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 02 June 2020
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  HEALTH CARE, INDIA - VISION 2010 - Section I
Dr. C.V.Krishnaswami
Senior Consultant Physician and Diabetologist
Head of the V.H.S Diabetes Department
- Voluntary Health Services, Chennai.
Formerly Honorary Clinical Professor &
Hony. Physician - Govt. Stanley Medical College
& Hospital, Chennai.
Deputy Editor, The Journal of the Science of Healing Outcomes (JSHO)
(Prepared in October 2002, presentation at the meeting on Health for the Planning Commission, Government of India, New Delhi).
Tele Health Service:
  To unite the knowledge and expertise of Health Care professionals and the Information Technology experts on a common platform for discussion and approval of an action plan to integrate Primary, Secondary and Tertiary levels of Health Care in our country through I.T networking of villages, districts and towns using on-line electronic medical record and interactive portal mechanism - In short, this could be termed Tele Health service.  
A Model National Health Care Plan:
  This plan requires the full support of the government, and all the Health Care groups in the Non - government sector (both voluntary and corporate), as well as the Health managerial groups (Health Insurance Companies); plus the Pharma industry, Educationists, communication experts (media), and societal transformers. Only then we could take the Nation's health Care from its present 19th century status towards the threshold of the 21st century. We have fortunately all the infrastructural facilities available within our country and what is envisaged is an attempt to integrate the various disciplines into an action module and plan its model implementation at a limited number of centers in different parts of the country for a specified period; get the feedback and inputs for any refinements, corrections etc., and finally launch the pilot schemes of Tele Health Service to several parts of the country in a graded step by step manner.  
A Time Bound Strategy:
  The time frame for the planning initiation and completion of model trial scheme should be 3 years; at the end of which the launch of Tele Health Service could be planned for selected areas in the country and its impact assessed over the next 5 years. Thus at 2010, India could be leading the countries which offer global quality modern scientific Health Care not only to the small affordable segment, but also to the rural & remotest segments of our vast and populous country.  
  National Tele Health Care Plan:  
  The first step towards achieving this National Tele Health Care Plan would be the availability of an online Tele Health Portal Which would serve three important functions that are required if any Health Care delivery system is to be successfully implemented.  
  a) Information Module: Providing speedy information to primary care physicians as well as specialists in the various medical sub disciplines regarding epidemiology, diagnosis, therapy, adverse reactions / management and preventive strategies. Also there should be availability of interactive facility (Chat mode) between the information provider and the recipient.  
  b) On-Line Electronic Medical Record System: For this to be meaningful we require proper and comprehensive as well as non-cumbersome documentation of all persons with long term disorder like Diabetes, Hypertension, Heart disease, Chronic Bronchitis and Asthma, Gastro-Intestinal problems, Chronic Neurological problems like Parkinson's, Epilepsy stroke, Dementia Syndromes / Alzheimer's, Chronic Kidney ailments etc., This can be achieved through a comprehensive on-line electronic medical record with inputs retrospectively and prospectively and retrievable by the patients and their nominated doctors, anytime, anyplace in the country or abroad. This should also be combined with interactive mechanism for teleadvice service.  
  c) Education Module: Easily accessible, informative and useful to patients and doctors and all Health-carers involved in the health care delivery system. This should be made available in English, Hindi and all other main languages in the country. This would prove to be a boon in scientific-management of several chronic disorders (during the asymptomatic stage) like diabetes, hypertension etc., and would definitely lessen the burden of complications, improve the quality of life, productivity and prove cost-effective both for the persons affected and for the country.  

Improving the morbidity, mortality of the country, particularly the Infant Mortality Rates (IMR): The National population policy 2000 has identified reduction of IMR to 30 /1000 live births, as one of the more important national socio-demographic goals to be achieved by 2010. Hardly 8 years left, the urgent need of the hour to achieve this target is I.T networking and centralized database for analysis. Tele Health Service is ideally suited for this and should be used for accessing reliable data from across the length and breadth of our country.

  Population Control Programs and Education:  
  Tele Health Service could form an ideal platform to achieve the targets in this important demographic exercise.  

