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Assisted Telemedicine for Rural Healthcare Ecosystem Project Report Assisted Telemedicine for Rural Healthcare Ecosystem Project Report Abstract Analyzing, developing and executing pilot runs of an “Assisted Telemedicine” model in rural Jharkhand towards exploring feasibility and designing blue-print of a tele-consultation platform for catering to the rural healthcare needs during Covid-19 and beyond Project Team E-Health Research Center, IIIT-Bangalore (https://ehrc.iiitb.ac.in) Collaborators: PHIA Foundation (www.phia.org.in), Patharitech Private Limited (www.patharitech.com) Project Funding COVID-19 Research Funding Programme of Azim Premji University Report Authors Divya Raj (E-Health Research Center, IIIT-Bangalore) Jhumur Dey (Patharitech Private Limited) Reviewer T.K.Srikanth (E-Health Research Center, IIIT-Bangalore) Contents About the document 2 Background 2 Project Objectives 3 Execution Approach 3 Details of Field Trials 5 Location 1 – Community Health Center Kamdara, Kamdara Block, Gumla 6 Location 2 – Maheshpur village, Angada Block, Ranchi 10 Location 3 – Kurmul Village, Kamdara Block, Gumla 14 Location 4 – Gankre Village, karra Block, Khunti 17 Outcomes 20 Telemedicine Application Overview 20 Technical Solution 25 Summary of Learnings and Observations 26 Relevance in context of Covid-19 pandemic 26 Relevance for non-Covid scenarios 27 Solution Acceptance among Stakeholders 28 Other learnings and observations 30 Conclusion 32 Scope for Enhancements and Future work 32 Summary 33 Annexure 34 Assisted Telemedicine for Rural Healthcare Ecosystem P a g e | 1 About the document This document is a project report covering details of the work done for “Blue-print for Assisted Telemedicine for Rural Healthcare Ecosystem” project by E-Health Research Center (IIIT- Bangalore) in collaboration with PHIA Foundation and Patharitech Private Limited, under the COVID-19 Research Funding Programme 2020. This includes details of the overall execution approach of the Project, the telemedicine skeletal technical solution created, details on the field work done, the learnings based on field trials of the telemedicine application and also some guidance on feasible approach for scaling up this model for usage during and beyond Covid-19. Background With the outbreak of Covid-19 in India, seeing the significant benefits of the telemedicine model and the need for quickly increasing the outreach while ensuring social distancing, telemedicine usage in the country got a strong push as the Telemedicine Practice Guidelines were announced by the Medical Council of India in March 2020. These guidelines are designed to serve as an aid and tool to enable Registered Medical Practitioners to effectively leverage telemedicine to enhance health services and access to all in India. This was followed by a rapid launch of numerous telemedicine platforms and apps by private companies and startups, government and semi-government agencies across the country and a huge spike has been reported in the count of telemedicine consultations across the states. Some of the government associated platforms are also offering consultations for free. However, a closer look at the pattern of telemedicine adoption clearly shows that the spread has been limited to the metros and urban regions, and almost negligible adoption in rural parts of the country. Telemedicine in the current model, design and adoption patterns again brings to fore the factors related to “digital divide” across citizens and regions. With the above perspective in mind, with a focus on Jharkhand, efforts were designed and put in by E-Health Research Centre (IIIT-B) along with PHIA Foundation towards exploring the feasibility usage of telemedicine for Jharkhand migrant workers from the rural parts of the states. This was done by leveraging the ecosystem around the Jharkhand Migrants Helpdesk digital platform which had been implemented by PHIA Foundation, E-Health Research Centre (IIIT-B) and Patharitech Private Ltd in collaboration with Government of Jharkhand, and which continues to be operated out of Ranchi (Jharkhand) since the initial announcement of national lockdown in March 2020. Based on the studies involving two key telemedicine platforms (CDAC’s e-Sanjeevani and RIMS e-OPD) and a set of migrant workers it was inferred that the regular telemedicine model involving patients on one end and physicians on the other, posed several challenges n Assisted Telemedicine for Rural Healthcare Ecosystem P a g e | 2 likelihood of adoption of telemedicine due to multiple technical and non-technical failure points in the entire appointment and consultation process. The same platforms were also tried with few citizens from urban regions of Jharkhand and the results were positive and encouraging. And similarly success was also observed