Telemental Health Counselling

Dr S B GogiaSATHI

S.A.T.H.I.Society for Administration of Telemedicine and Healthcare

Informatics

A Resource Organization for

•Developing Software

•Training of personnel

•Field Testing

•Project management– Tsunami Relief

•Standardization

What is Tele Medicine

•Tele ~Distance Medicine - An all encompassing term for any medical opinion or procedure carried out in which the user (i.e. Patient) and the provider (the Doctor) are not in the same premises. Range is from Telephonic consultations to Robotic Surgery

Where does it help

• Dissemination of knowledge• Fixing appointments• Tele-consultations• Online Discussion Groups• Tele Education• Online Training of Health

workers• Follow up

Equipment Required• PC• Communication Link• Multimedia accessories

– Cameras (Digital and Video)– Sound Devices

(Microphone/handset/Speakers)

• Medical Data Conversion Devices• Relevant Software

– Database for Medical Records– Video Conferencing– Image Editing (DICOM /JPEG)– Wave Form Transfer (ECG/EEG etc)

The Telemedicine solution

• Ensure access to specialists’ services

• Ensure quality of services

• Enable people – to articulate their needs– participate in interactive sessions with experts

• Enable service provider to be need specific

• Strengthen the health care delivery system

• Increased efficiency of service provider - more coverage

Psycho social Problems Largest cause of long term morbidity Proliferation in all chronic diseases Cancer Patient is (Why me)

Lonely and distressed Unable to work Unable to face the world

Wounds/scars/Loss of hair/LE

Guilt feeling Sick of doctors and injections

Counselling possible online

SATHI Tsunami Project- a case report

This project was conceptualized to provide Telemedicine based healthcare support to

the tsunami victims in Tamilnadu

The partners

• Oxfam – Funding and administrative support• SATHI – Technical support, designing and

operationalization of telemedicine system • Local NGOs – Implementation and coordination• Government of TN

– Service delivery– Frontline workers – Health subcentres/ PHCs

• Specialists’ institutions for actual Expert advice (SCARF, AIIMS)

Managing Change

• Needs AssessmentNeeds Assessment• Check BackgroundCheck Background• Concept marketingConcept marketing• MOUsMOUs• InstallationInstallation• TrainingTraining

•Test SessionsTest Sessions

•StreamliningStreamlining

•Create TCS Time Create TCS Time TableTable

•FeedbackFeedback

•Reporting Reporting MechanismsMechanisms

Technology contribution to success - 20%

Procedures followedProcedures followed

Outcome AnalysisOutcome Analysis

Outcomes

• A developed operational Model of telemedicine system that– ensures access to needed healthcare services– operable at village level – sustainable

• Capacity built : Community Health Team, NGOs, specialists institutions

• Package of Rapidly deployable Telemedicine Unit for disaster response developed and ready.

• Mental Health Services provided at community level (Over 250 consultations, 2 possible suicides prevented)

Lessons from our experience• Telemedicine possible in far flung areas• Special issues to be tackled for the same

– Connectivity– Language– Capacity Building– Orientation

• Such a Telemedicine system can improve health care delivery

• Can also provide timely help in Disasters

Problems faced by us

•New Technology

•Costs

•Service Taking Too long– Connectivity– Identification of Specialists– Identification of Caring Institution– NGO Coordination

•Funding

•Language Issues

Connectivity Problems

• PSTN Line– Not Enough Bandwidth

• ISDN Line– Not all exchanges have it– Within 2.5 Kms of Exchange– Immobile

• Mobile Phone (CDMA /GSM)– Service unreliable/ Low Bandwidth

• VSAT– Too expensive or only for Govt

• Internet/ADSL/WiFi – to be tested

S B Gogia

Lessons Learnt

• Community based telemedicine is– Sustainable– Excellent force multiplier– Effective facilitating tool for mental health

assistance

• Coordination among multiple partners necessary for operationalization.

• Difficulties in (ISDN) connectivity • Better awareness about telemedicine needed

Telemedicine is much more than Technology

Many reasons for failure but success can also teachMany reasons for failure but success can also teach

“Telemental Health is Economically viable” –Evaluation Report Findings

• “This project has indeed provided a working model to provide quality mental health care to the rural population. Further use of Telemedicine as a tool to cater to the health needs of the communities has improved availability, reduced cost and improves health outcomes at large”

• “Community empowered to seek the mental health care using telemedicine network providing access to specialists”

• “Significant local capacity built ensuring sustainability of service delivery system. Community Mental Health Volunteers Trained, Local facilitating NGO's capacity built”

Some lasting Images

General Problems

● Government – Motivation lacking

● Private sector – Not cost effective– No time

● NGOs??

The oppurtunity

● Cheaper Hardware● Better connectivity● People are more IT savvy● Higher demand

Our current efforts

● Cheap Software● Home Telecare● Tele Diagnostic services● Medical education

– Video Journals– Online Seminar

● Ekutir project (EHealth)– Implementation– Videophones