1. Telemental Health Counselling Dr S B Gogia SATHI

2. 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

3. 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

4. Where does it help Dissemination of knowledge Fixing appointments Tele-consultations Online Discussion Groups Tele Education Online Training of Health workers Follow up

5. 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)

6. 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

8. 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

9. SATHI Tsunami Project - a case report This project was conceptualized to provide Telemedicine based healthcare support to the tsunami victims in Tamilnadu

10. 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)

11. Managing Change Needs AssessmentNeeds Assessment Check BackgroundCheck Background Concept marketingConcept marketing MOUsMOUs InstallationInstallation TrainingTraining Test Sessions Test Sessions Streamlining Streamlining Create TCS Time Table Create TCS Time Table Feedback Feedback Reporting Mechanisms Reporting Mechanisms Technology contribution to success - 20% Procedures followed Outcome Analysis

12. 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)

13. 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

14. Problems faced by us New Technology Costs Service Taking Too long – Connectivity – Identification of Specialists – Identification of Caring Institution – NGO Coordination Funding Language Issues

15. 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

16. 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 teach

17. “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”

18. Some lasting Images

19. General Problems ● Government – Motivation lacking ● Private sector – Not cost effective – No time ● NGOs??

20. The oppurtunity ● Cheaper Hardware ● Better connectivity ● People are more IT savvy ● Higher demand

21. Our current efforts ● Cheap Software ● Home Telecare ● Tele Diagnostic services ● Medical education – Video Journals – Online Seminar ● Ekutir project (EHealth) – Implementation – Videophones