Leveraging ICT

(Telemedicine) in Healthcare
Delivery System (HDS) of J&K
Sher-i-Kashmir Institute of Medical Sciences Soura
PREFACE!
• India, has a current population of 1.25 billion. By 2050, it
is expected to reach 1.6 billion. Public health planners of
the country have a big challenge to cater to.
• The performance of the health sector is suboptimal
because of an increased burden of factors like
• Political instability,
• Underdevelopment,
• Weak institutions,
• Scarcity of resources,
• Inadequately developed social sectors and
• Evident social inequalities. 2
Preface!
• However, with an increase in population, healthcare
service resources will not increase in the same proportion.
• There are big geographical disparities in health and
wellbeing of the population along with demographic and
epidemiological transitions that take place.
• Technology has a huge potential to grow capacity in this
sector due to low-cost innovation, low-priced mobile
phones and more ‘inclusive’ solutions that fill crucial gaps
in health information and access.
Your Date Here Your Footer Here 3
 To tackle these challenges, the process
of health planning needs to evolve by
the use of ICT in healthcare delivery
and distribution and public health
decision making at every level.
This will ensure delivery of right health services
to right people at the right place as well as on
right time.
ICT has the capacity to influence all aspects of
the health sector.
Your Date Here Your Footer Here 4
ICT in HEALTHCARE
Health & Education
Hospital Management System
Health Research
Health Data Management
The use of ICT in HEALTH & EDUCATION
• In this Digital era, people can easily seek, access, learn &
communicate with others within a quick span of time. This
makes education accessible, available and open to all.
Health education creates awareness among the public
about the communicable diseases, health status,
prevention measures and various current diagnostic &
therapeutic procedures. This gives a freedom to the people
to choose the best hospitals and doctors to approach for
treatment and to have their life in a healthy way.
Your Date Here Your Footer Here 6
The use of ICT in HOSPITAL MANAGEMENT SYSTEM

• ICT helps the Hospital management to lead the

organization in a successful way. This helps the
management to overcome the challenges faced by the
Hospital. ICT helps the management to improve the
patient safety and satisfaction, get updated to the latest
technology, have a knowledge on population health &
statistics and keep a note on the government mandates
on track. Primarily, the workplace can be strengthened.

Your Date Here Your Footer Here 7

The use of ICT in HEALTH RESEARCH
(Clinical Data Repository etc.)

• ICT in healthcare research helps in finding the possible

prevention measures to eradicate and reduce the
spread of diseases. We can find new technology in
diagnosis which reduces the time and cost. This saves
the lives of many individuals by providing treatment in
advance. Through ICT, the traditional healthcare
systems can be eliminated and new models can be
formed for effective quality care.
Your Date Here Your Footer Here 8
The use of ICT in HEALTH DATA MANAGEMENT
(Health Information Exchange)
• The fundamental use of ICT in Hospital is for electronic storage of
medical data. This helps to retrieve the information easily. Through ICT
the data can be transferred to the patient or to the Doctors for
consultation. The patient can have medical records in hand which can be
used anywhere, anytime.

Information & Communication Technology offers various ways to

improvise the Healthcare system. The healthcare field has to use ICT
more intelligently to bring in more changes and elevate the healthcare
to a much higher level which is important for the country’s
development.
Your Date Here Your Footer Here 9
 • 01

ICT Initiatives in J&K

Hospitals
• Fully integrated HMIS at SKIMS
• TELEMEDICINE SINCE 2002
 HMIS at SKIMS

