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TeleMedicine

What is Telemedicine ?

Telemedicine is the delivery of healthcare services through electronic communication and information technology between patients and healthcare practitioner.

When to Use Telemedicine ?

You have an non-emergency condition, you need care, and can’t get to a doctor, telemedicine can help you.Our telemedicine vHealth365 platform enables primary care providers to consult with medical specialists who are not otherwise available. Providers can discuss patient cases, regardless of location, and without the need for travel.Primary providers and specialists can examine patients in remote locations when distance is a barrier, as is the case when patients live in rural and underserved urban areas.

Monitoring programs can collect a wide range of health data from the point of care, such as vital signs, weight, blood pressure, blood sugar, blood oxygen levels, heart rate, and electrocardiograms.

We have been offering telemedicine consultations to African countries by partnering with primary healthcare centers, secondary and tertiary care centers in countries like Nigeria, Djibouti ,Botswana,Ethiopia, Tanzania etc.

Super-specialists from our doctor’s panel offer their expert opinions and in some cases are involved in the vitals monitoring of acute cases via our telemedicine platform.

A case in point is Mrs B who is a 28 years old female who was relatively healthy 5 years back when she developed a left upper extremities swelling .She underwent biopsy and subsequent surgery because it was diagnosed as a soft tissue benign lesion.

After 3 years it recurred at the same site with similar symptoms She went to a different hospital and got the same diagnosis and treatment.

For the last 10 months she suffered the same problem but it worsened and has pain and numbness associated with appetite loss, weight loss and sweating.

Over a telemedicine consultation with a superspecialist from our telemedicine panel, she was diagnosed to have osteosarcoma. 2 months hence she had her first chemotherapy cycle.

Telepathology, Teledermatology, Teleophthalmology,Teleneurology, Telecardiology, Tele-education for Physicians are some of the Telemedicine Speciality Consults in our repertoire.

For a detailed discussion on how our services can augment your healthcare practice, contact us at info@telradsol.com

 

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Teleradiology in Africa – A retrospective study and review

Abstract

Africa is a continent where there is a crisis in healthcare and where a significant shortage of medical professionals poses one of the most important challenges. Teleradiology and telemedicine are an innovative healthcare delivery method which can bridge the existing gap between the specialists and the patients who are currently deprived of access to healthcare. This article is a review of a retrospective study performed on cases received from the organization’s African clients who have used our teleradiology services. This provides us an insight on the patterns of utilization and acceptance in the African setting. An analysis of various disease trends is also done to get an idea on their prevalence. This analysis reveals that teleradiology can be effectively utilized for early and accurate detection of disease in Africa which in turn can lead to early and appropriate treatment, improved patient outcome, decrease in spread of infection and overall decrease in healthcare costs. However, a pre-requisite for the growth of teleradiology in these regions would be a strong telecommunications backbone.

Key words: Teleradiology, Telemedicine, Telehealth, ultrasonography

Introduction and Background

Africa faces a growing healthcare crisis. Mortality rates have been mounting quickly with negative impacts on individuals, families and the society. Chronic diseases such as Cancer, Heart disease, Stroke and infections are still prevalent. Although government and private expenditures on health care have been growing rapidly, they have not grown as quickly as health care needs, with a resulting gap between health care needs and health care delivery [1]. Upon viewing Africa’s healthcare as a unit in 2012, the picture is still one of a generally poor population, subject to diseases that have been eradicated or brought under control on most other continents [2].

The challenges to better health services in Africa are well known: Africa lags behind all regions of the world, including other developing regions, on all indicators of better health. A recent report from the World Health Organization for instance shows that while Africa has 20% of the world’s sick people, it has only 4% of its healthcare workers – many of them vulnerable to the high mortality rate associated with malaria and notably the AIDS epidemic. The state of investment in healthcare infrastructure is also grossly inadequate as is the efficiency of healthcare delivery [3]. There has been a huge shortage of physicians and radiologists in these regions leading to long report turnaround and delayed patient care. As most radiologists are based in cities, the rural regions are highly impacted. According to a KPMG report, the number of physicians per 1,000 people in 2010 in Africa is just 2.3 whereas it is 14 for the world [2]. As per another report by WHO 2010, in Sub-Saharan Africa, 14 countries do not have a single radiologist in public service [4].

