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COMMENTARY
Year : 2022  |  Volume : 66  |  Issue : 4  |  Page : 527-528  

Video consultations with “Paper and Pen” health record: A path-breaking solution to troubleshoot acceptability of telemedicine practice in developing countries


1 Senior Resident, Tele-Medicine Centre, Department of Psychiatry, NIMHANS Digital Academy, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
2 Additional Professor, Tele-Medicine Centre, Department of Psychiatry, NIMHANS Digital Academy, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
3 Professor, Tele-Medicine Centre, Department of Psychiatry, NIMHANS Digital Academy, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Date of Submission29-Jun-2021
Date of Acceptance25-Oct-2022
Date of Web Publication31-Dec-2022

Correspondence Address:
Narayana Manjunatha
Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru - 560 029, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.ijph_1463_21

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   Abstract 


Telemedicine is the delivery of health care from a distance. It also includes research and evaluation of such services using health data which are stored in “Electronic Health Record” (EHR) platforms. EHR has proved to be useful in monitoring health care delivery but setting up of such platforms is tedious and resource-consuming in developing countries. With the recent surge of telemedicine utility during the COVID-19 pandemic, telemedicine has emerged to be pivotal in reaching stranded patients needing care without EHR-based practice. The practice of patient health record (PHR)-based teleconsultations in India has demonstrated how a conventional “paper and pen” method can be combined to popularise telemedicine utility. Thus, use of PHR-based system to maintain health records would prove to be a pragmatic solution for physicians in low-resource settings to improve their reach to a larger population in need for the future.

Keywords: Electronic health record, patient health record, telemedicine


How to cite this article:
Chander K R, Manjunatha N, Kumar CN, Math SB. Video consultations with “Paper and Pen” health record: A path-breaking solution to troubleshoot acceptability of telemedicine practice in developing countries. Indian J Public Health 2022;66:527-8

How to cite this URL:
Chander K R, Manjunatha N, Kumar CN, Math SB. Video consultations with “Paper and Pen” health record: A path-breaking solution to troubleshoot acceptability of telemedicine practice in developing countries. Indian J Public Health [serial online] 2022 [cited 2023 Feb 4];66:527-8. Available from: https://www.ijph.in/text.asp?2022/66/4/527/366566



The World Health Organization (WHO) defines “Telemedicine” as the delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for the diagnosis, treatment, and prevention of disease and injuries, research and evaluation, and for the continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities. This WHO definition clearly states that telemedicine involves not only the process of medical consultation but also patients' health data storage, retrieval, sharing, and audit.[1] Conforming with this principle, the Ministry of Health and Family Welfare, Government of India brought out the “Electronic Health Records (EHRs) Standards for India” in 2013 which was subsequently revised in 2016.[2] EHR-based telemedicine is a virtual framework that warrants encoding, storing, and retrieval of the medical records that are maintained in a server online with an aim to strengthen and streamline Telemedicine services in all possible dimensions.[3] EHR has proved to be meritorious in various ways improving the legibility of clinical notes and prescription, program monitoring, and hospital administration.[1] However, setting up an EHR platform needs to fulfill the prerequisites such as (a) a power source with a viable network and servers, (b) trained medical and non-medical staff who handle the interface (c) processes that include timely orientation and training of hospital personnel on updating and utilizing the system and (d) hardware and software which translates to an end-user friendly interface.[1] Most low-resource settings do not afford to maintain such full-fledged EHR owing to the inability to invest in either one or more of the components mentioned above.

While implementing EHR-based teleconsultation is possible for multispecialty and higher institutes, standalone practitioners cannot afford the such infrastructure and the very purpose of telemedicine; i.e., “healing from distance” might not be served. In countries with low doctor−patient ratio and poorly distributed physicians across rural-urban geography, telemedicine should prove to be a vital tool in having better penetration of healthcare delivery. The requirement of such prerequisites as EHR to initiate teleconsultations may constitute challenges in accepting telemedicine as a preferred tool by physicians to provide health care. In fact, physicians have raised hesitations as it is time-consuming, concerned regarding privacy and security of patients' data, fear of being penalized by patients in case of confidentiality breech due to cyber fraud while using EHR-based platforms.[4] Lack of awareness and regulations in using telemedicine as a standalone tool for consultation and management in most developed countries has led to unpopularity of telemedicine.[3],[4] Upcoming studies have documented resistance among hospital personnel in utilizing EHR-based telemedicine practice due to substandard end-user interface on account of unaffordability of simpler software and hiring skilled engineers, small settings where patient data is limited and minimal scope in maintaining administrative data and recurrent investment in time and manpower for training hospital/health care personnel on using the system.[1],[3],[4]

