MINI (June Edition, 2010)

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It gives me great pleasure to welcome you allto the very first edition of MINI Medical

Informatics Newsletter from IAMI.It has been long felt that there exists a void for discussing applied medical infor-matics, for the benefit of those whoare not academic scholars, but nev-ertheless need to keep current.

The medical informaticsdomain remains largely puzzling and misunderstood for a majority of stakeholders. It truly is a jungleout there. The people who need itthe most appear to have little or noclue regarding its key aspects.

While attending conferences doeshelp, the message often gets lost as thediscussions and deliberations that wereintended to act as the triggers towardsseeking deeper knowledge, are mistaken tobe the actual message itself. Thus, attend-ees end up with sketchy concepts and areunable to formulate the correct program

requirements or even ask the right qutions. The end result is a set of clients w

ask for things that they little understanand largely do not need, and vendors wend up delivering things that are larg

useless.Therefore the need for a one

stop place that both professionals and industry can contribuand refer to, in order to remaiupdated. Towards this end, MINdelivered to your mailbox anarchived online, will hopefully a giant step for all stakeholders

medical informatics.I wish the editorial team my very be

and I firmly believe theyll aim for the s to show you the way on a dark night!

Best wishes,

Dr. S. B. BhattacharyyaPresident, IAMI

Jun2010Medica l In fo rma t i c s News le t t e r f rom IAMI

JUNE 2010 VOLUME I ISSUE [email protected]

EXECUTIVE EDITOR / Ms. Vasumathi SriganeshPRODUCTION EDITOR / Mr. Mandar GoriTECHNICAL EDITORS / Dr. Kavishwar Wagholikar, Dr.Naresh YallapragadaNEWS EDITOR/ Dr. R. PrajeeshDESIGN & TECHNICAL /Dr. Amit Chatterjee, SM

www.iami.org.in

PRESIDENT / Dr. S. B. BhattacharyyaSECRETARY/ Dr. A. ThangaprabhuTREASURER / Dr. U. S. MahalonobishVICE-PRESIDENT / Mr. Bhudeb ChakravartiADDITIONAL SECRETARY/ Dr. R. PrajeeshEDITOR IN CHIEF, IJMI/ Dr. Supten N. SarbadhikariINTERNATIONAL REPRESENTATIVE/ Dr. R. S. Tyagi

ADVISORY BOARDDr. S. B. GogiaPro . Khalid Moidu

EXECUTIVE BOARDMr. B. S. BediDr. Naresh YallapragadaMr. Sukhdev SinghDr. Sanjay BediMr. A. U. Jai GaneshDr. Senthil K. NachimuthuDr. Kavishwar WagholikarDr. Rajeev JoshiDr. Amit Chatterjee, SM

CONTENTS1, From the Presidents Desk

Events2, ICEG 2010 at IIM, Bangalore3, The Bangalore CPS!

Tech Bytes4, Medical E Learning7, Some Key Performance Indicators (KPIs)8 , Telepsychiatry

From the Presidents Desk

Surgeon Rear Admiral V. K. Singh and Prof. D. Krishna Sundar, IIM at inauguralfunction of ICEG 2010


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m Left: Dr. Naresh Yallapragada, Dr. U. S. Mahalonobish, Dr. A. Thangaprabhu and Dr. Raghu

Events

MINI, Jun 2010

Events

IAMI partnered with ICEG to helpthem organize their 7th InternationalConference on Public Health, Micro-finance and eGovernance. The IAMIBangalore chapter met with the confer-ence organizers at weekly intervals, for amonth to make the conference a success.

Paper submissions were reviewed onlinein a double blind peer review processand of 200+ papers that were submitted,140 were accepted. The sessions werelively and the audience participated withzeal. SJRI (St Johns Research Institute),IAMI, IIT Delhi, IIM Bangalore andUniversity of Bergen, Norway were the partners who brought this first PublicHealth conference its success. A widespectrum of participants included theGovt, Industry, Students, Academics and

ICEG 2010 at IIM, Bangalore

Researchers.The Chief Guest, Surgeon Rear

Admiral V. K. Singh (Retd.) inauguratedthe conference on 22 April at 11 am, in themain auditorium of the IIM Bangalore,in the presence of other dignitaries. DrShiban Ganju, convener iHIND (Indian