Telemedicine and teleradiology can be instrumental in filling the gap between needs and delivery. Telehealth is considered a major innovation at the technological, social, and cultural levels [5]. This technology has the potential to increase access to, and quality of, health care services and to lower health system expenditures [6]. Thus, introducing telehealth as a tool to support the delivery of health care services implies numerous changes for providers, organizations, and the health system as a whole that must be accounted for during the implementation process [7].

Teleradiology basically involves transfer of diagnostic images over a network for remote interpretation. The network can extend from a village to a city or even across the globe. This helps in improving patient care by reducing the time of diagnosis, enhances quality by promoting subspecialist review and also reduces healthcare costs by utilizing manpower efficiently [4].

Materials and methods

A retrospective study on about 4111 cases (chosen by sequential sampling) was performed by radiologists at Teleradiology Solutions to see the trends and the distribution of cases across different regions of Africa. Our teleradiology workflow in essence consists of electronic receipt of images from the client site, review of the images by our team of expert radiologists, and electronic transmission of the reports back to the client site, with additional verbal discussion on as needed basis. An electronic workflow platform named RADSpa, developed with input from our own radiologists, is used in our organization for the distribution and archival of the reporting data. This simultaneously generates a large volume of data that captures all the various quality and workflow parameters that constitute the basis for our teleradiology operations. We reviewed our database for the year 2012 to assess the following parameters:

  1. Location break-up: The numbers of studies reported for African clients via teleradiology were reviewed.

 

  1. Gender break-up: The cases were divided into male or female depending on the gender of the patient.

 

  1. Distribution on the modality: The primary imaging modalities referred to our centre for reporting namely X-ray (CR), CT, MR and MG were individually evaluated.

 

  1. Distribution on the types of study: The reports of the studies were individually analyzed and broadly classified into 3 major categories (minor, normal and significant).

 

  1. Distribution of significant studies: The significant studies were further categorized on the type of disease to check the prevalence.

 

  1. Age break-up: Distribution of Studies between children and adults.

 

  1. Distribution of disease types in children: The trends of disease types in children were analyzed.

 

Results

Our teleradiology reporting services have been utilized by four different regions of Africa. The distribution of the cases among these four regions is as shown in Figure 1.

Africa

Figure 2 exhibits the distribution of the cases as per the gender of the patient. The distribution of cases across the gender was almost equal with males (54%) and females (46%).

Africa2

The modality break-up of the data is illustrated in Figure 3. The hierarchy from the most received images to the least is CT followed by MR, MG and then CR.

Africa3

Figure 4 shows the division of cases on the type of study. The studies were broadly classified into Minor, Normal and Significant based on the reports provided by the radiologists. More than 37% of cases had significant diseases which needed timely treatment. 16% of the studies had a normal report. The remainder of the cases had minor or incidental findings. The ratio of significantly positive to normal studies exceeds 2 which are high when extrapolated over an entire population, indicating low utilization of imaging restricted mostly to those patients with significant disease. It is an indirect metric that there is a significant burden of disease that remains undetected due to inadequate imaging.

Africa4

Out of the 4111 cases, we had 1199 pediatric studies. The age break-up of the total retrospective cases is shown in Figure 6.

Africa5

The distribution of the type of study among these cases is demonstrated by Figure 7. Out of these cases, 105 of them fell under the category of significant studies and only 80 cases were normal.

Africa7

Discussion:

We mainly attempted to explore the prevalence of various kinds of significant diseases across the population of Africa and evaluate if teleradiology could be an influential technology in providing superior quality healthcare to the underprivileged through this retrospective study.

The above data clearly reveals and validates that the burden of disease is huge in Africa. More than 37% of the cases had significant health diseases which could have been ignored, if not diagnosed and given timely treatment. In fact the pediatric examinations in our series show an alarming trend of more than 8% children being affected by significant diseases. As per a report by KPMG, the under-5 mortality per 1,000 live births in 2011 has been found to be 107 in Africa compared to just 57 in the world [2]. This clearly implies that there is an extreme deficiency of health professionals in these regions. An appropriate, robust, and sustainable model for improvement in health system performance is essential in order to reverse the declining trends in health and development status and break the vicious cycle of poverty and ill-health in Africa [8].