Both the above points could be implemented through one of Prasar Bharathi's Education Channel, as sponsored programs, thereby earning revenue as wel

Section - 2
Diabetopaedia.Com: A Telehealth Service for Diabetes
  Diabetopaedia.com is an unique, interactive portal on Clinical Diabetes which is presently available on - line for the past one year from Chennai. This dynamic portal has been designed to meet the challenge of providing personalized information to doctors, patients and other health - carers associated in managing people with Diabetes.  
  Its online Electronic Medical Record (Personalized Medical Record Chart or PMRC) is an exhaustive health file, which offers convenience, confidentiality and maintains Comprehensive Record retrospectively and prospectively for the patients and their personal doctors. This could be easily used as a Telemedicine (Telehealth) service whereby any doctor can view his / her patient's records in totality from anywhere in the world. Also it offers opportunity to both the patients and their doctors to obtain other specialists' opinions through the Tele - Medicine channel including Chat & Conferencing facility. This facility is not necessarily only useful for persons with Diabetes, but also for other long-term (Life time) disorders like Hypertension, CAD, and Chronic Cardiovascular problems, Chronic Bronchitis / Asthma / COPD, Chronic Neurological problems (eg., Parkinson's, MND, M.S., Alzheimer's and Dementia Syndromes etc.), Chronic skin problems, Renal Problems, GI Tract conditions and many more, where proper and easily retrievable history and investigations / responses are vital for continuous management of such chronic ailments. Most importantly Diabetopaedia.com offers scope for all doctors of all specialties to participate in this unique venture and futuristic experience with assurance of utmost confidentiality and service.  
  Meeting the challenge of doctors, patients and Health - carers in diabetes.  
  Diabetes Mellitus is the commonest medical problem of the 21st century, affecting the quality of day-to-day life of over 150 million people of the world cutting across age, gender, and racial and economic barriers.  
  Diabetopaedia.com gives  
Bird's eye view of the full range of diabetes mellitus and all the complications and co-morbid conditions seen in clinical practice.  
PMRC (On - line Electronic Personalised Medical Record)  
Practice-based management  
Solutions to diabetes- related problems  
  Diabetopaedia.com gives you  
  Full scale analysis and approaches to successful management of
1. Medical nutrition therapy
2. Pregnancy, diabetes and birth
3. Diabetic foot
4. Pain relief in severe diabetic polyneuropathy
5. Non-surgical techniques in wound - healing
6. Total care of juvenile IDDM - challenges and research potential
  Diabetopaedia.com gives  
  Full scale analysis and approaches to successful management of
1. Do's and don'ts in therapy
2. FAQs
3. Emergency in diabetes and management
4. Surgeries and diabetes
5. Economics of diabetic care
  Diabetopaedia.com gives  
  Philosophy and lifestyle approaches for positive living with diabetes - and many more topics in A-Z format for easy accessibility, presented in simple intelligible language and style, and speedy downloading technology. The second section is  
The academic and research section has over 20 important peer publications, which give new thrust and direction to research and particularly in the area of JIDDDM.  
The third section deals with the setting up of an ideal and comprehensive diabetes and multi-specialty hospital and research facility with readymade architect's plan, five year financial projection, staff, structure, etc.  
  Diabetopaedia.com helps  
1 As an education and information tool; has a worldwide on-line confidential permanent and personal medical record system; and Internet gateway to their doctors and much more.  
2 As a click reference for getting 24 hour first-line advice on any day-to-day problems concerning diabetes and related complications; a guide to diabetic cooking, replete with menus and recipes…  
3 As a quick reference manual for practical algorithms on clinical diabetes including broad information and flowcharts for dealing with various types of diabetes; its comprehensive PMRC offers ease and continuity in record-keeping and can be accessed on-line anywhere in the world helping the doctor to treat the 'whole' patient.  
4 Diabetes specialist nurse educator in educating persons with IDDM and IRDM, the correct technique of self-injection through a video clip; also details on self-monitoring of blood glucose (SMBG) are given lucidly.  
5 For Podiatrists; a special section gives the gist of information on foot care from the book 'International Consensus on the diabetic foot' (with permission).  
