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HEALTH CARE,
INDIA - VISION 2010 - Section I
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Dr. C.V.Krishnaswami
FRCP (E); F.A.M.S; D.T.M&H (EDIN)
Senior Consultant Physician and Diabetologist
Head of the V.H.S Diabetes Department
- Voluntary Health Services, Chennai.
Formerly Honorary Clinical Professor &
Hony. Physician - Govt. Stanley Medical College
& Hospital, Chennai.
Deputy Editor, The Journal of the Science of Healing
Outcomes (JSHO)
(Prepared in October 2002, presentation at the meeting
on Health for the Planning Commission, Government
of India, New Delhi).
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Aims
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Tele Health Service:
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To unite the knowledge and expertise
of Health Care professionals and the Information Technology
experts on a common platform for discussion and approval
of an action plan to integrate Primary, Secondary
and Tertiary levels of Health Care in our country
through I.T networking of villages, districts and
towns using on-line electronic medical record and
interactive portal mechanism - In short, this could
be termed Tele Health service.
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A Model National Health Care Plan:
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This plan requires
the full support of the government, and all the Health
Care groups in the Non - government sector (both voluntary
and corporate), as well as the Health managerial groups
(Health Insurance Companies); plus the Pharma industry,
Educationists, communication experts (media), and societal
transformers. Only then we could take the Nation's
health Care from its present 19th century status
towards the threshold of the 21st century. We have fortunately
all the infrastructural facilities available within
our country and what is envisaged is an attempt to integrate
the various disciplines into an action module and plan
its model implementation at a limited number of centers
in different parts of the country for a specified period;
get the feedback and inputs for any refinements, corrections
etc., and finally launch the pilot schemes of Tele
Health Service to several parts of the country in
a graded step by step manner. |
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A Time Bound Strategy:
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The time frame
for the planning initiation and completion of model
trial scheme should be 3 years; at the end of which
the launch of Tele Health Service could be planned
for selected areas in the country and its impact assessed
over the next 5 years. Thus at 2010, India could be
leading the countries which offer global quality modern
scientific Health Care not only to the small affordable
segment, but also to the rural & remotest segments
of our vast and populous country. |
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National Tele
Health Care Plan: |
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The first step
towards achieving this National Tele Health Care
Plan would be the availability of an online Tele
Health Portal Which would serve three important functions
that are required if any Health Care delivery system
is to be successfully implemented. |
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a) Information
Module: Providing speedy information to primary
care physicians as well as specialists in the various
medical sub disciplines regarding epidemiology, diagnosis,
therapy, adverse reactions / management and preventive
strategies. Also there should be availability of interactive
facility (Chat mode) between the information provider
and the recipient. |
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b) On-Line
Electronic Medical Record System: For this to be
meaningful we require proper and comprehensive
as well as non-cumbersome documentation of all
persons with long term disorder like Diabetes, Hypertension,
Heart disease, Chronic Bronchitis and Asthma, Gastro-Intestinal
problems, Chronic Neurological problems like Parkinson's,
Epilepsy stroke, Dementia Syndromes / Alzheimer's, Chronic
Kidney ailments etc., This can be achieved through a
comprehensive on-line electronic medical record
with inputs retrospectively and prospectively and
retrievable by the patients and their nominated doctors,
anytime, anyplace in the country or abroad. This
should also be combined with interactive mechanism for
teleadvice service. |
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c) Education
Module: Easily accessible, informative and useful
to patients and doctors and all Health-carers involved
in the health care delivery system. This should be made
available in English, Hindi and all other main languages
in the country. This would prove to be a boon in scientific-management
of several chronic disorders (during the asymptomatic
stage) like diabetes, hypertension etc., and would definitely
lessen the burden of complications, improve the quality
of life, productivity and prove cost-effective both
for the persons affected and for the country. |
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Improving the morbidity, mortality of the country,
particularly the Infant Mortality Rates (IMR): The
National population policy 2000 has identified reduction
of IMR to 30 /1000 live births, as one of the more
important national socio-demographic goals to be achieved
by 2010. Hardly 8 years left, the urgent need of the
hour to achieve this target is I.T networking and
centralized database for analysis. Tele Health Service
is ideally suited for this and should be used for
accessing reliable data from across the length and
breadth of our country.