Health Information Network Develop-ment) spoke in detail about this nationalHCIT initiative for India. India is being considered as having 626 districts and anHIE (health information exchange) hasbeen designed for one district. IHP (IndiaHealth Portal) and NEMS (NationalEmergency Medical Services) - the othertwo components of iHIND were men-tioned. He pointed out the fact that mostof the volunteers who are working on this project are based out of Bangalore and

present in the auditorium. Dr Balu, Pdent IAMI Bangalore chapter shhis expertise on eLearning and the lenges that he faced in introducingmedical students at St Johns MeCollege. He also showed glimpses

pioneering work. The audience couget enough of it and there were reprequests for more. SAPO (South AfPost Office) was a major participanttheir MD Totsie Memela-Khambulasenior officials attending and shhow in South Africa, the Post Offinow used to deliver public health,cation, pension, etc in addition toregular Postal services.

The IAMI was well represenIts members earned a special privof a discounted registration of Rs(regular registration was Rs 5,000)it was good to see the strong represtion. Some of the members who atte were: Dr Tony Raj, Dr DhinagaranAllen, Dr Sunita, Dr Thanga PrabhuBalu, Dr Amit Chatterjee, Dr Mohnobish, Dr Supten Sarbadhikari, BhChakravarti and Dr Naresh. The IAmembers took complete charge oPublic Health track. Dr Balu, Dr T

and Dr Prabhu (all IAMI members) speakers and chairs for multiple PHealth sessions in the conference.role of HCIT in making Public Heaccessible and affordable to one a was re emphasized time and againIAMI speakers. Prof Supten enlightthe audience on the need for HCstandards and the various standthat iHIND is debating on for InThe knowledgeable audience exprconcern about the use of mobile ph

Dr. Tony D S Raj, Touch-Screen Health Information KioskDr. Supten Sarbadhikari,Healthcare Interoperability standardsProf. V. Balasubramayam, President, Bangalore Chapter, IAMIDr. Shiban Ganju, HCIT as a Catalyst for Public Health DeliveryDr. A. Thanga Prabhu, Secretary, IAMI and Bangalore ChapterFirst Plenary Session, Venue: Main Auditorium, IIM, Bangalore


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Dr. Amit Chatterjee, SM

Events

MINI, Jun 2010

CPS??? Yes. Yet another acronym which expands to Chai-Pani-Ses-sions, and this was the first one.

Did you know that Bangalore hasone of the biggest collections of IAMIcrowds? As on date the strength is 43.Considering that the strength of all lifemembers of IAMI put together are 478,it does make almost one in 10!

But strangely enough, years roll byand noneof us evermeet! Thes i g n i f i -cance of a face toface meetis quited i f f e r -ent fromd i g i t a lc o n t a c t .

There is aneed to put names to faces. Just to coverthis gap, the indomitable USM, calledin a CPS at his clinic at Indiranagar on

Sunday the 16th of May. The invitationnotice said it all: Time: Dot 1000 HrsIST (Indian Stretchable Time)!

To be honest, though the Banga-lore group is quite well organised, witha mailing list of its own, the numbers who responded were about a dozen.Being a Sunday morning, most excusedthemselves with various reasons fromgoing out station to going for a haircut!Then the trickle began ... Not bad for a

start we thought! When things began, three of

people landed up 15 minutes beforeCheers, then three more.... then...

Then a phone call from St JoMedical College ... the census peoplanded up on campus, so they areup...

So in spite of reduced numberslet the show begin. There was no agto begin with ... just anything that to mind. Being just six, it was a contact discussion ... what did we diEverything and anything that camour minds, but what we gained winsight into each others capabilitiere-assessment of our own strength weaknesses.

The two most useful outcomecome out finally were:

The Bangalore Chapter would oup an Open Source project, sometthat would be useful to the medical munity, to be shared with the rest o world! For an initial start, we would with an online catalog of drugs avain India (something like the CIMMIMS). Technically this is not diff

at all, and if the venture is success venture to something more challengThe other outcome of importa

was, we will meet every 6-8 weekthis time on Saturday afternoons rathan Sunday... so that even bald folkchance to go for haircut... Watch ouus!~ Dr. U. S. Mahalonobish, Treasurer, IA Email: [email protected]

TeBangaloreCPS!