Your Date Here Your Footer Here

 Back Office
Supportive
Services IP ADT

Pharmacy MIS/HIS OPD

Server

Blood Bank Nursing

Station
Radiology

Your Date Here Your Footer Here 12

 Administration
Operation
MIS
Theatre

Material
Security MIS/HIS Manageme
Server nt

Stores Engineering

All Labs
13

Your Date Here Your Footer Here 13

Online Patient Report

Your Date Here Your Footer Here 14

Online Patient Appointment

Your Date Here Your Footer Here 15

 • 01

Telemedicine Initiatives
 What is
Telemedicine?
Telemedicine is process of using Telecommunication
Technologies to examine patients remotely. Telemedicine
combines state-of-the-art electronics and
telecommunications technology and applications to deliver
health care and education to patients at a distance. The
electronic tools used in telemedicine include both Low-tech
tools, which includes telephones, facsimile machines, video
cameras and monitors and some High-tech tools, which
include computers, digital imagery and Internet. Using any
one or a combination of these tools to facilitate improved
health care (relative to existing norms), or to deliver health
Your Date Here
care more efficiently, constitutes Telemedicine.
Your Footer Here
Advantages of Telemedicine
• Resource utilization • Value-based care and
• Early intervention population management
• Avoids unnecessary transportation
incentives
• Community based care
• Medical education and research • Patient access/workforce
• Cost saving limitations
• Improved patient documentation • Expanding technology
• Increased range of care and
education.
capabilities
Advantages of Telemedicine
Resource Utilization
• In India doctor population ratio is 1:15000 in comparison to 1:500 in developed nations, and these
doctors are not distributed equally.
• 80% Indian population lives in rural and semi urban areas.
• Telemedicine can help in cost effective utilization of meager resources and of the same time can
decrease patient work load on few referral centers.
Early Intervention
• There are factors that inhibit the continuity of care. Issues such as geographic location, inclement
weather, socioeconomic barriers.
• Patient apathy are significant factors that delay and even prevent the specialty care.
• By providing these primary cure sites with the ability to quickly access specialty consultation services.
• Patients are able to reap the benefits of early intervention while the health care system maintains
quality service and clinical efficiency.
Advantages of Telemedicine
Avoids Unnecessary transportation
• Patient can discuss the issues on Video Conferencing with the consultant.
• Even the vital parameters and be captured with the help of devices and sent to doctor.
• Unnecessary referral and patient transport can be definitely avoided.
Community base Care
• People like to receive high quality care in their local community.
• This reduces travel time and related stresses associate with many referrals.
Cost Saving
• Reduced physician’s fees and cost of medicine.
• Reduced visits to special hospitals.
• Reduced travel expenses.
Advantages of Telemedicine
Medical Education and Research
• When medical students are posted in rural area they can be
linked to medical college for grand rounds and they can also
do case presentation
to teachers in medical colleges.
• Physicians living in different parts of the world also use
telemedicine in collaborative research, they can also share
data or can discuses current
trends.
An increasing number of conditions can now be
handled remotely
General Health Dermatology Caregiving

• Abdominal Pain/Cramps • Flu • Complex/on-going • Non-emergency

• Abscess • Gas issues: care
• Acid Reflux • Gout • Acne • Advice
• Allergies • Headache/Migraine • Rash • Prescriptions
• Animal/Insect bite • Herpes • Shingles • 3-party calling
• Arthritis • Joint Pain/Swelling • Psoriasis
• Asthma • Laryngitis • Rosacea Tobacco Cessation
• Backache • Pediatrics • Skin infections
• Blood Pressure issues • Pink eye • Suspicious
• Nurse coach
• Bronchitis • Poison Ivy/Oak moles
• Bowel/Digestive issues • Rash support
• • Behavioral Health • Physician
Cellulitis Respiratory infection
• • treatment
Cold Sinusitis • Cessation content 
• Constipation • Skin Injury • Addiction
• Cough • Sore throat • Depression Sexual Health
• Croup • Sprains & Strains • Anxiety
• Diarrhea • Strep • Sleep problems • STD Testing
• Dizziness • Tonsillitis • Bipolar Disorder • Treatment options
• Eye Infection/Irritation • UTI/Urinary issues • OCD • Referrals 
• Fever • Vaginal/menstrual issues • Family difficulties  • Prescriptions
• Yeast infection
And leveraging video, instead of a phone call, has proven to increase patient engagement
and result in a stronger, more personal connection between patient and provider
TELEMEDICINE IN J&K
• Telemedicine facility was started at SKIMS by ISRO in the year 2003 on the
recommendation of Standing Committee of Parliament.
• It was followed by installation of 11 more nodes in the state which include :
• Govt. Medical College Srinagar
• Govt. Medical College Jammu
• District Hospitals at Doda, Kathua, Kupwara, Poonch, Kargil, Leh
• Sub District Hospital at Zanskar, Uri, Tangdar.

• SKIMS being the only super specialty Hospital in the State and having a well
established IT platform including LAN for 500 Nodes, Hospital Information
System etc, serves as the HUB for the Project.

