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A Pilot Study to Improve Access to Eye Care Services for Patients in Rural India by Implementing Community Ophthalmology through Innovative Telehealth Technology DR SHEILA JOHN AUTHORS Sheila John, M Premila, Mohd Javed and Vikas G

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A Pilot Study to Improve Access to Eye Care Services for Patients in Rural India by Implementing Community Ophthalmology through Innovative Telehealth Technology

DR SHEILA JOHN

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AUTHORS

Sheila John, M Premila, Mohd Javed and Vikas G Department of Teleophthalmology, Sankara Nethralaya, Medical Research Foundation, Chennai,India Amol Wagholikar The Australian e-Health Research Centre, CSIRO, Brisbane, Australia

03.08.2015 SN - Teleophthalmology department 2

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AIM

A telehealth pilot study that provides virtual telehealth consultation to eye care patients in low resource settings at villages in Tamilnadu, India

03.08.2015 SN - Teleophthalmology department 3

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AIM

  • Our pilot study - illustrates real-time imaging access

to ophthalmologists from campsite.

  • Our innovative software led technology solution

allowed screening of patients with varying ocular Disease conditions

03.08.2015 SN - Teleophthalmology department 4

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HEALTH CARE AVAILABLITY IN INDIA

  • 80% of population resides in rural area
  • 70% of health care resources are in urban

area and practice in cities

  • One Ophthalmologist / 100,000

population.

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BLINDNESS IN INDIA

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 18 million blind in India

 80% of the blindness is avoidable  Primary eye care services in rural India by trained Manpower and the state of art Ophthalmic equipments  Mobile eye care services of SN

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INDIAN SPACE RESEARCH ORGANISATION - SATELLITE

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ISRO SATELLITE MOBILE TELEOPHTHALMOLOGY UNIT

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DISADVANTAGES WITH SATELLITE CONNECTIVITY

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  • Skilled and trained manpower to implement the

satellite connectivity

  • Due to Satellite dish antennae a large bus was

needed, difficulty in navigating the narrow roads / pathways to approach villages

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TELEOPHTHALMOLOGY MOBILE VAN – INTERNET

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PROVIDING URBAN FACILITIES TO RURAL AREAS THROUGH MOBILE TELEOPHTHALMOLOGY UNITS

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  • Comprehensive eye examination in rural areas at

patient’s door step with Spectacles dispensing

  • Diabetic Retinopathy Screening Camps
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PROVIDING URBAN FACILITIES TO RURAL AREAS THROUGH MOBILE TELEOPHTHALMOLOGY UNITS

SN - Teleophthalmology department 12

  • Eye Screening for School children
  • Free surgery, Medicines, transport, boarding and

spectacles for cases that require surgery at the base hospital

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SNTOP – PRESENT MAN POWER

►Mobile unit at campsite – Optometrists

  • 4

– Social Workers

  • 2

– Drivers

  • 2

– Optician

  • 1

– Project Officer

  • 1

– Fundus Photographer - 1

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SNTOP – PRESENT MAN POWER

  • Sankara Nethralaya Central hub - Chennai

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– Technical Assistant

  • 1

– Information and Technology

  • 3

– Assigned Ophthalmologist

  • 1
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METHODS

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Period : January 2014 – December 2014

  • Camps Conducted in the identified Villages of Thiruvallur

and Kanchipuram Districts

  • 150 – 200 kms from the base Hospital
  • Permission of the head of the DBCS was obtained
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TELE-EMR – RURAL EYE CAMPS

ADVANTAGES

  • Conservation of paper and storage space
  • Instant access & rapid reproducibility to large amounts of

clinical data over multiple locations

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TELE-EMR – RURAL EYE CAMPS

  • Minimizes errors due to illegible handwriting
  • Integrates all patient related data and helps in

chronic disease management

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ONE EMR CHART WITH COMPREHENSIVE OPHTHALMIC EXAMINATION

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NORMAL FUNDUS PICTURES

Clinical picture uploaded in the EMR file

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CHRONIC DISEASE MANAGMENT

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METHODS – EMR AT CAMPSITE

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Server and Client Model

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WORK FLOW AT THE CAMPSITE

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EMR entry Pre camp activity Campsite Registration

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WORK FLOW AT THE CAMPSITE

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Autorefraction Slit lamp examination Fundus examination Subjective refraction

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WORK FLOW AT THE CAMPSITE

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Spectacles Dispensing Physical fitness Teleconsultation Awareness program

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CASES THAT REQUIRE TELECONSULTATION

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 Unexplained visual Loss  Glaucoma Suspects and Manifest Glaucoma  All diabetic patients  Squint cases / Corneal cases / Lid abnormality

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CASES THAT REQUIRE TELECONSULTATION

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  • Optic Nerve diseases
  • Any History of previous ocular surgeries or injury / trauma
  • Any case where either the optometrist has a doubt or if the

patient would like to interact with the ophthalmologist at

  • ur base hospital
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VIRTUAL VISIT

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 Videoconferencing - internet connectivity and data card  Does not involve technical training of manpower  Tele Health software for Teleconsultation which works at low bandwidth of 120 to 150 kbps  Data visualization and analytics

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TELEHEALTH SOFTWARE

SN - Teleophthalmology department 28

 Real time image sharing with annotation  No transmission of images and no loss of pixels  Reliable video - HIPAA (The Health Insurance

Portability and Accountability Act – HIPAA) secure

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VIRTUAL VISIT

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Central Hub

  • 2 Mbps internet

connectivity

  • High Definition Web camera
  • Screen sharing of the images
  • Sound proofing room
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VIRTUAL VISIT

SN - Teleophthalmology department 30

  • Campsite – Data card with

2Mbps internet speed

  • Remote villages - internet

speed only 100 to 250 Kbps

  • Software supports video

conferencing at low bandwidth 120 -150 Kbps

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TELECONSULTATION

SN - Teleophthalmology department 31

Real time sharing of images

  • Campsite – Optometrist

with patient

  • Sankara Nethralaya base

hospital – Ophthalmologist consultation /advise

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TELECONSULTATION

SN - Teleophthalmology department 32

Patient at campsite interacting with Ophthalmologist at base hospital

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Patients Examined 19634 Male 10068 Female 9566 Refractive error 9070 Cataract 1950 Retina 644

2014 RURAL CAMP - DATA ANALYSIS

Diabetic Retinopathy 275 Glaucoma 75

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DATA ANALYSIS - JAN TILL DEC 2014

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Cornea 139 Posterior capsular thickening 139 Neuro ophthalmology 32 Pterygium 66 Oculoplasty 29 Counseling 3327 Squint 44 Cycloplegic Refraction 309

16.07.2015 03.08.2015

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PREVALENCE OF OCULAR DISEASES

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MOBILE REFRACTION VAN

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Dispense glass at remote villages Supported by Essilor India Private Limited

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SCREENING FOR GLAUCOMA

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DIABETIC RETINOPATHY SCREENING MODEL

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Ophthalmologist – Based Model Ophthalmologist – Led Model

SN - Teleophthalmology department

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DIABETIC RETINOPATHY

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DIABETIC RETINOPATHY

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DIABETIC RETINOPATHY

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CONCLUSION

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Software led telehealth implementation to screen patients in low resource settings showed that Virtual visit based eye care services in villages can assist in identifying causes of blindness and treating avoidable blindness.

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