1. Healthcare Technology Aspects of Disaster Planning Based on the Post Tsunami Experience SATHI Dr. S B GogiaDr. M R Surwade

2. S.A.T.H.I. Society for Administration of Telemedicine and Healthcare Informatics A Resource Organization for Developing Software Developing Software Training of personnel Training of personnel Field Testing Field Testing Project management Project management –Tsunami Relief Standardization Standardization

3. The concerns More people die of after-effects of natural disaster than the disaster itself More people die of after-effects of natural disaster than the disaster itself Mismatch between needs and services Mismatch between needs and services Inadequate no. of mental health specialist Inadequate no. of mental health specialist Increasing trend of psychosocial effects – depression and alcoholism Increasing trend of psychosocial effects – depression and alcoholism Stress and fatigue among relief workers Stress and fatigue among relief workers No community participation No community participation Dr. M R Surwade

4. The Telemedicine solution Ensure access to specialists’ services Ensure access to specialists’ services Ensure quality of services Ensure quality of services Enable people Enable people –to articulate their needs –participate in interactive sessions with experts Enable service provider to be need specific Enable service provider to be need specific Strengthen the health care delivery system Strengthen the health care delivery system Increased efficiency of service provider -more coverage Increased efficiency of service provider -more coverage Dr. M R Surwade

5. Problems with Telemedicine Telemedicine effective in reducing Healthcare costs Telemedicine effective in reducing Healthcare costs EMR and telemedicine - two different streams EMR and telemedicine - two different streams Tight integration of EMR with telemedicine helps growth of both Tight integration of EMR with telemedicine helps growth of both Differing perspectives of doctor and IT persons Differing perspectives of doctor and IT persons Computer usage poor among doctors Computer usage poor among doctors S B Gogia

6. Current status Despite all efforts, telemedicine yet to take off on a large scale. Reasons---- Despite all efforts, telemedicine yet to take off on a large scale. Reasons---- –Lack of awareness –Still in innovation phase –High costs (no economy of scale) –Lack of standards –Low payment capacity of medical profession A comprehensive EMR lacking in most hospitals A comprehensive EMR lacking in most hospitals EMRs not integrated with currently available apps for telemedicine EMRs not integrated with currently available apps for telemedicine S B Gogia

7. Health Management after Tsunami in Tamilnadu Immediate Excellent Immediate Excellent Intermediate Excellent Intermediate Excellent Long Term ??? Long Term ??? –Alcoholism –PTSD –Panic Reactions Dr. M R Surwade

8. The Healing Touch Project Community based Community based Village level operable Village level operable Integrated with present health system Integrated with present health system –vertically: primary - secondary - tertiary –horizontally: among the networked units Empowering the community Empowering the community Exemplary partnership Exemplary partnership –between Government, NGOs, Community and development support agencies - DISTINCTIVE FEATURES M R Surwade

9. Lessons Learnt Community based telemedicine system is Community based telemedicine system is –Sustainable –Excellent force multiplier –Effective facilitating tool for mental health assistance Coordination among multiple partners necessary for operationalization. Coordination among multiple partners necessary for operationalization. Difficulties in ISDN connectivity Difficulties in ISDN connectivity Better awareness about telemedicine needed Better awareness about telemedicine needed Dr. M R Surwade S B Gogia

10. Problems faced by us New Technology New Technology Service Taking Too long Service Taking Too long –Connectivity –Identification of Specialists –Identification of Caring Institution –NGO Coordination Funding Funding Language Issues Language Issues Dr. M R Surwade S B Gogia

11. Connectivity Problems PSTN Line PSTN Line –Not Enough Bandwidth ISDN Line ISDN Line –Not all exchanges have it –Within 2.5 Kms of Exchange –Immobile Mobile Phone (CDMA /GSM) Mobile Phone (CDMA /GSM) –Service unreliable/ Low Bandwidth VSAT VSAT –Too expensive or only for Govt Internet/ADSL/WiFi Internet/ADSL/WiFi –to be tested Exchanges themselves got flooded S B Gogia

12. NGO Coordination Problems Unfamiliarity Unfamiliarity Fixed Mindset Fixed Mindset Looking for Doles Looking for Doles Cross Restrictions Cross Restrictions Unwillingness to spend Unwillingness to spend Flagging off of Interest Flagging off of Interest S B Gogia

13. Three Phases of Disaster Management (Healthcare) Immediate Immediate –Evacuation/Transfer/Manage Acute Injuries Intermediate Intermediate –Drinking water / Sanitation / Food / Stopping Epidemics Rehabilitation Rehabilitation –Mental Health –Occupational Therapy Dr. M R Surwade S B Gogia

14. Acute Stage Management Help in Evacuation Help in Evacuation On Site Injury Care On Site Injury Care Know when and where to shift Know when and where to shift Possible to wheel patient in OT Possible to wheel patient in OT Running and Functional Systems work better in Emergencies Emphasis on Mobile Units Emphasis on Mobile Units Satellite / Mobile connectivity Satellite / Mobile connectivity Pre Trained Staff to be sent with the equipment Pre Trained Staff to be sent with the equipment Would help to have pre-trained local volunteers Would help to have pre-trained local volunteers

15. Intermediate Stage - Epidemiology Data Collection Data Collection Online Mass Training of Health Workers Online Mass Training of Health Workers Program Evaluation Program Evaluation Prevention and control Prevention and control Disease surveillance Disease surveillance Monitoring Monitoring Efficient health measures Efficient health measures Administration Administration

16. Suggestions and Planning for future disasters Create Delivery Network Create Delivery Network Pre Response to Trauma Pre Response to Trauma Testing Testing Pre Arrange Funding Pre Arrange Funding –?Sign MOUs Immediately

17. Suggested Future Actions GIS System GIS System Creation of National Population Database Creation of National Population Database –Smart Cards/Key Numbers Database of Stakeholders Database of Stakeholders –NGOs / Government / Private Players Database of Health Service Providers Database of Health Service Providers

18. Suggested Future Actions --cont Penetrating IT into Healthcare Penetrating IT into Healthcare –Knowledge Kiosks E Governance Project E Governance Project Private Sector Private Sector Operated by Health care professionals Operated by Health care professionals –Role of IAMI Computerization of all Patient records Computerization of all Patient records –Standardization Issues –Data Locations ?Personal ?Personal ?Web server ?Web server Involve Hospitals in Training and Disaster Planning Involve Hospitals in Training and Disaster Planning

19. Thank You Acknowledgements SATHI Team OXFAMSCARFISEDPEDA Ministry of IT WHO And many more