Establishing Tele-Ophthalmology Centres in North East India

Establishing Tele-Ophthalmology
Centres in North Eastern States
of India

Dr M R Surwade Dr S B Gogia

SATHI

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

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

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

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

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

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

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

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

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

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

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”

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

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

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

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

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

LEARNINGS REQUIRED

 Marketing / orientation
 of link workers and pts
 Registering the patient
 Arranging Tele-consultation

 Maintaining Equipment

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

OBJECTIVES

 TRAINING IN EYE CARE
 Eye examination
 Slit Lamp
 Vision
 Ophthalmoscope
 Glass grinding
 Streak retinoscope

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

METHODS

 METHOD - Training come workshop
DURATION – 15 days
 3 ASSISTANTS - Basic knowledge

 INCLUDES

 classroom lectures
 workshops at 2 hospitals
 optical center
 trip to lenses manufacturing company.

RESULTS

WRITTEN ASSESSMENT – 1 hr questionnaire of 60marks + spotting
of 40 marks.

CONCLUSIONS OF ASSESSMENT – Reviewed for feedback.

CONSENSUS – Advance comprehensive course

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

TELEOPHTHALMOLOGY MODULE
OBJECTIVE 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.

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.

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

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

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

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

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

GENERAL MANAGMANT MODULE
 Human Resources Management
 Financial management
 Operational management
 Medical Records management
 Eye care administration

MODULE ON MARKETTING
/COMMUNITY INTERFACE

 Clinical Acceptance
 Public Awareness
 Government officials
 Community leaders
 Patient Satisfaction
 Public and community medicine.

MODULE ON NATIONAL
PROGRAMMES

 Scope, objectives and government aids provided under various national
programs.
 National program for blindness control.

PRESENTATION

© 2011 Spanco Ltd, All rights reserved

COMPANY PROFILE: INTRODUCTION
• Spanco Limited is a company engaged in creating Large scale
Global 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


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


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


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


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


Thank You

7


Community Level Limb Care
Through Telemedicine
Arun Rekha Gogia and Dr S B Gogia
S.A.T.H.I.
www.sathi.org

Telemedicine for Limb care

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


What is Limb care

Care of diseases All have common
largely localized to Localized Treatment
the limbs processes
Lymphoedema Cleaning and Dressing
Venous Ulcers Compression
Bandaging
Diabetic Foot
Exercizes
Other tropical diseases like
Yaws and Dracunculosis Drugs

4/15/2012 Telemedicine for Limb care 3

Why Limb
Care is ideal
for Telemedicine
Knowledge 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

OBJECTIVE
Lymphoedema
4th highest cause of morbidity in the world

The provision of lymphoedema services worldwide varies
from very well developed care to virtually no provision
(e.g.India/Africa).

Many patients are not properly diagnosed and there is a
pervasive impression that the condition is
rare,
causes few problems,
is not life threatening and cannot be treated.

However, without adequate treatment, lymphoedema
can have major effects, including long-term disability,
difficulties with work and emotional problems.

Filariasis
- extent of problem
Global: 1100 million at risk of infection,
120 million pts
India: 553 million at risk, 48 million pts
40% of Global disease burden in India
India 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.

Possible Solution
Creating Integrayted lymphoedema service centers that would aim to identify
patients with swelling early so that treatment is timely and effective and enables
patients to remain active and to self-manage their condition.

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

DEFINING THE
DESIRED 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

The project

The 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)

Range of Problems
Lymphoedema and Processes they need
associated cellulitis
Diagnosis
Diabetic foot
Dressing
Non Specific Ulcers
Bandage
Antibiotics/other medicines
Physiotherapy and
Exercizes
Most can be understood through
visual or aural means so IT based
support possible


More Details
Local health workers provide Set up franchises with local
basic care on a profit sharing Surgeons for
model 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

Limb care clinics
?Funding
Agency/
(Funds)
SATHI AIIMS/GMC
(Conceptualization Coordinator Local Hospital
and implementation) Hardware
Consumables Plastic Surgeon

Expert Doctors LOCAL NGO/ Patients
VLE

Range of diseases:
Lymphedema/Ulcer/Venous for Limb care
Telemedicine
problems/Diabetic foot

Current Progress
Lymphedema counseling
centre at AIIMS
– Around 200 patients given
advice (mostly breast cancer)
– Support from Rotary for free
bandage kits


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


Camp at Cardinal Gracias Hospital
Vasai (Thane)