The recent Telemedicine Practice Guidelines 2020 released by the Government of India has regulated its use with minimal standards of record maintenance as simple as a patient health record (PHR). Physicians are expected to maintain a log of the tele-based interaction for a stipulated period, not necessarily using EHR platforms.[5],[6] Few medical branches, for example, the Telepsychiatry Operational Guidelines 2020 provide an option for psychiatrists to choose a standalone telemedicine solution without EHR and can maintain patient details manually in a physical file (similar to traditional in-person documentation) directly.[7] In such practice, technology can just be used for consultation and its related purpose like scheduling appointments, consultation via video-conferencing application/software, and transmitting prescription.[8],[9] This has proved to be a feasible and acceptable practice among patients and physicians.[10]

The WHO definition of telemedicine remains idealistic and has not demonstrated a pragmatic approach. The practice of video consultation with PHR; i.e., paper and pen-based maintenance of health data is the way forward to break the barrier for physicians accepting telemedicine readily.[8] Integrated telemedicine solutions entail EHR with video conferences and automated digital prescription facilities. Maintaining EHR poses ethical and legal dilemmas and can be costly for low-and middle-income countries (LMIC). With videoconferencing being easily available via smartphones, a standalone video consultation with PHR is the near-best pragmatic solution for LMICs.[8],[9] With a dearth of experts across stakeholders in setting up optimal EHR-based telemedicine services, LMICs need to demonstrate simpler and more effective ways of reaching out to their patients using information technology, thus emerging to be a potential solution for setting up quick and accessible telehealth care in the upcoming future.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Jawhari B, Ludwick D, Keenan L, Zakus D, Hayward R. Benefits and challenges of EMR implementations in low resource settings: A state-of-the-art review. BMC Med Inform Decis Mak 2016;16:116.  Back to cited text no. 1
    
2.
Electrronic Health Record, Government of India, 2016. Available at https://www.nhp.gov.in/NHPfiles/EHR-Standards-2016-MoHFW.pdf . Last accessed on 23 Nov 2022.  Back to cited text no. 2
    
3.
Ali F, Kamila V, Gowda MR, Srinivasa P, Gowda GS, Math SB. Setting up and providing telepsychiatry services in India. Indian J Psychol Med 2020;42:4S-10S.  Back to cited text no. 3
    
4.
Bali S. Barriers to Development of Telemedicine in Developing Countries. Telehealth. Open Access Book: IntechOpen; 2019. Available from: https: www.intechopen.com. [Last accessed on 2021 May 06].  Back to cited text no. 4
    
5.
Board of Governors – Indian Medical Council. Telemedicine Practice Guidelines MCI, India – 2020. New Delhi:Indian Med Council; 2020.  Back to cited text no. 5
    
6.
Dinakaran D, Manjunatha N, Kumar CN, Math SB. Telemedicine practice guidelines of India, 2020: Implications and challenges. Indian J Psychiatry 2021;63:97-101.  Back to cited text no. 6
  [Full text]  
7.
e-Book: Telepsychiatry Operational Guidelines-2020 | Indian Psychiatric Society. Available from: https://indianpsychiatricsociety.org/e-book-telepsychiatry-operational-guidelines-2020. [Last accessed on 2021 May 06].  Back to cited text no. 7
    
8.
Das S, Manjunatha N, Kumar CN, Math SB, Thirthalli J. Tele-psychiatric after care clinic for the continuity of care: A pilot study from an academic hospital. Asian J Psychiatr 2020;48:101886.  Back to cited text no. 8
    
9.
Mukku SS, Manjunatha N, Kumar CN, Sivakumar PT, Math SB. Video consultations from Tele aftercare clinic: An early experience from an Indian geriatric psychiatry service. Indian J Psychiatry 2021;63:102-3.  Back to cited text no. 9
  [Full text]  
10.
Naik SS, Rahul P, Harihara S, Pahuja E, Chithra NK, Ramachandraiah S, et al. Telephonic follow-up during COVID-19 to maintain continuity of care for persons with psychiatric disorders. Asian J Psychiatr 2021;57:102564.  Back to cited text no. 10
    




 

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