Wednesday, December 7, 2022

Trend of Bringing the Doctor Home via Telemedicine Gaining Popularity

Wireless technologies, micro-electromechanical systems, high-tech medical devices, mobile apps and the Cloud have brought about some exciting—and promising—improvements in the telemedicine and health monitoring sector in recent times -- Janani Gopalakrishnan Vikram

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VereMTB is a multiplexed molecular diagnostic lab-on-chip that can identify the specific mycobacterium causing the infection and drug resistance in less than three hours from natural samples. It eliminates the need for culturing—the most time-consuming part of the traditional method. Additionally, due to its compact size, the system can be deployed in a wide range of settings at the point-of-need.

“The remote monitoring solutions from ST are based on the most innovative MEMS devices and detect even the slightest physiological movements. These signals are, in turn, processed by an internal microcontroller, and sent via Bluetooth, Zigbee, Internet, GSM or local network to a control station for monitoring, diagnosis and urgent life-support therapy,” says Sharma.

ST’s health monitoring solutions use a range of ultra-low power microcontrollers (the STM32L and STM8L series) based on a proprietary 130nm ultra-low-leakage process technology, which decreases overall energy consumption without compromising on speed and functionality. The company also has the required technologies for both short-distance (monitoring-device-to-recording device) communication as well as longer-distance (device-to-hospital) communication. Steady communication is enabled through its STM32W wireless network line of microcontrollers as well as its Bluetooth, NFC, Smartcard and RFID solutions. Their hybrid dual-interface EEPROM is used for data logging.

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Keeping safety in mind
When developing health monitoring solutions, one should remember that it is more often than not used by people with special health constraints or conditions. Hence the solution itself must be non-intrusive and harmless without adding to their strain or causing new complications.

The non-intrusive, cloud-based pregnancy monitoring solution offered by Wipro Healthcare is an interesting example. The solution, piloted in hospitals in Bengaluru and Delhi, has been deployed in collaboration with a UK-based start-up, which provides the device for measuring foetal heart rate, maternal heart rate and other vital signs. Wipro provides the embedded systems solutions along with storage and analytics technologies on mobile and cloud platforms.

The technology, based on the principle of ECG, is so sophisticated that it can detect and interpret even the faintest heartbeat of the foetus. The wearable device is small in size as against an ultrasound device, which is large and uncomfortable, especially for women in the last trimester. The technology is also non-intrusive for the foetus and there are no transmissions to the womb as like in the case of ultrasound devices. It accurately records maternal and foetal heart rate, and uterine activity, thereby providing information on foetal and maternal well-being. The device is suited for both antenatal care, and during active labour and delivery. The comprehensive solution helps gynaecologists to monitor patients 24/7 using information delivered to their mobile.

This as well as Wipro’s cardiac care solution are based on the Wipro AssureHealth platform, which leverages Microsoft’s cloud, mobility and analytics offerings to allow care providers to monitor patients regularly and precisely. This is done through hosted services and mobile apps that integrate medical devices, IT Infrastructure and 24×7 customer support, to deliver highly-scalable solutions.

Managing diversity and individual choices
When we speak of healthcare in a country, there is a lot of diversity. There is diversity in needs, culture, infrastructure and usage. So a telemedicine platform has to be able to encompass all of these smoothly.

“Cisco HealthPresence 2.5 gives a lot of choices to our customers. Our vision is to allow healthcare collaboration across any standard video endpoint, and Cisco provides almost ten choices from low-end desktop based to mid-end Tandberg-based to high-end truly-immersive-based video endpoints. In addition to high-quality audio and video, we believe in integrating with all the relevant medical devices and giving lots of choices to our customers based on standards-based medical device integration. We also want to make it very efficient for the doctors to do the consultation. So we have enabled integration with any EMR the customer may have, as well as integration with any kind of imaging modalities,” says Gupta.

The Cisco healthcare solution leverages the network as a platform, and combines advanced audio, video and third-party medical devices to create a high-quality clinical consultation environment enabling doctor-patient consultation remotely. Primary healthcare centres or community healthcare centres in rural areas are connected to the district hospital or a super-speciality hospital that hosts the healthcare solution. The process starts with a patient visiting a village healthcare centre where the point-of-diagnosis (PoD) is installed. Thereafter, the local paramedic initiates a call with the specialist, who consults as if they were face-to-face, and gives a prescription.

“While the platform can perform well from about 256 kbps, to get the optimal user experience, we recommend about 1 Mbps. The whole interaction is managed out of a cloud with some specialised software at the edge,” adds Gupta.

