugurated by Cabinet Minister, Shri Suresh Khanna Ji and

Principal Secretary, Shri Rajnish Dubey

51 Medical College Healthcare Worker Training Programme in ECHO ZOOM Platform

Faculty Meeting on Preparedness for CoVID 9

Nursing Staff Training on Covid-19

Meeting with Hon’ble Anandiben Patel, Governor of UP & VCs - UP

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

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

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

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

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

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

Broad areas of application 4Information, Communication & Education

SGPGI COVID Web URL : https://www.covid19sgpgi.com/

Broad areas of application 4 Contd. COVID-19 Educational Videos

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

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

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

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

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

COVID Training at Medical Colleges

Online classes using telemedicine

eICU at Rajdhani COVID-19 Hospital, SGPGI, Lucknow

Remote monitoring and Decision Support COVID Hospital

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

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

Thank you for Kind Attention