Another main issue that Africa faces is that many public hospitals are dependent on aid grants. Through such grant funding the hospital is able to purchase say an MRI scanner; however the trouble is that they are unable to adequately maintain it, due to a combination of high cost of maintenance and lack of support. So when such equipment breaks down, it breaks down permanently. This is probably the biggest problem. However, World Health Organization is attempting to establish a program to train engineers to repair the equipment. The WHO developed the Basic Radiological System a few years back, which appears to be a very durable and good system. Apart from plain films, ultrasound utilization demonstrates robust growth. There is therefore significant demand for training of health professionals in ultrasonography not necessarily just radiographers or radiologists; but potentially nurses as well [9].

 

If the challenges are overcome telemedicine can provide access to scarce specialist care, improve the quality of care in rural areas and reduce the need for rural patients to travel to seek medical attention. International cross border service can alleviate the regional shortages of doctors [10]. Telehealth can support the delivery of specialized services in a timely manner for remote populations; facilitate access to education for clinicians, and save travel costs for both patients and professionals. Moreover, as telehealth technologies become more integrated into the health care system, they will increasingly contribute to the reorganization of medical workforce supply and exert a profound influence on physician practice, especially in remote areas [5].

 

The ability to transfer digital images seamlessly around the world has globalized a previously localized medical specialty. There are few areas of medicine that could adapt to such a change so readily. Radiology is showing that it can not only cope with this transition, but can actually embrace new technology and harness it to improve speed of delivery, accuracy, reporting quality, cost-effectiveness and patient outcomes. An important factor in the success of quality teleradiology services will be maintaining open channels of communication [11], especially in the international setting.

 

References:

[1] http://dl.acm.org/citation.cfm?id=1672164&preflayout=flat

[2]https://www.kpmg.com/Africa/en/IssuesAndInsights/Articles-Publications/Documents/The-State-of-Healthcare-in-Africa.pdf

[3] http://adonisandabbey.com/book_detail.php?bookid=97

[4]http://africahealthexhibition.com/speaker-presentations/Imaging/Arjun%20KALYANPUR.ppt%20[Compatibility%20Mode].pdf

[5] http://www.implementationscience.com/content/1/1/18

[6] http://www.ncbi.nlm.nih.gov/pubmed/10884967?dopt=Abstract&holding=f1000,f1000m,isrctn

[7] http://ieeexplore.ieee.org/xpl/login.jsp?tp=&arnumber=926799&url=http%3A%2F%2Fieeexplore.ieee.org%2Fiel5%2F6709%2F20043%2F00926799

[8] http://www.wilsoncenter.org/sites/default/files/Kaseje2.pdf

[9] http://www.diagnosticimaging.com/articles/african-radiology-competes-scarce-health-money

[10] http://www.ncbi.nlm.nih.gov/pubmed/?term=Telemedicine+and+Advances+in+Urban+and+Rural+Healthcare+Delivery+in+Africa

[11] https://www.mja.com.au/journal/2009/190/1/changing-face-radiology-local-practice-global-network

 

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FROM TELERADIOLOGY TO TELEPATHOLOGY: A CASE STUDY FROM RANGIA TO BANGALORE

Introduction:

Doctor shortages are acute in developing countries, where disease burden is the greatest and resources for health care are limited. An absence of pathologists in these countries has lead to delays in diagnosis and misdiagnoses that unfavorably influence patient care and survival. The introduction of telepathology into areas with specialist pathologists shortage is however one of the approaches that can be utilized to reduce the problem.

Telepathology: How it is done:

Telepathology is the electronic transmission of computerized or digital images that can be utilized for education and diagnostic consultation. The system comprises of a microscope with a mounted digital camera linked to a computer. The pathologist selects the video images for analysis and and then submits a diagnostic report.