Eventsfor public health data collection, andemphasized upon the need for cautionregarding the health hazards of prolongedmobile phone usage. The SAR (specificabsorption rates) of mobiles and theassociation of cancer with use of mobile phones was discussed with alacrity. It washighlighted that when mobiles enteredthe market their SAR was kept high tocompensate for the poor signal availabil-ity at that time. Today SAR is well belowindustry-accepted norms and all mobilemanufacturers declare the SAR for their products.

Stalls at the venue enlightened theaudience on technology that is availableto deliver care almost anywhere todayin India. Intels theme was Telemedicineand they were joined by their partners inthe stalls, who talked about the remotediagnostic kits, mobile devices for datacapture, tough tablet pc, and the class-mate series of affordable but resilientlaptops to use in public health data col-lection. The Simputer (Simple Computerdeveloped by IISc researchers) was ondisplay and the many variants that haveevolved were also available for attendees

to check out. A tech savvy medic fromSt Johns Medical College demonstratedaerial disease surveillance in the IIMfootball ground. It was a scene straightout of the movie 3 idiots wherein fromthe ground the altitude and circling area was defined and the aircraft circled at aset height over our heads. A flock of kites were annoyed and we all held our breath when they came near it suspiciously butluckily no harm was done and the UAV (Unmanned Aerial Surveillance Vehicle)made a safe landing.

On the last day, the organizersthanked the IAMI for helping them inorganizing this international conference.For IAMI it was another feather in thecap an important event that was a big success!~ Dr. A. Thangaprabhu, Secretary, IAMI Email: [email protected]

From Left: Dr. R. Prajeesh, Dr. Sridhar Bodapati & Dr. Vijay Chandru


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MINI, Jun 2010

Tech BytesApplications of computers in educa-tional environment is now an acceptedconcept worldwide. However its poten-tial has not yet been fully exploited formedical education. Very little work hasbeen done in applications research - themultimedia aspect of this technology isa likely to emerge as a landmark utilityfor medical education. This communi-cation is a summary of our applicationtrials as it evolved during the period1986 to 2010. I am notattempting to provethat computer assistedlearning is better thantraditional learning

systems. Rather theobjective to bring forth the domains inmedical education where its utility canbe optimized into themedical curricularneeds of our country. Almost the entireseries of experiments are reported frommy department - a multimedia inten-sive, Department of Human AnatomySt. Johns Medical College, Bangalore.

During the DOS era, we starteddeveloping small programs in BASICto test its application for a teach-ing environment. Student volunteers with knowledge of programming wereinducted to design modules for whichcontent and instructional design was provided by the author. Program wasrendered into a menu driven modeand students were allowed to use it inbatches of five each. MC s were the

best outcome of this trial although wedid release a few modules on neuroanatomy. In spite of restriction in reso-lution and colours, we still realized its potential to deliver any time learning for the student.

The arrival of Microsoft Windowsenabled us to use graphics in higherresolution without the bother of pro-gramming. Pictures were digitized

Medical E Learning a journey of two decades!

and a theory wrap was weaved into itand tested on students. Random nonlinear access to any slab of information both text as well as graphics was theoutstanding benefit noted in the trial.Besides, the students felt they can runthe program any number of times asthey please without the fear of a teachersitting on their necks. We realized forthe first time computer assisted learning (CAL) can offer a relatively tension free

environment for learning. In subsequent years we were able to added audio and video clips to the presentations to make itfully multimedia intensive. Students feltthat complex concepts are better under-stood by this method. Programmes inembryology, introductory radiology,and genetics were pointed out as spe-cially good. We started out initially withPowerpoint and Harward graphics butslowly added Adobe Photoshop to theutility basket. CCD camera with frame/ video gabber card, digital camera and printer were added over time to makeour multimedia lab fully digital.

