Â A revolution is happening in healthcare sector. It is called: Telemedicine 2.0. This new revolutionÂ is providing many with the hope of access to quality healthcare anywhere, anytime
By Pragya Gupta
Handheld devices have very important role to play inÂ hospital information management and patient care.Â Devices like PDAs, smartphones, tablets, hand monitors,Â and scanners are easily available in the market. TabletsÂ are the latest in the array of devices that the healthcare segmentÂ is betting on.
Usage of tablet computers and smartphones in health segmentÂ has had the effect of providing us with better outcomes inÂ patient care. Tablets and smartphones are widely being seenÂ as tools for expanding the reach of education. But now theÂ healthcare industry is taking the leverage of handheld devicesÂ like tablets to have an efficient health service delivery.
The Rise of the Handheld
Healthcare industry works as an enterprise, which has far tooÂ many critical needs and features. Enterprise segment has alwaysÂ been chasing after mobility. Tablets were first accepted asÂ mobile computing devices by consumers, but gradually theirÂ significance has been realised by two important sectors whereÂ reach is still a challenge – healthcare and education.
Healthcare delivery is a function of diagnosis, care plan andÂ timely action. The handheld devices can help in reducing theÂ time that is usually wasted in transmitting information from oneÂ interface to another. Devices can lead to seamless integrationÂ of information leading to a faster decision making process.Â However, use of new devices and technology must be combinedÂ with good clinical practices.
The handheld products and its applications are accepted inÂ the vertical because of the mobility it offers to the doctors andÂ patients for care and administration.
Devices improving healthcareÂ delivery
There are two major roles that tabletsÂ play in healthcare. The first is clinical roleÂ that is for patient care and the second isÂ for non-clinical role, which is mainly administrative Â in nature.
In the clinical process, these devicesÂ are directly used for diagnosis and careÂ like the glucose checks, blood pressureÂ equipment, ECG and ultrasound, etc. Â Over a period of time these devices haveÂ become smaller and smaller and are nowÂ more or less âportableâ.
Their non-clinical use offers CEOsÂ and managers the facility to track theÂ performance of the hospital. Use of tabletsÂ and smartphones keep them connectedÂ round the clock through closed Â group emails, group instructions, customerÂ feedback, graphs, charts, etc.
These days it has become commonÂ for ordinary stores and nursing countersÂ to use the bar code scanners for quickÂ disbursal.
âTypically hospitals where IÂ worked they use Bar code scanners inÂ lab for sample collection and processingÂ in automated equipment. There areÂ glucometers in wards, portable USG,Â ECG, Blackberrys for communicationÂ and emails for all senior managers,Â and few other devices,â says Dr AkashÂ S Rajpal, MD and CEO, EKOHEALTHÂ Management Consultants Pvt Ltd andÂ former AGM-Operations and IT Head, LÂ H Hiranandani Hospital.
Healthcare providers are always hardÂ pressed for time. The premise of a handheldÂ device is to bring information in a mobileÂ work environment at the time of need.Â Such a promise holds a huge benefit in a Â healthcare setting. This can free the providerÂ from being tethered to a desk.
CIO, Max Healthcare Pvt Ltd
âWe are actively planningÂ to extend the reachÂ to our various dataÂ sources on hand held Â devices. Towards thisÂ end we are looking for windows based devicesÂ which should be costÂ and power efficient, andÂ provide new features likeÂ handwriting and voiceÂ recognitionâ
âIn our hospital, we have implemented Â mobility of access device at the pointÂ of care by the use of âComputers onÂ Wheelsâ. Access of diagnostic images Â on handheld devices and patient ADTÂ messages are also being made available.Â Looking at the new age of tablets, Â I soon see some of the roles done onÂ COWs moving to these tablets. Additionally,Â these tablets have Â good softwareâsÂ for handwriting recognition, which theÂ doctors really need for entering notesÂ into the computer,âÂ says NeenaÂ Pahuja, CIO, MaxÂ Healthcare Pvt Ltd
There are manyÂ other critical applicationsÂ where tablets Â and handheldsÂ are playing crucialÂ role. Some of the Â important areasÂ where handhelds Â are being adoptedÂ include ECG (OPD/Â Consulting Â rooms,Â wards, ICU, casualty,Â and monitoring devices whileÂ shifting patient with bed/ambulance), Â Blood pressure devices, USG(portableÂ in ward/ICU), Pulse oximeters (ICU/Â Casualty), diabetes insulin monitors,Â fetal heart monitor(labour room/ward),Â TENS (Transcutaneous Electrical NerveÂ Stimulation(physiotherapy/ward/OPD), Tablet PCs for consultants, nurses toÂ view patient charts/communication), Â inventory scanners (bar codes in lab,Â pharmacy and stores), Smartphones inÂ administrative and nursing for dose calculation,Â home alerts, home monitoring devices after discharge.