Your Date Here Your Footer Here 23

Telemedicine Facility in J&K.
Nodes established in 2002-04 Nodes established in 2004-06
• Sher-I-Kashmir Institute of • District Hospital, Doda,
Medical Sciences, Soura, • District Hospital, Kathua,
Srinagar
• District Hospital, Kupwara,
• Government Medical
College,Srinagar • District Hospital, Poonch,
• Government Medical College, • District Hospital, Kargil
Jammu, • District Hospital, Zanskar.
• S.N.M Hospital, Leh
 TELEMEDICINE NETWORK IN J&K

So far around 8000 patients have been benefited by this facility across the State
25
Why SKIMS as Main HUB for Telemedicine?
• SKIMS is the only tertiary care Hospital of J&K
• It is the first & only Organization in J&K to have a Management Information
Service (MIS) since 1982.
• Super Specialties of Cardiology, Urology, Nephrology, Neurology,
Gastroenterology, Endocrinology, Neuro Surgery, Medical Oncology, Gen.
Medicine, Plastic Surgery, Pead. Surgery, Neonotology, CVTS, Gen. Surgery.
• Advanced Centre for Genetic Diseases
• Regional Cancer Centre
• Nodal Centre for IYCF
• AIDS Reference cum Community centre.
• Fertility Centre, Bio Technology Centre
• EMRS.
Over the years from its establishment the numbers of patients
attending SKIMS, Soura has increased many folds as shown in the
table below, strengthening its position as pivot in implementation of
Quality healthcare in J&K state.
S. No. 1985 2009 2018

1 Outpatient Attendance 2.15 Lacs 5.32 Lacs 10.8 Lacs

2 Hospital Admissions 9.87 thousands 40.41 thousands 69.9 Thousand

3 Accident & Emergency 10 thousands 58.88 thousands 1.57 Lacs

4 Surgeries (Routine) 2,463 8,209 12,409

5 Surgeries (Emergency) 308 2871 4380

Your Date Here Your Footer Here 27

TELEMEDICINE IN DISASTER MANAGEMENT

• In the year 2005 India and Pakistan shared massive earth quake fallout(7.2 on richter scale)
• On Indian side the severely hit areas were Uri and Tangdhar.
• ISRO Head Quarters extended their help by way of providing Telemedicine Nodes: on at Uri
and other at Tangdhar.
• The installation was supported by team of SKIMS and formally inaugurated by Hon’ble
President while surveying disaster hit areas.
• During earth quake disaster management many patients in these areas were managed by
the local Medicos in consultation with super specialists at SKIMS through Telemedicine.
• One boy of age 10 years who had lost his parents and all others in the disaster was shifted
to SKIMS for the treatment and all the NGOs concerned about him and active in disaster
management were updated about his health daily through Telemedicine.
HON’BLE PRESIDENT INAUGURATING THE
TELEMEDICINE CENTRE AT URI
DISASTER MANAGEMENT ACTIVITIES POST
2005 EARTHQUAKE
HON’BLE CM INTERACTING WITH DISTRICT
HOSPITAL LEH
 Recently, SKIMS connected and
added two more locations, Siachen
Base Camp and Amarnath Base
Camp.

In addition, creation of
telemedicine node at Gurez is in
progress
Your Date Here Your Footer Here
SIACHEN BASE CAMP WITH SKIMS
AMARNATH -NUNWAN BASE CAMP
 Telemedicine During
COVID 19 Pandemic
COVID 19 being a largely asymptomatic disease with its
long incubation period, makes identifying a virus carrier
difficult. This essentially makes everyone vulnerable to
infection, even the non-COVID healthcare workers who are
treating patients for other diseases.

Your Date Here Your Footer Here

Telemedicine During COVID 19 Pandemic
• The ongoing COVID-19 pandemic has severely compromised the
existing healthcare delivery system.
• The pandemic poses several challenges in regular patient care even
in the tertiary care hospitals like SKIMS, where healthcare delivery
was generally deemed to be good.
• The lockdown phases have forced a paradigm shift with the health
care sector falling back on Telemedicine as a solution to these
challenges.
• As the industry gears up to face the new normal, the adoption of
Telemedicine has become one of the priority areas
Your Date Here Your Footer Here 36
Telemedicine During COVID 19 Pandemic
• To prevent healthcare facilities from being a contamination zone, it
became important to reduce the footfall of patients, especially in OPD
care.
• For the same, Deptt. of IT established a Telephonic OPD running
consultations for patients over 6 dedicated lines offering Medical
consultations on the following
• 1. Medicine and Allied
• 2. Surgery and Allied
• 3. Neonatology and Paediatrics
• 4. Medical-Surgical and radiation oncology
• 5. Obstetrics and Gynaecology
• 6. COVID 19 Consultations
Your Date Here Your Footer Here 37
Telemedicine During COVID 19 Pandemic
• Apart from this, the Department of IT also managed
one Dedicated COVID 19 helpline for the public in
general.
• To let SKIMS patients be in touch with their respective
doctors, Department of IT also provided 36 Mobiles
along with working SIMS to various departments
free of cost.