Our work on computer anima-

tions resulted in the production of atrial module entitled : rotation of thegut using Macromedia Authorware.The programme attempted to test the potential of computer animations inteaching embryology. The topic chosen was deliberately one of the toughestareas to teach. Animations were ren-dered in Anipro for Windows andthen incorporated into the timeline

matrix of Macromedia Authorware.response from students was overwing and there was pressure on us forsuch modules (V.BalasubramanyamI.M.Thomas 1995). Computer anitions are a boon for teaching embryoa view endorsed by Habbal and H(1995) and Harold P Lehmann (19 We have slowly moved over to accthe power of Macromedia Flash low space consumption is specially for medical teaching, although its ilearning curve is proving to be diffi

Besides indigenous productionsoftware, the department also attemto incorporate commercially ava

software into the teaching plan ftime to time. Using ADAM (anatodissections applied to medicine) fessional version, we could presenstudents with a virtual cadaver wcan be dismantled layer by layer aassembled. This software lasted four year of intense use until the generation of hardware started reing it due to resolution and colour mincompatibility. Today we are woron designing objective oriented vdissections using Adobe Photoshopimage editing and Macromedia Flainterface authoring. We also tried ouanatomy productions of the PartheGroup and were impressed with the rial and quiz modes. The same procan to cater to learning requiremendifferent student groups PGs, Unursing students etc a software stuse in our dept.

Objective proof for CAL

obtained as pre and post test scores first few trials only. We noticed that has more or less the same potential ditional teaching in general but a hteaching potential in areas like emology and flowcharting complex functions. Hence this attempt to pits better qualities on a objective fo was discontinued. Besides there beappear several hundred papers in w

Using ADAM (anatomical dissections applied to medicine) professional version, we could present the students with avirtual cadaver which can bedismantled layer by layer and reassembled.


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MINI, Jun 2010

Tech Bytesliterature about the power and utilitiesof CAL in medical education (ThomasE. Piemme 1988). We therefore shiftedtowards adopting and testing betterinstructional designs for multime-

dia based teaching. Precisely focusedmodules were designed to addressclearly marked objectives. This led toestablishment of two basic themes of our

production One is a broadcast modeand the second in an interactive mode.The broadcast mode was found advanta-geous for use as a virtual lecture that cancompletely substitute the teacher. Pro-grammes were made based on curricularrequirements of the subject in areas of gross anatomy and histology.

Interactive modules were a spin off of the same basic theme of broadcastmode but with the material being pre-sented in small slabs on a menu basedaccess. Interactive mode was more popular amongst our students since it provided an element of participationin the process of gaining knowledge,thereby converting an otherwise passivesession into a dynamic active learning platform. To make the program evenmore effective, question and answer ses-sions were introduced into the modules.

Our experiences with MC s in theearlier decades were recalled and incorporated here in a move effective design. We were at this stage able to give valueadded functions like timer control,marks analysis etc. The success of this program led us to design an exclusivequestion answer module called windowsanatomica upper limb a program which is now on its way to be released as

a commercial software.Our experiments with three dimen-

sional graphics has evoked mixedreactions. Current commercial softwarein this field is in its infantile stages. Vox-

elman 3D navigator ( Springer Verlag Publications, Germany) was tried outfor - It did not catch on beyond thestages of initial fancy to the technology.

Use of the 3D spectacles was a problem eye discomfort during use beyond 15minutes was the main problem among all the users, teachers included. Howeverthe technology does give a greater visu-alization than 2D especially in areas where complex structural interrelation-ships need to be taught. Such programs were best felt useful as short bursts of demonstrations during practical classesespecially when the teacher notices thatstudents are not able to catch up witha concept. The best example is during neuroanatomy teaching to small groups, which we call as tutorial sessions.

Moving on from a purely academicR&D work in medical e-learning, we were able to link up with industry partners and offer our experience todevelop learning management systems.Smarteach is one such production for

which we have provided consultancyto MEdRC Edutech, Hyderabad. The product is now available as a commercial package to medical colleges.