Market and players
A report has estimated that total handheldÂ healthcare device market is aboutÂ US$ 9 billion. Total sales in 2009 for patientÂ monitoring tools was about US$ 6 Â billion and PDAs, Smartphones, TabletÂ PCs and handheld scanners generatedÂ about US$3 billion. Market is expectedÂ to grow at a rather fast pace.
Many players have now introducedÂ customised tablets for healthcare. RIM,Â Apple, GE Healthcare, Global Media,Â Medtronic, Omron, Siemens Healthcare,Â Socket Mobile, Welch Allyn, HP, Motorola, Â etc. are now offering products in variousÂ platforms. In fact, Blackberry andÂ Apple are leaders in tablet and smartphone Â market in healthcare. AndroidÂ platform based devices are also gainingÂ momentum in the market as the openÂ platform of Android is an attraction.
Healthcareâs wish list from handheldÂ devices
With the increasing utility of these productsÂ more and more healthcare providersÂ are seeing tablet as a solutions forÂ providing better service and internal hospital Â management. Still there are manyÂ hospitals, which have not adopted theseÂ handheld devices due to reasons like lackÂ of supporting infrastructure in the hospital, Â resistance among doctors, securityÂ related issues, etc. But they are welcomingÂ tablets with open hands and lookingÂ forward to adopt these devices in Â nearÂ future. Dr Karanvir Singh, (Head of HISÂ Implementation), Sir Ganga Ram HospitalÂ (SGRH), Delhi says, âPersonally, I feel that Â handheld devices have a big role to play inÂ hospital information systems.â However,Â the hospital is yet to adopt tablets.
Many hospitals have started by usingÂ handheld devices from one vendor,Â and gradually they started using devicesÂ from multiple vendors. For instance, NarayananÂ Netralaya started with iPad andÂ now they are using blend of iPad andÂ BlackBerry. Similarly, Max healthcare isÂ using iOS, Android, and Blackberry, allÂ of which allow the provider to access diagnostic Â images and results in real time,Â helping a faster formulation of care plan.Â For mobility on EHR, they are working onÂ Windows based tablets.
Dr Anand Vinekar
Dr Anand Vinekar, Associate ProfessorÂ & Head, Department of PediatricÂ Retina & Pediatric Visual Rehabilitation,Â Narayana Nethralaya Postgraduate InstituteÂ of Ophthalmology, Bangalore, says Â âWith the use of these devices, I can talkÂ to patients and ensure that I am seeingÂ your reports and images according to the Â condition we will call you for consultation.Â If technician gives the report, patient feelsÂ that the doctor has not seen report or not Â paid attention. We thought we need toÂ integrate it to cover the gap so we haveÂ started with Blackberry solutions.â
The adoption level at private hospitals isÂ more than that in government. However,Â government hospitals are gearing up toÂ equip themselves with tablets and otherÂ handheld devices.
Tier -2, 3 and rural markets offerÂ huge potential for tablet and smartphoneÂ companies. This is a market thatÂ needs infrastructural revamp to integrateÂ handheld devices in non clinical Â function. The increasing popularity ofÂ 3G and WIMAX technologies in the ruralÂ areas and smaller cities will reinforceÂ the adoption.