Your Date Here Your Footer Here 38

Telemedicine During COVID 19 Pandemic
• As the coronavirus disease 2019 (COVID-19) pandemic
surged in J&K, Government of J&K and Healthcare
organizations recognized that innovative technological
solutions were needed to respond to the crisis and started
making use of information technology to improve public
health.
• The existing 6 Lines of Tele OPD were increased to 17
dedicated lines, each line managing a set of super
specialties over telephone.
Your Date Here Your Footer Here 39
Telemedicine During COVID 19 Pandemic

Your Date Here Your Footer Here 40

Extending Use of Telemedicine Infrastructure

• During the pandemic, there are operational

challenges at multiple levels and there is an urgent
need to find the right solutions for contactless
healthcare delivery.
• At such time Telemedicine and virtual meetings
became the crucial link between all the stakeholders
in tackling the pandemic.

Your Date Here Your Footer Here 41

Extending Use of Telemedicine Infrastructure
• Department of IT provided videoconferencing services,
webinars facilities between SKIMS administration with
ICMR, NCDC and COVID apex Level Advisory groups.
Departments also provide web facility for Virtual Court
and various Interviews conducted at SKIMS
• A total of 150 such meetings were conducted at SKIMS
Telemedicine center in 2020 and till date 84 such events
have been conducted this year.

Your Date Here Your Footer Here 42

 Challenges and
Solutions

Your Date Here Your Footer Here

Challenges
• The System sometimes does not function well in respect of Data
Connectivity/Transfer.
• Most of the other hospitals in J&K prefer to link with SKIMS
rather than GMC Srinagar or other hospitals in the country.
• The System needs operation by a dedicated skilled computer
knowing personnel.
• Further there is lack of interest from Doctors due to Treister Reasons
working in the hospital.
• All stakeholders need to be trained and get involved in successful
implementation of Telemedicine
Challenges
• Human resource development related to ICT in health is a vast area
that is critical to the successful application of ICT in the sector.
• Skills in information systems design and implementation are critical
to successful application of ICT in the sector.
• We need to build on our own local skills and infrastructure, based
on local demand.
• We should ensure that e-health becomes an integral part of health
organizations.
• Build competencies for e-health; find & retain skilled people.
SOLUTION
• Create an e-health vision and strategy designed for
broader and ongoing consultation.
• Identify targeted investments in key initiative areas.
• Develop funding strategies to support e-health
initiatives. Develop a governance framework to co-
ordinate and integrate e-health strategies.
• Create an e-health office that will ensure co-ordination,
integration and monitor delivery of all e-health
initiatives
 It is high time that digitalisation, cloud
solutions, and analytics technologies are
leveraged in the healthcare setting.
Digitally connected processes enable
paperless operations.
The COVID era calls for perception change
of viewing IT as an enabler to healthcare
delivery.
Your Date Here Your Footer Here 47
Future of SKIMS Telemedicine/Telehealth
Direct to Patients SKIMS to SKIMS to
State Hospitals External Partner
1. Online Scheduling
2. Tele-Urgent Care 1. Video-consults 1. Video-consults
3. Virtual Medical a) Inpatient a) Inpatient
b) Outpatient b) Outpatient
Office
2. Store and Forward 2. Store and Forward
4. Home Remote
3. Transitions of Care 3. Transitions of Care
Telemonitoring
4. Secure Messaging 4. Secure Messaging
5. Patient Portal
5. e-ICU 5. e-ICU
6. Remote 2nd
Opinion
7. Patient Education

Patient Health Record

Clinical Information

Quality Measures
Leaving Card
• Keeping in view of the recent trends like:
• Increasing Acceptance of Telehealth as a Trend in Standard Of Care
• International Collaboration
• Peer Sharing Instead Of Hub Sharing
• Mobile Health
• Virtual Medical Centers
• New Remote Clinical Services
• And the fact that IoT devices shall outnumber mobile devices in future, we can expect:
• Telemedicine will become a standard service offered across all care settings
• Patients will choose providers, health systems, and hospitals based on telemedicine access
• Medical facilities that embrace telemedicine will see business and revenue growth
• Telemedicine will become an efficient option for preventative care
• Access to specialists will become the norm, which will benefit hospital wait times

Teleconsultation Telemonitoring. Tele-surgery

49
THANK YOU !

Made with by