Sheer curiosity led us to explore the web for similar works as ours and wereoverwhelmed to see several university web sites doing works almost as identicalas ours. The student projects of McGillUniversity provided us tremendous

inspiration and we realized we were work at par with the best medical teaacross the world in spite of financiastraints typical of an Indian scenarioalso realized that sixty percent of m

curricular requirements of a stanmedical university is already availathe web. Some of these are in veryinteractive format and available in pdomain. Many are under subscripcontrol. Nevertheless a ocean of mais available in raw, unedited form wthe e-learning specialists now careusable learning objects. There imendous scope for using these resofor generating specific object dteaching modules. At present we arusers, but are moving over shortlyconversion of software already deveby us into web hosted modules. Acollaboration with MEdRC Hyderais presently being web hosted and itsmercial viability is being keely watc

The facility of trial by error ismost important benefit of compassisted learning, and the exampthe virtual eye simulator on the wecase in point. In summary this we provides an on line model of the e which the extra-ocular muscles cselectively paralysed and the effect noted instantly. Similarly nerves coling these muscles can also be parselectively. Student can learn by triaerror any number of times. A quiz takes the discovery learning to its be

On the whole our trials with Chas been rewarding as far as the prgoal is concerned providing oplearning environment to the studen

that knowledge that is imparted canrealistic as possible. We have realizeareas in medical education that nebe understood by sheer imaginatiobetter depicted using multimedia tnology. Besides high resolution gracan help to distribute accurate dosinformation so that there in no ambity in interpretation among the stude

In the course of these trials,

The student projects of McGill University provided us tremendous inspiration and werealized we were doing work at par with thebest medical teachers across the world inspite of financial constraints typical of anIndian scenario.


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Contributions invited forthe July issue of MINI.

1. Last Date for Submission

14th Jun 2010

2. Type:

a) Events Medical Infor-matics conferences/semi-nars/workshops.

b) Technical Industrytrends, concepts, products,techniques, experiences,software / hardware / litera-ture reviews.

3. Article length:a) 350 to 400 words; orb) 700 to 800 words.; orc) 1200-1600 words.

4. Format: Formatted Textas a Word Document. Highresolution Graphics in anyformat.

5. Submit to:[email protected]

MINI, Jun 2010

Tech Bytesauthor was fortunate to catch up withinstructional design techniques specificto a CAL environment, although ourentire teaching team had adequate expo-sure to general pedagogical approaches

to medical education. The author alsobelieves that several applications can becreated in the years to come consistent with optimal use of computer technol-ogy, a view echoed by several authors worldwide (Trisha Greenhalgh 2001).Haptics is one area to watch out formedical education, although work onthis is not yet available in India at anaffordable price.

I must emphasize that our teach-ing team has picked up using computersby sheer trial and error and keeping intouch with the computer world throughcontacts, books, journals and in recent years from the recent years. Since mostsoftware in Windows are fairly userfriendy, the author has at no time felt theneed to learn programming languages.Our knowledge and experience is there-fore restricted to application researchonly. On the whole our experience hasbeen a journey of discovery all along and this constant quest has resulted inestablishing a full fledged multimediateaching lab in our campus. All the workreported in this document are carriedout on PC based systems. In the last two years we have established a client serverbased LAN system capable of handling multimedia applications in the depart-ment. We have added one work stationto the armamentarium to take care of handling high resolution graphics. For programming complex concepts in

medical education, we take the help of the IT industry. While student acceptance of this

technology has been remarkably good,the same is not true for teachers. Seniorteachers and administrators are slow toacclimatize this into their day to day work patterns. Quite a few suspiciousteachers are resistant to implement thismode of education for the fear that it

may make the teacher profession extinct.There is a dire need for sensitization of the medical teachers and provide them with hands on training before we canlaunch a more systematic participation

at the campus level. The author hasattempted to achieve this to the extent possible by conducting regular nationallevel computer workshops towards thisobjective.

Although our focus has been pri-marily on MBBS curricular needs, we were also in due course able to generatesimpler and scaled down versions for paramedical courses like nursing andmedical laboratory technologists.