6 Budding diabetologists will find the research and academic section useful in giving them direction and information on areas for future research particularly in juvenile IDDM.  
7 Surgeons will find this portal as their cyber-diabetologist in managing diabetes in pre, peri and post operative situations.  
8 For OBGYN it helps in diagnosing, understanding and managing the controversial GDM cases, as well as the nuances of metabolic control in diabetes, pregnancy and birth.  
9 For the emergency and ICU staff we believe this portal would be a most useful guy to help the team to tackle tricky and complicated problems like metabolic acidosis, ARDS, acute MI 'stroke' etc. associated with DM.  
10 Nutritionists and dieticians, who could click to get 'special diets' eg.renal, hepatic, low purine diet etc.  
11 Tertiary carers and health insurance groups will find the section on economics of diabetes care useful as it is dealt at three different economic levels (low-middle-high).  
Kaiser outperforms the NHS
  Kaiser Permanente, a Californian non-profit health maintenance organization, has costs similar to those of the NHS but performs considerably better. This finding emerges from a detailed study of the costs and performance of the two systems (P-135). Feachem and colleagues adjusted costs to allow for differences in the population served and other factors, and compared performance by using multiple criteria. Kaiser members have faster access to consultant and hospital services, possible because Kaiser saves resources by having only a third of the NHS' hospital utilization rate (bed days per thousand per year). The authors' attribute Kaiser's better performance to better integration of all the elements of the system, management of hospital utilization, competition and greater investment in information technology….  
  In short Diapetopaedia.com gives the A to Z in diabetes education, management and prevention plus an on-going facility of dialogue with your doctors for prevention, amelioration and management of complications.  
  This Tele - Health model could be easily replicated and multiplexed with suitable modifications for covering all medical diseases / disorders across the board.  
Section - 3
A PILOT Telehealth Care Model using Diabetopaedia.com System
  Requirements for 3000 patients Health records and managements data prospectively.  
  1. Human Resources.
2. Computers.
3. Satellite / land Connectivity.
  Requirements for 2000 patients Health records and managements data prospectively.  
  1000 Referred cases from primary center  
  1. Human Resources.
2. Computers.
3. Satellite / land Connectivity.
  Requirements for 2000 patients Health records and managements data prospectively. (A)  
  2000 direct cases at tertiary level (B)  
  1. Human Resources.
2. Computers.
3. Satellite / land Connectivity.
Information Analysis
Primary Level
Secondary Level
Tertiary level
1) Disease Frequency Index          
2) Referral Frequency Index          
3) Treatment Efficacy Index          
4)(a) Complications Index          
4)(b)Treatment Outcome Index          
5) Economic Index          
V Conclusions arising from this Data Analysis:  
Section - 4
  Summary and Salient Points  
1. This presentation and the annexure tries to give a simple, low - budget and pragmatic Health care delivery model for our vast and populous country with its multilingual, multicultural and predominantly rural based people, using a contemporary I.T tool viz. A Tele Health Portal Service (Diabetopaedia.com) and its internationally accepted on-line Electronic Medical Record System (PMRC).  
2 The main aims are  
a To develop a credible and reliable Health Database for the chronic and disabling illnesses.  
b Health education permeating through the length and breadth of our country and reaching patients, doctors and all health cares, with speedy access to information and solutions through its interactive mechanism.  
c Making available scientific and expert advice on all health problems to all sections of the people in rural, semi - urban and urban areas, through Telehealth Service.  
3 Morbidity Mortality improvement of the population particularly IMR - whose decline has stagnated over the last decade (1991-2000) viz. decline by only 6 points as compared to 34 points between 1981-1991.  
4 To run population control programmes linking the states and the control agencies and maintaining on-line records for continuous monitoring, identifying deficiencies, and improvement of performance through corrective measures.  
  It is our earnest belief that if early steps are taken to start implementing a National Telehealth care plan for our country along the lines suggested, it would go a long way in fulfilling the dreams of our Honorable Prime Minister and His Excellency the President of India, in their vision of India for the new millennium.  
Prof B.M.Hegde Health Mongering
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