Operations and Implementation

Oral Presentation

(OI6-03) Telehealth in the Himalayas: Operational and Clinical Challenges

Monday, April 24
12:00 PM - 12:30 PM
Location: Tangerine Ballroom

Introduction: Non availability of quality healthcare in mountainous inaccessible, regions is universal In this pilot project, remote virtual healthcare is being provided at two government centres ,Keylong and Kaza in district of Lahaul and Spiti (height 3,800 metres, population 34,000) in state of Himachal Pradesh in North India. This innovative, Public Private Partnership (PPP), provides 24/7, affordable quality healthcare to a community where people commuted 40 kms for primary and 250 kms for secondary healthcare services. Following a need assessment study, an MoU was signed by Apollo Hospitals with the National Health Mission. Government paid for all services delivered, CAPEX and OPEX. Non-compliance to auditable weekly, monthly program MIS would result in penalties.
1. To carry out a detailed need assessment study interacting with all stakeholders to customize a cost effective turnkey solution for providing remote health care, end-to-end, on a program management approach, with measurable milestones, in a first of its kind Public Private Partnership mode.
2. To identity key health issues and identify an appropriate, dependable, need based technology withstanding landslides and sub-zero temperatures.
3. To effect a major cultural transformation by recruiting staff from a secluded community and training them in a state of the art, quaternary JCI accredited institution. Urban teleconsultants also had to be sensitized, for remote community interaction,
4 To deploy a Program Management approach including budgeting, defined Service Level Agreements (SLA) for all major activities, training and retraining, capacity building, CME programs, weekly and monthly project reporting, efficient community engagement and optimized capacity utilisation with regular monitoring.
Methodology: After procuring infrastructure, the trained team activated the sites in 3 weeks. A well-integrated teleconsultation unit with remote diagnostic devices and a Comprehensive Patient Health Information System (CPHIS) was set up. Major change management issues including limited infrastructure, multiple dialects, poor health seeking behaviour and total unawareness of telehealth were addressed. Drugs prescribed and tests requested were made available. Social Health Education Programs resulted in patient empowerment and health literacy.
Results: In the first 71 weeks, 4314 teleconsults were provided including 317 emergencies. Teleconsults from 16 specialities will be reviewed. 57% were in age of 30-70 years (youngest 13 weeks oldest 94 years). Mean distance travelled for specialist consultation was reduced to 35km. 381 teleECG's, 50 telespirometry were carried out. Savings to community (besides major societal impact) justified the total $350,000 expenditure. Cost per patient will be 13$ in the fifth year. Feedback from 377 patients revealed that 92% were very happy and only 3% dissatisfied.
Innovations: Telelaboratory services with FDA approved Point-of-Care Diagnostics (1617), Tele Cervical Cancer Screening (23) solar power back up and promoting e Wellness were some of the novelties.
Takeaway: Remote healthcare delivery, in a PPP mode is socially relevant, financially sustainable and scalable. With the right partners, it is possible to innovate, customise and scale up remote healthcare in inhospitable terrains.
Conclusion: A Programme Management approach with community outreach, optimized capacity utilization, ongoing impact assessment, process re-engineering, confidence, knowledge and experience is essential.

Learning Objectives:

Ganapathy Krishnan

Apollo Telemedicine Networking Foundation

K. GANAPATHY M.Ch.(Neurosurgery), FACS, FICS, FAMS Ph.D is a former Secretary & Past President of the Neurological Society of India, Past President of the Indian Society of Stereotactic & Functional Neurosurgery and the Telemedicine Society of India. An Emeritus Professor at Tamilnadu Medical University he has been working relentlessly for the last 17 years to promote the growth and development of Telehealth in India. He has organised several international conferences (www.transformhealth-it.org). Founder President of the Apollo Telemedicine Networking Foundation the largest and oldest multi-specialty Telemedicine network in South Asia his cv is available at http://www.kganapathy.com


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Arunabh Sarma

Apollo Tele Health Services

A Social Development professional with over six years of experience of working in some of the most difficult areas of the country, like regions of Odisha and Chattisgarh, North East Region( Assam, Meghalaya, Manipur and Arunachal Pradesh) Kashmir Valley and trans Himalayan districts of Lahaul and Spiti.Experience includes execution of projects across E- Health, Skill Development and Investment Promotion sectors for clients like Ministry of Rural Development, GoI, Government of Arunachal Pradesh, Government of Himachal Pradesh, National Scheduled Castes Finance & Development Corporation, Oil India Ltd., World Vision India, and Landmark Group.


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Lovakanth Nukala

Medical Research Analyst
Apollo Tele Medicine Networking Foundation

Dr. Lovakanth Nukala, is a healthcare professional, with Bachelors degree in Dentistry (BDS). With an in MSc in Public Health Informatics, his primary interests include application of ICT solutions for quality and cost effective health care provision in rural and remote areas. He has worked on several aspects like surveillance, prevention, health promotion and health care service provision, utilization of health care data generated through Telemedicine for analysis and research. He is also involved in health education content development and delivery, and training provision for different projects.


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Saroj Thakur

Apollo Tele Health Services

Saroj Thakur, is an operations professional with bachelor’s degree in Arts. He is responsible for the day to day management of the Telemedicine units including the Teleemergency Services at Kaza and Keylong.


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Premanand Satgunam

Vice President
Apollo Tele Health Services

An ICT for Health Care professional with a particular interest in creating sustainable and viable healthcare business models for rural. Experience includes setting up ICT enabled information centers in India including being part of project management unit for Ministry of IT, GoIndia for formulating the CSC Scheme as part of the National e-Governance plan. Conceptualized, Designed and Implemented Telemedicine programs in a sustainable manner for allopathic stream including ophthalmology, emergency-support, specialty care, alternate medicine (Ayurveda and homeopathy).
Architected outreach monitoring and screening ICT-solutions for prevention of parent to child transmission of HIV/AIDS and NCDs.


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(OI6-03) Telehealth in the Himalayas: Operational and Clinical Challenges

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