for the cases where new patients were not technology-aware but were assisted by people who were comfortable with the basics of overall processes involved. Lower digital awareness, technical glitches, connectivity and infrastructure issues, apprehensions due to new channels were some of the underlying reasons observed during these studies and field trials. The findings pointed to the need for focused efforts towards designing of new models and applications for telemedicine which are more suited for the rural ecosystem and citizens, while applying the principles of design thinking as the “bottom-up” approach. Project Objectives The objectives of the project were broadly defined as analyzing, developing and doing pilot runs of an “Assisted Telemedicine” model towards designing a blue-print of a Telemedicine platform for catering to the rural healthcare needs during Covid-19. Below activities were outlined to be done as a part this initiative: ● Analyzing the rural healthcare ecosystem in the identified blocks to closely understand the dynamics, constraints and challenges in Covid-19 times ● Analyzing the user personas of doctors in primary healthcare centres (as teleconsultation- providers), community health-workers (as teleconsultation-facilitators) and rural populations (as patients) ● Designing and developing a pilot telemedicine platform aligning to the basic principles of design thinking towards addressing the need for screenings with social distancing, and working around the infrastructure and resource constraints ● Building design features towards enabling longitudinal case history of patients and studying the possibility of leveraging those for their subsequent visits towards ensuring better quality of care and continuity of care at lower costs ● Analyzing design possibilities for incorporating concepts of “family-doctor” and “community- doctor”, integrating the proposed model with effective surveillance mechanism ● Incrementally adding features into the telemedicine platform leveraging the learnings from the trial runs. ● Identifying parameters to be considered for scaling up of the platform at district and state levels Execution Approach Assisted Telemedicine for Rural Healthcare Ecosystem P a g e | 3 The project was for studying feasibility and exploring options for leveraging tele-consultation based primary healthcare services to the rural citizens leveraging doctors in primary healthcare centres, while plugging in community health workers and paramedics for assistance. E-Health Research Centre (IIIT-Bangalore) in collaboration with PHIA Foundation and Patharitech Private Ltd did the field work and trials of this platform in Maheshpur village (Angada Block, Ranchi district), Kurmul Village (Kamdara Block, Gumla district) and Ganker Village (Karra Block, Khunti district) in Jharkhand. ● The basic telemedicine video-consultation software developed by Patharitech and IIIT-B was leveraged and customized for the technical solution (tab based application) needed for the trials ● The collaborative engagement of the three teams (IIIT-B, PHIA Foundation and Patharitech) in the JIDHAN initiative was leveraged for identification of locations, doctors and field workers needed for the field trials ● The villages and blocks were identified based on following factors: - Covering rural setups with a mix of remote and not-so-remote locations - Availability of effective and enthusiastic field workers for being able to gather patients and try out this new kind of consultation model - Availability of Doctors from government and other hospitals and clinics - Safety and security of the team members and field workers The initial approach of leveraging telemedicine for consultations with Doctors for Covid-19 related diagnosis and treatment had to be adjusted later due to: 1. Reluctance of field workers to do consultation alongside any Covid-19 suspected cases 2. Low Covid-19 incidence rate in Jharkhand, especially in the rural regions the numbers are very low Instead of this, the approach was altered to look for rural citizens who were reluctant to go to hospitals due to Covid-19 scare and arrange a consultation for them with the doctors in the government or non-government setups. In the later stage of the Project, due to challenges faced with limited availability of Doctors in Government hospitals, the team also leveraged a private practitioner in Ranchi (who was paid for each of the tele-consultations) to ensure good amount of time was spent for consultation towards getting the approach validated and get required feedbacks. This was also done to explore the feasibility of scaling up this model in non-government setups. The execution of the project was done in two parallel threads - technical software development on one side and field trials on the other.
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