Hospitals that have experience in tabletsÂ are looking for acquiring more andÂ more tablets. âWe are actively planningÂ to extend the reach to our various dataÂ sources on hand held devices. Towards Â this end we are looking for windowsÂ based devices which should be costÂ and power efficient, and provide new Â features like handwriting and voice recognition,âÂ says Neena Pahuja, CIO, MaxÂ healthcare
Factors for choosing handheldÂ devices
Security â If doctors use their own tabletsÂ than there should be a way of making Â sure they can be used securely.
Mobility â Mobility is the key. WhileÂ opting for any device it should be crossÂ checked whether it suits your requirement.Â For instance, to conduct remoteÂ consultations with a patient faster connectivityÂ and high resolution camera optionsÂ in a tablet is a must.
Battery life â Mobility can only be offeredÂ if tablets have battery backup forÂ long hours. Invest in devices with a longÂ battery life and short recharge time.Â Available apps â Different tablet runsÂ different apps, so it is really important toÂ research and compare what all application Â are available on different platform.Â The tablet should be chosen that supportsÂ all the apps that a doctor needs.
Central file system â The AndroidÂ operating system includes a centralizedÂ file system. The iPad lacks this, meaningÂ files might not be easily movable fromÂ one app to another.
Note-taking style â Certain tabletsÂ allow freehand sketching and longhandÂ note-taking, which some doctors mayÂ prefer.
|âTablet TechnologyÂ Goes a Long Way inÂ Establishing EffectiveÂ Servicesâ
Please give us an overview about tablet market in IndiaÂ especially in healthcare segment?
Tablet devices could deliver a lot to doctors, practitioners andÂ telemedicine experts. In India, there is a huge need to outreachÂ the rural population through technology such as telemedicine.Â These tablets actually make a massive change in Â the way weÂ deliver services. It is going to bridge the gap between doctorsÂ and the number of patients. This helps him track many patients Â and he can actually talk to the patient via video chat. TheseÂ technology interventions actually go a long way in establishingÂ how big vendors are making it available in the right time Â at the right place. The devices which are out of the field canÂ be controlled from a central location, and thatâs what a Blackberry Â enterprise server does. So BlackBerry Enterprise ServerÂ at the core allows this data from those devices securely and aÂ specific compression technique reduces the band width and Â battery usage
This is an emerging space. It could be annoying to put it as aÂ market cap, because, itâs just an outcome. We have deployedÂ services at various places like Narayana Nethralaya, MaxÂ Hospitals and Nanavati Hospital in Mumbai. Our technologyÂ platform provides seamless support to the right and relevantÂ partner for developing deployed solutions.
What can be the emerging areas where these PlaybooksÂ or tablets, the hand-held devices can be used?
Recently, we launched the e-track on Playbook. e-track is anÂ equipment that sets in the ICU and monitors about 12 or 14Â parameters of the patients in the ICU. This kind of technologyÂ made this collaboration very much easier. Another area isÂ urban-rural telemedicine to remove the rural part. TechnologyÂ reduces the time and thus facilitates better healthcare serviceÂ delivery.
By when do you think we can expect such servicesÂ expansion in India?
Teleopthalmology solution in Narayana Netralaya or the e-trackÂ which is the ICU monitoring has already emerged as a successÂ and the pilot phase will be finished by March. We areÂ working with government and government hospitals to createÂ a commercial and sustainable model. The early adopters as ofÂ now are definitely the private players. But definitely governmentÂ hospitals are also coming up. We have seen lot interest a lotÂ of interest from the government side also at the telemedicine Â congress, the Cardiology Society of India. A huge interest fromÂ the e-governance groups at the centre, from NRHM, they areÂ all very interested and they are discussing this technology andÂ they are supporting this. The government has equally invested Â in this, just waiting for right model that will make it scalable andÂ sustainable.
What should be done to overcome concerns aboutÂ privacy and lack of infrastructure support?
We need secure relations in India where the patient demandsÂ for privacy of his reports irrespective of the fact how minor aÂ problem may be. In rural setup, a doctor addresses one patientÂ in a single room with others waiting in the same room,Â thus violating the privacy of the patient. When I talk enterpriseÂ grade then we shouldnât be quiet. We can still make it workÂ through a sustainable solution.