Telepathology systems are divided into three major types: static image-based systems, real-time systems, and virtual slide systems. Static image systems have significant advantages of being the most sensibly valued and are usable in most settings; however the downside is that just the chosen subset of microscopic fields are transmitted for review by the pathologist. Real-time systems and virtual slides permit a specialist pathologist the chance to evaluate the entire specimen. With real-time systems, the specialist effectively works a microscope located at a distant site – changing focus, illumination, magnification, and field of view at will. Virtual slide systems use a robotized scanner that takes a visual image of the whole slide, which can then be sent to another area for diagnosis.

Case study: From Assam to Karnataka:

Teleradiology solutions (TRS) based in Bangalore, India provides radiology reporting services to hospitals and diagnostic centers across the world. With its team of experienced radiologists, TRS has a decade long large cumulative experience in interpreting non invasive diagnostic imaging studies including digital radiographs, CT, MRI, sonography, and nuclear medicine studies including PET-CT. With an experience of reporting for over 3 million patient studies and an understanding of technology usage in health care, TRS extended its domain to the pathology space.

Rangia is a small town in the Kamrup rural district in the Indian state of Assam. People in Rangia had no radiologist in the neighboring area to provide diagnostic assistance. A medical entrepreneur in Rangia who set up pharmacy, ultrasound, X-ray and a pathology lab approached us for teleradiology services in 2012. After 3 years of successful teleradiology and tele ECG coverage, we found that they did not have a pathologist who could interpret their hematology slides. They had to take blood samples to a pathologist at a lab located 70 kilometers away from the clinic. After hearing about this situation, using our understanding of technology for teleradiology (RADSpa), we created a solution for telepathology (PATHSpa). And proceeded to set up a new platform for Telepathology in this small town in Assam. The camera fixed on the microscope and the unit configured to the computer was the basic investment for the clinic. Hence with minimal investment, the clinic in Assam had the basic set up for a digital pathology reporting unit.

Initially technicians at Rangia had difficulty in preparing the peripheral smear and staining it. However, with training this improved. The diagnosis and reporting of the patients was quick with the help of Telerad’s pathologist. The digitally signed reports were then sent back to the clinic through the PATHSpa platform.

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AEC- Absolute Eosinophil count, CBC- Complete Blood Count, TC- Total Count, DC- Differential Count, ANC- Absolute Neutrophil Count, P.S- Peripheral Smear

A Total of 131 Telepathology reports (As shown in the figure above) were generated over a period of six months. PATHSpa was the platform used for the Telepathology service.

Challenges of rural and semi rural India:

Most of the 620 million of rural Indians lack access to basic health care facilities as 70% of total population in India is living in villages. The Indian government spends only 0.9% of the country’s yearly total domestic product on health, and little of this spending reaches remote rural areas. The poor infrastructure of rural health centers makes it difficult to retain doctors in villages, who feel that they maybe professionally and socially isolated if positioned in remote areas.

One of the solutions for this is low cost telemedicine technology coupled with robust medical service delivery. However, telemedicine activity in India has not been free of difficulties and controversies. There are certain challenges associated with the introduction of new systems and technologies. Despite the fact that the systems are easy to use, there is initial trepidation in handling computers and other digital equipment. There is a fear that the setup costs may be high and therefore monetarily not practical. In addition, there may be specialized hitches, for example, low data transfer capacity, bandwidth and electricity outages and absence of interoperability standards for software.

However, there is a significant potential for delivering medical services in rural areas of India using Telemedicine methods. At Teleradiology Solutions we developed a customized teleradiology and later a telepathology solution, which overcomes the barrier-technological as well as professional and financial-to Telemedicine. This case study demonstrates that the benefits of teleradiology can be extended to the space of pathology as well.

Pathologist view:

Dr. Seema Pavan, MBBS, MD Pathology: I am glad to be a part of Telepathology, and to help patients in Assam where diagnostic facility is not available. Here we visualize the videos sent by the clinic technician and send them the reports. The quality of the images is good, as the blood smear is of good quality which is prepared by the technicians.

Dr. Anamika Pal, MBBS, DCP Pathologist: It’s amazing to see that with the use of technology we are able to serve patients where healthcare is scarcely available. These slides and videos are as good as personally seeing slides under microscope. There are cases where Coulter gives us wrong reports and it should be verified by a pathologist. Now Telepathology makes it possible for us to reach patients even in Assam.