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Population
Control Programs and Education: |
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Tele
Health Service could form an ideal platform to achieve
the targets in this important demographic exercise. |
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Both the above points could be implemented through
one of Prasar Bharathi's Education Channel, as sponsored
programs, thereby earning revenue as wel
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HEALTH CARE, INDIA - VISION 2010
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Section - 2
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Diabetopaedia.Com: A Telehealth
Service for Diabetes
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Diabetopaedia.com
is an unique, interactive portal on Clinical Diabetes
which is presently available on - line for the past
one year from Chennai. This dynamic portal has been
designed to meet the challenge of providing personalized
information to doctors, patients and other health -
carers associated in managing people with Diabetes. |
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Its
online Electronic Medical Record (Personalized Medical
Record Chart or PMRC) is an exhaustive health file,
which offers convenience, confidentiality and maintains
Comprehensive Record retrospectively and prospectively
for the patients and their personal doctors. This could
be easily used as a Telemedicine (Telehealth) service
whereby any doctor can view his / her patient's records
in totality from anywhere in the world. Also it offers
opportunity to both the patients and their doctors to
obtain other specialists' opinions through the Tele
- Medicine channel including Chat & Conferencing
facility. This facility is not necessarily only useful
for persons with Diabetes, but also for other long-term
(Life time) disorders like Hypertension, CAD, and Chronic
Cardiovascular problems, Chronic Bronchitis / Asthma
/ COPD, Chronic Neurological problems (eg., Parkinson's,
MND, M.S., Alzheimer's and Dementia Syndromes etc.),
Chronic skin problems, Renal Problems, GI Tract conditions
and many more, where proper and easily retrievable
history and investigations / responses are vital for
continuous management of such chronic ailments.
Most importantly Diabetopaedia.com offers scope for
all doctors of all specialties to participate in this
unique venture and futuristic experience with assurance
of utmost confidentiality and service. |
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Diabetopaedia.com
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Meeting
the challenge of doctors, patients and Health - carers
in diabetes. |
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Diabetes
Mellitus is the commonest medical problem of the 21st
century, affecting the quality of day-to-day life of
over 150 million people of the world cutting across
age, gender, and racial and economic barriers. |
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Diabetopaedia.com
gives |
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Bird's
eye view of the full range of diabetes mellitus and
all the complications and co-morbid conditions seen
in clinical practice. |
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PMRC
(On - line Electronic Personalised Medical Record) |
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Practice-based
management |
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Solutions
to diabetes- related problems |
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Diabetopaedia.com
gives you |
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Full
scale analysis and approaches to successful management
of
1. Medical nutrition therapy
2. Pregnancy, diabetes and birth
3. Diabetic foot
4. Pain relief in severe diabetic polyneuropathy
5. Non-surgical techniques in wound - healing
6. Total care of juvenile IDDM - challenges and research
potential
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Diabetopaedia.com
gives |
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Full
scale analysis and approaches to successful management
of
1. Do's and don'ts in therapy
2. FAQs
3. Emergency in diabetes and management
4. Surgeries and diabetes
5. Economics of diabetic care
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Diabetopaedia.com
gives |
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Philosophy
and lifestyle approaches for positive living with diabetes
- and many more topics in A-Z format for easy accessibility,
presented in simple intelligible language and style,
and speedy downloading technology. The second section
is |
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The academic and research section has over 20 important
peer publications, which give new thrust and direction
to research and particularly in the area of JIDDDM. |
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The
third section deals with the setting up of an ideal
and comprehensive diabetes and multi-specialty hospital
and research facility with readymade architect's plan,
five year financial projection, staff, structure, etc. |
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Diabetopaedia.com
helps |
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As
an education and information tool; has a worldwide on-line
confidential permanent and personal medical record system;
and Internet gateway to their doctors and much more. |
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As a click reference for getting 24 hour first-line
advice on any day-to-day problems concerning diabetes
and related complications; a guide to diabetic cooking,
replete with menus and recipes… |
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As a quick reference manual for practical algorithms
on clinical diabetes including broad information and
flowcharts for dealing with various types of diabetes;
its comprehensive PMRC offers ease and continuity in
record-keeping and can be accessed on-line anywhere
in the world helping the doctor to treat the 'whole'
patient. |
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Diabetes specialist nurse educator in educating persons
with IDDM and IRDM, the correct technique of self-injection
through a video clip; also details on self-monitoring
of blood glucose (SMBG) are given lucidly. |
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For Podiatrists; a special section gives the gist of
information on foot care from the book 'International
Consensus on the diabetic foot' (with permission). |
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Budding diabetologists will find the research and academic
section useful in giving them direction and information
on areas for future research particularly in juvenile
IDDM. |
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Surgeons will find this portal as their cyber-diabetologist
in managing diabetes in pre, peri and post operative
situations. |
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For OBGYN it helps in diagnosing, understanding and
managing the controversial GDM cases, as well as the