67 patients seen in 1 day
51 given initial dose of penicillin
14 planned for surgery
Candidiasis in 49


Vasai Experience


Rural Centre in Sindhudurg
Training and Orientation Setbacks
camp done Connectivity slow
Wide publicity thanks to s

Press conference No doctor to administer
Penicillin!
Machine provided curtsey
RCDS Nearest identified and
approved hospital is Goa
Online sessions through
but a different state
Skype

–


Goa Medical College
51 Patients seen, Lectures and Inquiries for further extensions -
two demonstrative surgeries Kerala, Orissa, Tamilnadu
done in a 3 day workshop s
Plan to set up 3 centres in
collaboration with DHS
–


A Teaching example

Wrong - adding obstruction
The correct method


To summarize
www.sathi.org
Lymphedema is common and treatable with or without
ulcers
Treatment mostly at the community level -
requires care of infections and Compression

A community based approach supported by telemedicine
has been started

48 million pts are suffering


Dr. Karanvir Singh
MBBS, MS, FRCS (Glasgow)
Consultant Surgeon
Head of Medical Information Informatics
Sir Ganga Ram Hospital

 Data mining
◦ Extracting patterns from large data sets

 Business intelligence
◦ Analyzing this data with an aim to support better
decision making

 Hospital information systems capture huge
amounts of data

 Although reports are available for viewing
captured data, analysis is not always possible

Abnash Puri
Arun Kumar
Ashok Kumar
Chander Kanta
Gouri Ghanshyam How many persons have a K in their name?
Gulab Devi
Gulab Chhikara … or R
Harkishan Batra … or S
Jaya Sonowal
Lalita Singh How many have all three in their name?

K R S
Abnash Puri Ö Ö
Arun Kumar Ö Ö
Ashok Kumar Ö Ö Ö How many persons have a K
Chander Kanta Ö Ö in their name?
Gouri Ghanshyam Ö Ö … or R
Gulab Devi
Gulab Chhikara Ö Ö … or S
Harkishan Batra Ö Ö Ö
Jaya Sonowal Ö How many have all three
in their name?
Lalita Singh Ö

…before the questions are asked

 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.

 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

Internal process monitoring
Clinical data analysis
Financial analysis

 Looking up patients with Diabetes and
Hypertension

◦ Diagnosis_2.avi

Operation diagnosis analysis

◦ Operation Diagnosis analysis.avi

 Dashboards interact with users. They can
accept input parameters and display results

 Key Performance Indicators (KPI)

C_Section.avi
Lab income.avi

 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

 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

Role of Knowledge Based
Expert Medical Systems in
improving Quality of
Healthcare
NCMI 2012 – Paper submission 64

DR SHRUTI GADGIL, MBBS, IAMI Life member

31-Jan-2012 Dr Shruti Gadgil 1

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 India


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


Clinical Workflow & CDSS
• Patient’s Demographic Details Inputs to 1. Patient’s age, sex
• Patient’s Insurance Details CDSS 2. Insurance Health Plan
Patient Registration

• History of present illness 1. Chief complaints
• History of known medical conditions & Inputs to
2. Allergies
allergies CDSS 3. Vital Signs
Initial 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 up
Consultation (part 2) • Follow up instructions 4. Patient’s experience of episode of
with Physician for
plan of action care


Measurement Of Quality Of Care – A key
Driving Factor

Physician
Performance
Monitoring

Measurement
of Quality of
Care

Improvement in
Quality of Care and
Reduction in the cost
of Healthcare


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.


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.


Benefit to All – cont….


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.


Knowledge Based Expert Systems – Need
in 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.


Benefit to All

Thank You!


EVALUATION OF COMPUTER USAGE IN
HEALTHCARE DELIVERY AMONG
PRIVATE PRACTITIONERS OF NCT DELHI

ORAL PRESENTATION

Ganeshkumar P* Arun kumar sharma O.P.Rajoura

Assistant professor, Department of Community
Medicine,
SRM University, India.

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


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


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


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



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


• 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


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


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


THANK YOU FOR YOUR
ATTENTION
DR.P.GANESHKUMAR MD
SRM UNIVERSITY
ganeshkumardr@gmail.com
+91 98406-40483


WISHING YOU ALL MERRY CHRISTMAS
AND A VERY HAPPY NEW YEAR

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Graduate Institute of Biomedical Informatics
College of Medical Science and Technology
Taiwan Medical University

Taiwan
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