A Mobile Telemedicine Solution to Support Limb Care in Rural India

摘要

The purpose of this presentation is to share experiences of SATHI project and to introduce a mobile telemedicine solution to support limb care as our future work in rural India. Recent advances in Information and Communications Technology (ICT) and widespread use of mobile phones, present an opportunity for alternate methods of healthcare delivery to rural population in resource poor settings. Mobile phones can have a tremendous impact in disease surveillance, data collection and remote patient monitoring. We therefore proposed, “Sana” a pilot mobile telemedicine program for supporting limb care in the rural areas of India. Sana’s technology is a mobile phone-based, open source software platform for providing telemedicine services. The Android-based system supports multimedia (audio, images, and soon video), location-based data, and text. In a health clinic, a healthcare worker interviews a patient and collects data through a step-by-step clinical protocol on a smartphone. As patient data is collected and uploaded, diagnosis-specific information is automatically requested by the Sana system. The partner hospital’s physician can read the clinical information about the patient and make appropriate diagnoses and treatment recommendations from his or her urban location. The Sana system is easy to use and highly customizable; doctors can build customized questionnaires for healthcare workers and can create decision trees for diagnosis, triage and treatment to broaden the healthcare workers’ scope of practice. The limb care application on an Android based mobile phone was integrated with an electronic medical record system (OpenMRS) for portability and used by primary providers to collect the data during point of care. All data obtained were uploaded from the phone by the primary providers or health workers to OpenMRS which could be accessed at a remote site by an expert. They made recommendations for further follow up or care management. Compliance rate for follow up and definitive treatment at secondary center was monitored through OpenMRS. The objectives of the current limb care program is that while care is simple, there is a lack of knowledge of how to treat. This needs to be upgraded and use of telemedicine technology can provide a great boon in this aspect. For lymphedema specially, treatment is largely long term and can be domiciliary or community based. Diagnostic modalities like examination and history taking can be done and reviewed online. Hints on how to manage the problem properly are then provided aided by visualization which is done in real time using Video Conference or transmitted through store and forward of images or multi media. Hospitalization is required only for a short while when there need for a procedure.SATHI, an NGO is now trying to provide online support to rural practitioners to help them setup community based limb care centres especially for common simple problems like ulcers and lymphedema. Because of the similarity of the treatment, those providing leg ulcer services can use their extensive experience in lower limb compression bandaging, for management of associated lymphoedema. This entails additional training in use of pumps, Manual Massage (MLD) compression bandaging. Development of compression hosiery – taking measurements and the fitting of compression garments, shall be added over time. A three tier system is planned where in, bandages and other materials are provided to rural practitioners. Telemedicine based support and video conference is done with surgeons in nearby hospitals who do the initial examination, monitoring as well as call the patients to their hospital for procedures or management of complications. Door to door awareness programs are planned through link workers as well as Community Educationists. SATHI does the administration and overall supervision to ensure that the requisite equipment as well as consumables and drugs etc are available. Skills enhancement is done upfront as well as continuously through the monitoring process. The first few clinics have been started in Maharashtra with an average turnover of 2-3 patients per week. Care has been found possible at a small fraction of just the cost of travel to the city. A couselling training centre has been setup at AIIMS New Delhi has an average of 100 fresh cases a month. Camps for orientation and training have been conducted in hospitals in Goa and Maharashtra. Plans are afoot for other centres in India as well as abroad especially in the Swaziland and San Tome and Principe in Africa. There is a great interest and support from the Taipei Medical University in Taiwan. Orientation of the stakeholders is in progress.