Telemedicine in Camp Mode While Screening for Noncommunicable Diseases: A Preliminary Report from India.

Introduction: Noncommunicable diseases (NCDs) are a major cause of disease burden. NCDs are a global epidemic and India is no exception. Risk factors contributing to NCDs can be detected before symptoms occur. Screening is an effective tool. Real-time teleconsultation during screening is a value-added service. This preliminary report documents the process and observations during teleconsultations provided in NCD screening camps, across multiple locations in India. That real-time teleconsultations in camp mode make a difference and are relevant in India is discussed. Materials and Methods: To provide awareness about risk factors of common NCDs such as diabetes, cardiovascular diseases, and anemia, screening camps were conducted. A 22-member field team organizes internet-enabled camps using point-of-care diagnostics. Software was developed to capture participant details and provide decision support to the field team. This resulted in identification of participants eligible for teleconsultations. Participants with risk factors of the targeted NCDs (hyperglycemia and dyslipidemia) were offered teleconsultations during screening. Currently, the program is active across six locations (Bengaluru, Coimbatore, Delhi National Capital Region, Kolkata, Pune, and Vijayawada) in India. Results: Since program inception from August 27, 2015 to October 31, 2018, a total of 757,325 participants have been screened. Twenty-seven thousand three hundred fifty-three participants were eligible for teleconsultations. Thirteen thousand six hundred fifteen availed onsite teleconsultations; 99.8% of the 1409 teleconsultation beneficiaries surveyed were "extremely satisfied and very happy." Conclusion: Providing real-time teleconsultations to 13,615 individuals "at risk" of specific NCDs from six centers across India is doable and well received by beneficiaries.

Tele-Emergency Services in the Himalayas.

Introduction:Nonavailability of emergency healthcare services in mountainous, isolated, and sparsely populated regions is a universal problem. In a first of its kind initiative, Tele-emergency services (TES) was provided in Keylong and Kaza in Himachal Pradesh in Northern India, at an altitude of 3,353 meters with temperatures of -30°C during winter months.Methods:Existing rooms in regional hospital (Keylong) and community health center (Kaza) were converted into tele-emergency centers by connecting them, to a state-of-the-art emergency department at the Joint Commission International-accredited Apollo Main Hospital at Chennai, 2,925 km away. Training was carried out at both ends. Average turnaround time for an emergency teleconsult was less than 12 minutes. Tele-ECG, Spirometry, and Point-of-Care Diagnostics for blood biochemistry were made available.Results:In the first 35 months, 753 teleconsults were given in the 24/7 TES, out of a total of 10,213 teleconsults constituting 7.4%. Out of a total of 6,442 telelaboratory tests, 431 tests were done in an emergency setting constituting 6.7%. Of the 16 cases of myocardial infarction remotely diagnosed, 4 were thrombolysed through telementoring. Of seven patients with Supra Ventricular Tachycardia, six patients were stabilized through electrical cardioversion and one through chemical cardioversion through telementoring. Ten deaths were documented, of which one occurred at the site. One hundred ninety-six were stabilized and transferred to higher centers. Thirteen required helicopter evacuations. Detailed analysis revealed that the total average cost for a single emergency teleconsult during this period was US$208.Conclusions:Preliminary analysis confirms that delivering TES in inhospitable terrains in a Public Private Partnership mode is doable and is welcomed by the community.

Telemedicine in the Himalayas: Operational Challenges-A Preliminary Report.

INTRODUCTION: Nonavailability of quality healthcare in mountainous, isolated, inaccessible sparsely populated regions is a universal problem. In this project, remote virtual healthcare was provided at Keylong and Kaza in Himachal Pradesh (HP) in North India. This innovative public-private partnership (PPP) provides 24/7 affordable healthcare to an alpine community where people commute 20-50 km for primary and 250 km for secondary healthcare services. Following a need assessment study, an MoU was signed by Apollo Hospitals in January 2015 with the National Health Mission. The government paid for all services delivered, Capital Expenditure (CAPEX) and Operating Expenditure (OPEX). Noncompliance to auditable weekly and monthly program MIS would result in penalties. METHODS: Apollo Telehealth Services customized a turnkey solution, end-to-end, on a program management approach with measurable milestones and monthly reports. Key health issues in the region were identified. Very Small Aperture Terminals were installed amidst landslides and subzero temperatures. In February and March 2015, staff recruited from the community and local government staff were trained in Chennai. A major cultural transformation had to be effected. Urban teleconsultants were sensitized for community interaction, while deploying cutting- edge technology. RESULTS: Case records were audited. In the first 42 weeks, 2,213 teleconsults were provided, including 171 emergencies. Telelaboratory services and telehealth education programs have also been added. CONCLUSIONS: Evaluation confirms that delivering remote healthcare in inhospitable terrains in a PPP mode is effective.