1. Role of Nurses in
Teleconsultation for patients
in remote areas
JPNATC experience
Dr Deepak Agrawal, Ms Metilda Robin,
Nursing Informatics Specialists Program,
Department of IT,
JPNA Trauma centre, AIIMS, N Delhi

2. BACKGROUND
• Bedridden and wheelchair bound patients
(head & spinal injuries) have to travel long
distances for follow up visits.
• This increases the socio-economic load on
the families.
• Scarcity of specialist doctors in rural areas
• Local doctors unable to attend to simple
queries of these patients

3. BACKGROUND
• Mobile penetration in India exceeds
90%
– The subscriber base in wireless segment increased to 563.73 million in February (TRAI- march 2010)
• Almost every family has access to
mobile
• Pilot study at JPNATC shows that all
patients could give a mobile number
at the time of registration

4. INTRODUCTION
• Although Call-centres are common in
commercial industries like telecom,
the concept has been alien to
hospitals.
• Hospitals usually have reception
desks which manage general
enquiries and appointments.

5. INTRODUCTION
• An integrated call-centre on the
other hand manages extensive
backend administrative chores and
services besides providing a host of
patient related activities on a
common platform.
• JPN Apex Trauma Centre has a
mature EMR system along with
integrated call centre

6. JPNATC-Call centre
• Call Centre agents are able to handle
basic queries and asked the patient
to attend OPD/ see local doctor for
all other queries.
• It was envisaged to have a special
cadre of nurses who would form a
middle layer for these type of queries

7. Aims & Objectives
• To evaluate teleconsultation using
nurses to handle patient queries.

8. Methodology:
• Started March 2011
• JPNATC has a call center which
provides appointment for follow
up patients & also respond to
basic queries of patients.

9. Methodology
• New software introduced in JPNATC
(New Delhi) & call centre (Noida) in
MArch 2011
– Call can be transferred to any phone in
JPNATC
– Nurse has access to agent screen in
JPNATC
– Calling party cannot access nurses
number

10. • New Cadre of Nurses created called
Nurse Informatics specialists
(NIS).
• Posted in ED round the clock
• Job responsibilities include receiving
patient queries (through call centre),
coordinating with doctors In ED &
resolving the queries.

11. Workflow
• Patient phones call centre (011-
40401010)
• Agent answers. In case of medical queries
transfers call to NIS.
• NIS understands query, opens patients
electronic chart and goes through the
patient condition
• Discusses query with concerned doctor in
ED (NS, Ortho, Surgery, Med)

12. Workflow (contd)
• Asks Call centre to patch call with
patient and gives answer to query.
• Types a ‘teleconsult’ note in CPRS
(EMR) detailing the query &
response.

13. Observations
• Of all calls received by NIS in 2012, 86%
cases were rectified & Solved by the
nurse at their level itself
• 14% cases were further discussed with
concerned doctors

14. Observations
Types of queries
• 63% medication queries
• 9% cases related to symptoms/ signs
• 16% cases related to appointments
• 13% cases others.

15. Conclusions
• Telemedicine using Nurses can play a
extremely important role in follow up
queries of patients
• Our study shows that almost 90% of
all queries can be handled at the
nurse level itself.

16. • Use of Computerised Medical records
has a vital role to enable quick
briefing of case history by the
medical personnel at the time of call.
• This project has the potential to
revolutionize health care delivery in
developing countries like India