 

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Tele Medicine for Corporates

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TeleMedicine for Corporates

Corporates

In this fast changing economy, corporations have increasingly matured from the traditional organizational set up to a fast pace, credible service that deliver to the high demand of the consumer market. Globalization has opened up vast global market in the healthcare spectrums to deem services and products to.

Customers now have access to a global market where borders are gradually thinning out in view of the advances in IT and communication and digital revolutions. Companies have taken advantage to open global offices and deploy their man power globally . A highly distributed and collaborative nature of today’s workforce enabled by remote access technologies raised the stakes in this fast evolving and increasingly dynamic and virtualized work environs.

Corporates are reconsidering their stance on handing over the employee’s healthcare systems to third party providers that don’t fully grasp the complexities and changing dynamics. They are looking for specialized knowledge that can fill in this gap and still meet the compliance and regulatory issues.

TRS understands this changing scenarios in the new corporate businesses and we have leveraged telemedicine to reduce the huge healthcare cost burden in view of the distributed workforce and adapting to the changing reimbursement models in different geographies and the also the dissimilarities in the Quality of healthcare when they deploy workforce in disease prone geographies like interior Asia and Africa.

With a large number of solutions that have sprung up in the name of telehealth – their relative immaturity in handling large scale enterprise wide requirements discourages their adoption by enterprises from deploying them globally. TRS Telehealth has its built in security mechanisms over cloud that can be automated and its flexibility causes the enlistment of corporates with our services and solutions.

In some situations , due to high propensity for the occurrence of occupational hazards for eg in offshore oil rigs and factories , regulatory body mandates setting up of healthcare facilities that will address any emergency for the employees at risk.

To effectively tackle all these situations that may arise in the course of business growth involves a lot of costs in terms of setting up dedicated healthcare system that might take your focus away from your core business . At TRS telemedicine is not a separate specialty but an essential part of the larger eco system where delivery of clinical dare is made the top priority. As such in sync with the different needs of the customer , we aim to bring high quality point of care delivery through a combination of deep domain expertise , operational excellence and innovative care paradigms.

Our founders and patrons are graduates of Ivy league institutions and are the virtual who is who in their respective fields and thought leaders in their areas of specialization ; coupled with strategic educational and organizational partnerships across the globe in different domains.their industry experience is unparalleled when it comes to healthcare delivery. When great teams team up ; they create truly world class products and world class solutions to age old global problems ensues.

Our products incorporate the latest advances in Mobile and Cloud Computing to delight the end user by providing a truly global experience in healthcare delivery.

Having serviced clients in over 25 countries world wide , with global delivery centres in Singapore , India, Israel and USA we have exhibited and mastered the operational efficiency that it takes to achieve excellence.

We have pioneered telehealth concepts being a world leader in innovation in healthcare delivery arena be it teleradiology , telemedicine consults, telepathology, telecarediology, teleneurology , etc. We have incubated and launched widely successful initiatives like clinical imaging and tele –counselling to tele-education .

 

Providing telehealth and corporate healthcare solutions and services to over 60 global clients through our subsidiaries have taught us a thing or two about telehealth in corporate arena. We are the healthcare service provider of choice to 65 corporates in a short span of 10 years.

 

Key Services

TRS Telehealth helps you address your major corporate healthcare challenges and also supports you in your flexible work environments with fast low cost implementations and reduced burden to the clients. Our solutions and services across the entire care continuum includes

Corporate HealthCare packages

Pre and Post Employment Checks

Employee health Risk Assessments

In House Medical Services

In House Doctors and Nursing Staff

In house clinics on a BOT model

Emergency and Ambulatory Services.

Offshore Health care for the Distributed workforce.

Telemedicine Plug N Play – Completely or Partially Client Operated.

Telemedicine Hubs in SEZs and Corporate Parks.

We serve the top brands in each category as their preferred healthcare partner, because we help them breathe a sigh of relief when it comes to the health of their employees as they navigate the rough waters of new market acquisition and entering new geographies for scalability and nimble delivery.

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