I do not believe that computer is atotal replacement to traditional teach-ing. However that there are severalsituations where patient safety andconcept trials can better ensured in a virtual environment (James Gordon2000).References:1. Thomas E. Piemme. Computer assisted Learning and evaluation in Medicine. JAMA, Vol 260. No. 3. Pg.368 372. July 19882. V.Balasubramanyam and I.M.Thomas Computergraphics - applications in Anatomy. .Trends in Medicaleducation. Vol 2. No 1. Pg . 25-26, 1995.3. Trisha Greenhalgh, Computer assisted learning inundergraduate medical education BMJ 2001;322:40-44( 6 January )4. Habbal OA and Harris PF. Teaching of humananatomy: a role for computer animation. Journal of Audiovisual Media in Medicine.. Vol 18, No.2, Pg 69 73. 19955. Harold P Lehmann, Christoph U Lehmann, Joan AFreedman. The use of simulations in Computer AidedLearning over the World Wide Web.JAMA, Vol 278,No 21.Pg 1788. Dec 1997.6. James A Gordon. The Human Patient Simulator: Acceptance and Efficacy as a teaching tool for students.

Acacemic Medicine. Vol 75. No 5. Pg 522. May 20007. Helene Hoffman and Dzung Vu. Virtual Reality:Teaching tool of the twenty first century? Academic Medicine, Vol 72, No 12, Dec 1997

~ Dr. V. Balasubramanyam, Domain Consultant:Computer Applications in Medical Education, Professor and Head, Dept. of Anatomy, St. Johns Medical College, Bangalore, India Email: [email protected]


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MINI, Jun 2010

Tech BytesKey performance indicators or KPIs are excellent bench-marking measures for performance evaluation, organisational planning and determining priorities.

It is necessary to remember that a balance approach isessential and all three key areas of clinical services, humanresources and financial performance need to be evaluated.

In carrying out these measurements, it is most impor-tant to ensure that analysis paralysis does not occur. Themost important word in the phrase is the word key and not

performance as it might seem at first.Therefore, the management would be well-advis

determine what the key areas are before they even begsuring. In order to accomplish this activity, it is imperatall stakeholders from each of the three areas be actively and a consensus opinion be derived beforehand.

The KPIs have been divided under the broad funcheadings. Only the indicators have been listed and ntime-period or categories.

ADT Total no o admissions (also aver-age) Total no o discharges (also aver-age) Total no o trans ers (also average) Total no o births (also average)

Total no o deaths (also average)

Occupancy Bed Occupancy Rate Length o Stay Average Length o Stay Patients with more than 3 days stay Patients with more than 5 days stay Patients with more than 7 days stay Patients with more than 10 daysstay Bed Turnover Interval

Revenue Total revenues (also average) Total expenditures (also average) Total Accounts Receivable (alsoaverage) Total Accounts Payable (also aver-age) Total Credit Overdue (also average)

Billing

Total bill amount (also average) Total discounts amount (also aver-age) Total unpaid bill amount (also aver-age) Total bad debt amount (also aver-age) Total written-o amount (also aver-age)

Nursing Acuity Total nursing hours required Average nursing hours required Total nurses used Average nurses used

Facility Performance

Patient Satis action Waiting times or availing servicesor undergoing procedures includingsurgeries In ection Control o critical hospital-acquired ones Financial current ratio, acid ratio,net pro t, earnings be ore incometax depreciation adjusted, ree cashfows, etc. Mortality Rate Admitted patients developing pres-sure ulcers Unplanned stay (post-day caresurgery) Rate o medication incidents Rate o hosptial-acquired in ections Physician Commitment Sta Commitment

Response Time Average response time a ter log-ging a call Average time rom arrival to needle Average waiting time or re errals Average waiting time or investiga-tion sample acquisition

Average waiting time or investiga-tion reporting Average waiting time in recovery(post-surgery)

Operation Theatre (OperatingRoom) Prime-Time Utilization Start-Time Accuracy or the FirstCase o the Day Start-Time Accuracy or SubsequentCases Estimated Case-Duration Accuracy Add-on Rate Day o Surgery

Triage Total Emergency Visits (alsoaverage) Total Deaths (also average) Total Admissions (also average) Total Discharges (also average) Total Trans ers (also average) Total Re usals (also average)

Some Key Performance Indicators (KPIs)for Healthcare Service Providers

~ Dr. S. B. Bhattacharyya, President, IAMI; Email: [email protected]


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MINI, Jun 2010

Tech BytesIntroductionSuicide is a public health burden in India.14 lakh suicides take place every hour andmore than 1, 25, 017 persons died by com-mitting suicide in 2008 in our country.