The medical solution has been implemented in seven districts (Raichur, Shimoga, Chitradurga, Gwalior, Sehore, Datia and Chindwara) in partnership with the state governments of Karnataka and Madhya Pradesh. As of December 2012, they had conducted 27,000 speciality and super-speciality consultations in just one year.

“Our aim is to provide healthcare solutions to the rural population in a manner that eliminates the need to travel long distances to obtain basic healthcare facilities. Our solutions are being successfully implemented and we have contributed to the reduction in maternal mortality and infant mortality rates. Women and children form over half of the patients who use the system. We have used the same infrastructure to educate pregnant women on what to expect when expecting,” says Gupta.

Understanding rural India

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ReMeDi is one of the oldest telemedicine solutions, made for India, in India. It has around 700 village centres, each one located at a population of 5000 or less, in the most rural areas. More than 200,000 consultations have been carried out in the last couple of years, where patients have actually paid for the consultations.

The ReMeDi medical data acquisition unit and ReMeDi software can measure basic physiological parameters of the patient and provide vital information to a doctor for preliminary diagnosis. Video conferencing integrated into this solution works even at a bandwidth as low as 32 kbps. With both the capital and operational expenses reduced, it is an extremely cost-effective solution for telemedicine applications. After a minimal amount of training, the solution can be used by anybody who is familiar with the usage of computers.

“ReMeDi facilitates the basic diagnosis of a patient remotely by a doctor by enabling the real-time measurement of the patient’s ECG, temperature, oxygen saturation and blood pressure, as well as real-time transmission of auscultation sounds of the patient, captured using the electronic stethoscope. A preliminary diagnosis of cardio-vascular problems can be carried out using stethoscope, ECG and BP measurement. Using high-resolution images taken from a normal Web camera, doctors can provide eye care, dermatology and ENT services,” says Rajeev Kumar.

Multiple consultations can take place simultaneously, with the server performing the task of session management. All the medical data is stored in the electronic medical records of patients on the central server and is available on-demand. Both real-time as well as store-and-forward modes of data transfer are supported. The client-server architecture also enables various other entities (pharmacies, clinics, diagnostic labs, etc) to be part of the network. It allows associated services to be offered to the consumers through this network.

The solution features customised billing, customer feedback, offline audits, etc. It is rugged, designed for rural conditions, and is very easy to use. It is completely isolated from external power supply, and is suitable for any kind of IP connectivity. It has a low-bandwidth requirement (32 kbps) for real-time audio, video and medical data transfer. In all, it is designed perfectly for Indian usage conditions.

Providing healthcare where it matters the most
In areas like Kargil or remote villages in Andaman & Nicobar, where there are no communication links, providing healthcare would require not just technology but also infrastructure.

The Indian Space Research Organisation’s (ISRO) telemedicine pilot project was started in 2001, to overcome precisely this problem—and they have done it quite successfully. The initiative involves several system providers including Infinium, Apollo, OTRI, BEL-VEPRO and TeleVital, and connects remote health centres with city-based super speciality hospitals using INSAT satellites.

The telemedicine system consists of customised hardware and software at both the patient’s and doctor’s end, and diagnostic equipment such as ECG, X-ray and pathology microscope/camera at the patient’s end. All this is connected using a very small aperture terminal (VSAT) system and controlled by ISRO’s network hub station. A telemedicine system consisting of simple computers and communication systems conveys the medical images and other patient-related information to the specialist doctors—either in advance or on a real-time basis through the satellite link—in the form of digital data packets. These packets are received at the specialist centre, where the images and other information are reconstructed so that the specialist doctor can study the data, diagnose, interact with the patient and suggest appropriate treatment during a video conference with the patient.

Presently, ISRO’s telemedicine network has enabled 306 remote centres and 16 mobile telemedicine units to be connected to 60 super-speciality hospitals in major cities. About 150,000 patients are being treated every year.

“It is a myth that establishing a telemedicine platform is expensive and a challenge. We have been able to demonstrate that the platform costs can be brought down to less than a dollar per consultation. The basic requirement for setting up the system is hardware, software and a telecommunication link. Also, there is a significant reduction in the prices of these basic requirements, making them well within the reach of most hospitals. The expenses may even be recovered by nominal charges to the patients, which would be much less than the physical travelling costs incurred,” comments Gupta.

“The need of the hour is standardisation of telemedicine practices and communication hardware protocol in the country,” he adds.


The author is a technically-qualified freelance writer, editor and hands-on mom based in Chennai

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