nuances of metabolic control in diabetes, pregnancy
and birth. |
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For the emergency and ICU staff we believe this portal
would be a most useful guy to help the team to tackle
tricky and complicated problems like metabolic acidosis,
ARDS, acute MI 'stroke' etc. associated with DM. |
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Nutritionists and dieticians, who could click to get
'special diets' eg.renal, hepatic, low purine diet etc. |
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Tertiary carers and health insurance groups will find
the section on economics of diabetes care useful as
it is dealt at three different economic levels (low-middle-high). |
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Kaiser outperforms the NHS
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Kaiser
Permanente, a Californian non-profit health maintenance
organization, has costs similar to those of the NHS
but performs considerably better. This finding emerges
from a detailed study of the costs and performance of
the two systems (P-135). Feachem and colleagues adjusted
costs to allow for differences in the population served
and other factors, and compared performance by using
multiple criteria. Kaiser members have faster access
to consultant and hospital services, possible because
Kaiser saves resources by having only a third of the
NHS' hospital utilization rate (bed days per thousand
per year). The authors' attribute Kaiser's better
performance to better integration of all the elements
of the system, management of hospital utilization, competition
and greater investment in information technology…. |
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In
short Diapetopaedia.com gives the A to Z in diabetes
education, management and prevention plus an on-going
facility of dialogue with your doctors for prevention,
amelioration and management of complications. |
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This
Tele - Health model could be easily replicated and multiplexed
with suitable modifications for covering all medical
diseases / disorders across the board. |
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HEALTH CARE, INDIA - VISION 2010
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Section - 3
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A PILOT Telehealth Care Model
using Diabetopaedia.com System
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| I |
PRIMARY LEVEL: |
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Requirements
for 3000 patients Health records and managements data
prospectively. |
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1. Human Resources.
2. Computers.
3. Satellite / land Connectivity. |
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SECONDARY LEVEL: |
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Requirements
for 2000 patients Health records and managements data
prospectively. |
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1000
Referred cases from primary center |
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1.
Human Resources.
2. Computers.
3. Satellite / land Connectivity.
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TERTIARY LEVEL: |
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Requirements
for 2000 patients Health records and managements data
prospectively. (A) |
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2000
direct cases at tertiary level (B) |
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1.
Human Resources.
2. Computers.
3. Satellite / land Connectivity.
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COMPARATIVE DATA AND INFORMATION ANALYSIS: |
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Information Analysis
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Primary Level
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Secondary Level
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Tertiary level
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Remarks
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A
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B
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| 1) Disease
Frequency Index |
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| 2) Referral
Frequency Index |
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| 3) Treatment
Efficacy Index |
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| 4)(a) Complications
Index |
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| 4)(b)Treatment
Outcome Index |
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| 5) Economic
Index |
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Conclusions arising from this Data Analysis: |
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HEALTH CARE, INDIA - VISION 2010
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Section - 4
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Summary
and Salient Points |
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This presentation and the annexure tries to give a simple,
low - budget and pragmatic Health care delivery model
for our vast and populous country with its multilingual,
multicultural and predominantly rural based people,
using a contemporary I.T tool viz. A Tele Health Portal
Service (Diabetopaedia.com) and its internationally
accepted on-line Electronic Medical Record System (PMRC). |
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The main aims are |
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To develop a credible and reliable Health Database for
the chronic and disabling illnesses. |
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Health education permeating through the length and breadth
of our country and reaching patients, doctors and all
health cares, with speedy access to information and
solutions through its interactive mechanism. |
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Making available scientific and expert advice on all
health problems to all sections of the people in rural,
semi - urban and urban areas, through Telehealth Service. |
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Morbidity Mortality improvement of the population particularly
IMR - whose decline has stagnated over the last decade
(1991-2000) viz. decline by only 6 points as compared
to 34 points between 1981-1991. |
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To run population control programmes linking the states
and the control agencies and maintaining on-line records
for continuous monitoring, identifying deficiencies,
and improvement of performance through corrective measures. |
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Conclusion
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It
is our earnest belief that if early steps are taken
to start implementing a National Telehealth care
plan for our country along the lines suggested,
it would go a long way in fulfilling the dreams of our
Honorable Prime Minister and His Excellency the President
of India, in their vision of India for the new millennium. |
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