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Telehealth: THE NIMBLE-FOOTED DOCTOR

by: Dr. Jayanth G. Paraki 06/15/01

To successfully cope with the current demands and pressures, every healthcare professional should possess a working knowledge of computers and IT applications. The health needs of people are rapidly changing and it has become imperative to re-train healthcare professionals to meet these changing requirements. These needs reflect changing life styles, disease patterns and lacunae in medical training.

Organizations all over the world are adapting to rapid changes in different ways and an approach that has made invaluable contributions to resurrection of post-war Japanese industry is the Deming philosophy of Total Quality Management (TQM). The principles and philosophy of TQM can easily be applied fruitfully to the training of healthcare professionals even in India. Healthcare professionals (HCPs) are all those involved directly or indirectly in the care of a sick person. This includes medical students, nursing students, interns and post-graduate medical students, practicing doctors and nurses and paramedical and laboratory personnel.

There is an urgent need for such professionals to become multi-skilled. Doctors and nurses have to introspect periodically and adopt a plan for self-improvement that should include acquiring new knowledge, developing a positive mental attitude and learning new skills to meet the rapidly changing health needs of people.

Urban medical practice is dependent on availability and proper utilization of technology that complements medical knowledge and skills. Computers and information systems are playing an important role in the healthcare industry. To successfully cope with the current demands and pressures every HCP has to possess a working knowledge of computers and applications.

The field of medicine is fast evolving and rapid changes are occurring. HCPs need to not only constantly update their medical knowledge, but also deliver services to their clients quickly and efficiently. The following is a brief description of areas of medical practice or healthcare delivery that are profoundly influenced by information technology. The first field, of course, is information management, where infotech plays a very crucial role.

For instance, consider these:

• Maintenance and retrieval of patient information, clinical information, laboratory information, diagnostic processes and therapeutic processes.
• Recording and creating charts and graphs of therapy such as anti-hypertensives, insulin therapy in diabetics and long-term chronic therapy, such as rheumatoid arthritis and bronchial asthma, among a host of others.
• Creating powerful online presentations to assist patient education/treatment and producing slides for seminars and conferences.
• Enabling graphic records of patient data such as clinical photos and X-rays to be stored easily.
• Video-conferencing to share knowledge/experience and also seek and provide consultation.

What immediate real-world benefits would these usages bring in? Rapidity of interaction with patients and other professionals (located elsewhere); clarity of message and communication; ease and low-cost maintenance of health records; avoidance of duplication of records and networking are some of the immediate benefits.

The second important application area is clinical research and health education. Here the usage of infotech can directly help in:

• Evaluating effectiveness of drugs-like anti-hypertensives, anti-diabetic and homeopathy.
• Launching campaigns-such as anti-drug, anti-tobacco and anti-alcohol.
• Health education about AIDS and cancer.
• Mental health-data analysis and inventory administration and analysis, among others.
• At the high-end of automation is robotic surgery and virtual surgery. The scope is limitless.

If you consider effective technical and human implementation of computer-based systems, management of information systems is of crucial importance in the administration and delivery of healthcare in our country. Health for all by 2000 A.D. as a primary objective was proclaimed long ago by many public and private health agencies. Reaching set objectives need planning and design of systems and processes to realize the objectives.

Obviously, the key first step is to look at past efforts and their results, identify objectively the gaps between design and implementation and then take necessary corrective steps to prevent repeating the same errors. The key elements that contribute to the successful implementation of a computer-based system are the technical and, of course, human resources.

A casual market survey reveals that most companies who develop software for hospitals restrict to operational systems meant to assist and speed-up day-to-day tasks such as billing, accounting, payroll and inventory. Complex and extensive information systems are required to effectively utilize the full scope of information systems in diagnosis and management of chronic diseases such as diabetes, bronchial asthma and cancer.

Similar to medical transcription, programming health data is going to emerge as a key leader in knowledge management in the years to come. But for that computer training course would have to play a major role. We have to make learning of computers for healthcare professionals easy.

Acquisition of new knowledge and skills is dependent on the availability of a training course that is very strong in its fundamentals and at the same time easy to learn. However, most computer institutes do not offer a simple, practical training course for healthcare professionals. A fundamental course in computer skills is necessary so that healthcare professionals can become multi-skilled. The fundamental course should consist of the following modules: introduction to computers and operating systems; use of computers in healthcare; writing medical documents; creating patient and hospital databases; designing and presenting reports and scientific papers; arriving at cost-effective treatment protocols; and communicating clinical and research data.

Networking of IT professionals and healthcare professionals are desirable and extremely urgent. Considerable focus is required on development of viable information systems for hospital use. Training programmes and courses for healthcare professionals is primordial, for there is no doubt that IT's influence on the healthcare industry is going to increase in the future.