Sadly, there is no gold standard treat-ment method that can completely preventsuicide related deaths. Interestingly,suicide is common in the socially andeconomically stressed and deprived societ-iesin India. In this context, Telepsychiatrymight provide some innovative remediesby reaching these remotely located areasin terms of accessibility to health care.

Telepsychiatry is the branch of telemedicine that uses telecommuni-cations technology for the delivery of health services when the patient andhealth professional are at different loca-tions and it focuses on mental health careapplications. It is the interactive com-munication through live, two-way audioand/or video transmission to facilitatediagnosis, education, treatment, or otherhealth care activities.

Rationale behind Telepsychiatry inSuicide prevention

Research clearly has shown that all those who contemplate suicide communicatetheir suicidal intention verbally or non- verbally before they make an attemptto die. This is the working principle of Befrienders worldwide, an Internationalnongovernmental organization (NGO) which has telephone help lines, emailand postal modes of communication, allaimed at suicide prevention. Working with nonmedical, nonpsychiatric volun-teers who are trained on skills of activelistening, nonjudgmental positive regardfor expressed emotions, and maintaining utmost anonymity and confidentiality,this NGO now has over 400 volunteercenters in 39 countries, across 6 conti-nents. India has 10 such branches. Thiskind of mental health care system provesthe excellent utility of information andcommunication tools in dealing withsuicide in the absence of well trained

mental health professionals.

Telepsychiatry Suicide ClinicsAdapting the above model into

all district hospitals, primary health carecentres, and Taluk hospitals, an innovativeservice termed as Telepsychiatry SuicideClinic can be established. The follow-ing steps are the authors constructive andimaginative program framework:

1. Each district, primary and Talukhealth care centre should have a 24 hourhelpline through telephone, dedicatedsolely to provide support to suicidal patients and this unit can be attached tothe Department of Psychiatry that invari-ably exists in these centres.

2. All undergraduate and residentdoctors must be trained on the principlesof Befrienders worldwide as above during their psychiatric rotation. In addition vol-unteers from the local community can alsobe recruited to man the 24 hour helpline.

3. Helpline through the most cost-effec-tive technological tool, the telephone, ismore than sufficient to provide the imme-diate support to listen to those who are

emotionally disturbed and are contem- plating on ending their life.4. The availability of this program and

the 24x 7 hour helpline number can be publicly advertised at all the villages thatform the catchment area of a particularhealth care centre.

5. Review, supervision of this programand expert guidance can be organized bya psychiatrist available nearby district orcity hospitals, on a regular basis via tele-conferencing with the volunteers andsupport medical staff, who function atthese remotely located health centres.

6. This program will entail full confi-dentiality and anonymity if preferred bythe caller or else the identity of the listenercan be revealed and further support toaddress any underlying mental illness canbe offered.

7. Because each communitys clinicalneeds are unique, the telemedicine center

works with each remote site to declinical protocols specifically tato the site. Each site assigns someofunction as the telemedicine coortor to ensure that all necessary medata are sent to the consultant beforscheduled appointment. This personorients the patient to the telemedicenter room and maintains the remsites telemedicine medical recEncounters are videotaped by the ring and consulting sites.

8. Lastly, the Ministry of HealthFamily Welfare, Government of must collaborate with the MinistrInformation and Technology, and o

private health sectors to desigtechnical framework of this projeformation of a national rural suicide vention policy.

ConclusionImplementation of this prog

requires the conviction and conceeffort of National medical resecouncils and policy makers. The ICouncil of Medical Research (ICcan take up pilot projects on this fr work and convey the huge benefithis technique offers. Once this sy proves to be effective, more techncal sophistication can be introducedaccessibility can be improved fuPrimary prevention of suicide has advocated by World Health Organtion as the cornerstone of manageof suicidal burden in developing naTo conclude, the role of technologycommunication science in psych

cannot be underestimated and like other medical specialities that have the widespread benefit of technolosophistication in their practise, psychalso, should follow track soon.~ Dr. Anand Lingeswaran. MD, Assist sor & Head of Department of PsychiGandhi Medical College & Research(IGMC &RI), Pondicherry, India. Email: [email protected]

elepsychiatry for prevention of suicide in India

MINI (June Edition, 2010)

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