Technology For Health (T4H) Programme aims for a Health care services, hygiene, nutrition, and sanitation in Nepal are of very poor quality and fail to reach a large proportion of the population, particularly in rural areas. The poor have limited access to basic health care due to high costs, low availability, lack of health education, and conflicting traditional beliefs.
Health care services in Nepal are provided by both the public and private sectors. They are generally regarded not to meet international standards. The prevalence of disease is significantly higher in Nepal than in other South Asian countries, especially in rural areas. Moreover, the country’s topographical and sociological diversity results in periodic epidemics of infectious diseases, epizootics, and natural hazards such as floods, forest fires, landslides, and earthquakes. A large section of the population, particularly those living in rural poverty, are at risk of infection and mortality by communicable diseases, malnutrition, and other health-related events.
Much of rural Nepal is located in hilly or mountainous regions. Nepal’s rugged terrain and the lack of properly enabling infrastructure make it highly inaccessible, limiting the availability of basic health care in many rural mountain areas. In many villages, the only mode of transportation is by foot. This results in a delay of treatment, which can be detrimental to patients in need of immediate medical attention. Most of Nepal’s health care facilities are concentrated in urban areas. Rural health facilities often lack adequate funding.
According to the Annual report published by the Department of Health Services, 2072/73 were the 104 public hospitals, the 303 private hospitals, the 202 primary health care centers (PHCCs), and the 3,803 health posts. Primary health care services were also provided by 12,660 primary health care outreach clinic (PHCORC) sites. A total of 16,134 Expanded Programme of Immunization (EPI) clinics provided immunization services. These services were supported by 49,523 female community health volunteers (FCHV).
WHO estimates that fewer than 23 health workers (physicians, nurses, and midwives only) per 10,000 would be insufficient to achieve coverage of primary healthcare needs.
We have 3 Program categories for Technology For Health program.
1) Infrastructure development for Telemedicine
3) Technology tanning for Telemedicine
Infrastructure development program
There are several factors that make a telehealth solution successful. One of the most important can also be the most fickle – infrastructure. This is the combined set of hardware, software networks, and more that is needed to develop, test, deliver, monitor, control, and support IT services. The system was created to provide specialty care services to veterans in rural and medically underserved areas by using video-conferencing equipment.
The growth of the knowledge society and the development and pervasiveness of the emerging information and communication technologies (ICT) represents a major challenge and a major opportunity for Health. Our Infrastructure development program also focused on equipping Hospitals with adequate hardware, software, and internet (WIFI) connections.support the integration of ICT in Healthcare, taking inequality in financial and human capital endowments between different regions or/and countries into consideration.
In order to improve Healthcare infrastructure through emerging technologies (ICT), first of all, Hospitals should be equipped with adequate hardware, software, and internet connections.
Nepal also economically backward countries still strongly lack financial and human capital, and supportive institutions to enable them to build telecommunication, internet, and to procure and efficiently apply ICT products for their Healthcare system. To help people from rural areas gain access to better treatment and cost-effective, Our Infrastructure development program will be developed.
“The delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for the diagnosis, treatment, and prevention of disease and injuries, research and evaluation and for the continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities.”
Rural residents often experience barriers to healthcare that limit their ability to obtain the care they need. In order for rural residents to have sufficient healthcare access, necessary and appropriate services must be available and obtainable in a timely manner. Even when an adequate supply of healthcare services exists in the community, there are other factors to consider in terms of healthcare access.
Telehealth targets the elderly population, those living in remote, poor, and rural areas.
Levels of telehealth:
• Level 1 – using emails or faxes to transfer medical data over telephone lines;
• Level 2 – transmitting still images or “store and forward” information such as
electrocardiogram strips, pathology slides and/or x-rays;
• Level 3 – transmitting synchronous, interactive, audio-visual communications.
This requires satellite, telephone, and microwave or internet technology;
Telehealth interventions are based on patients or professionals obtaining an opinion on treatment or care from someone who is more experienced or an expert in a particular field. Accordingly, telehealth interventions could be classified on the basis of the type of interaction and information transmitted between patients and professionals .
Telehealth impacts healthcare by increasing the communication between patients and the healthcare provider via phone, email, video transmission, and conferencing and remote monitoring systems. The health providers are able to receive and access patient information, such as labs, EKG, and view x-rays, anywhere on smartphones, iPads, and laptops. Additionally, “web-based disease management programs encourage clients to assume greater responsibility for their own care.”.
• Reducing inappropriate visits to high cost setting, such has ER.
• Reduce cost of managing chronic patient population.
• Reduce unnecessary care requested by patients.
Remote monitoring of patients, such as elderly patients in their home, notifying a caregiver or
healthcare provider if activities of patient change or of a fall. It impacts health care by transcending geographical boundaries by using GPS to direct rescue/ambulance to the nearest trauma, heart or stroke facility for patient treatment Further impacts as it relates to patients is that it reduces cost, less travel time, and less wait time because appointments are made online. Less travel time is due to the population able to be seen at the local health clinics by using telehealth.
However, it is not cost-effective, from the health services perspective, for local delivery of service between hospital specialists and primary care, particularly due to additional health care staffing. Across settings, equipment and connectivity costs have been major factors in setting up telehealth services, but even as these costs reduce, this will not necessarily make telehealth more cost-effective, unless the other factors such as health workforce and facility space are also addressed. Improvement in the quality of economic analysis is also needed to provide data for more accurate modeling of the effects of the widespread introduction of telehealth into the health care system
Technology training for Staffs program
However, providing high-quality infrastructure facilitates (computers, hardware, software, access to the internet, and Healthcare systems ) does not automatically get benefit from these facilities. When deploying technology in the Hospitals, it’s important to understand the distinction between training staff how to use the technology and how to incorporate the technology effectively. Technology tanning for hospital staffs program helps to improve the staff’s skill to operate and update with the new technology trends, for these staff requires training to use the ICT tools.
Telemedicine has been growing rapidly because it offers four fundamental benefits:
Telemedicine has been used to bring healthcare services to patients in distant locations. Not only does telemedicine improve access to patients but it also allows physicians and health facilities to expand their reach, beyond their own offices. Given the provider shortages throughout the world–in both rural and urban areas–telemedicine has a unique capacity to increase service to millions of new patients.
Reducing or containing the cost of healthcare is one of the most important reasons for funding and adopting telehealth technologies. Telemedicine has been shown to reduce the cost of healthcare and increase efficiency through better management of chronic diseases, shared health professional staffing, reduced travel times, and fewer or shorter hospital stays.
Studies have consistently shown that the quality of healthcare services delivered via telemedicine are as good those given in traditional in-person consultations. In some specialties, particularly in mental health and ICU care, telemedicine delivers a superior product, with greater outcomes and patient satisfaction.
The greatest impact of telemedicine is on the patient, their family, and their community. Using telemedicine technologies reduces travel time and related stress for the patient. Over the past 15 years, study after study has documented patient satisfaction and support for telemedical services. Such services offer patients access to providers that might not be available otherwise, as well as medical services without the need to travel long distances.
Rural areas lack the skill, time, and process for carrying out counseling sessions. Through the-counseling programs for multiple conditions like depression, HIV, and smoking, skilled professionals could give counseling sessions to patients in their homes.
Most common telemedicine objectives are:
- Improving patient outcomes
- Increasing patient engagement and satisfaction
- Improving patient convenience
- Providing remote and rural patients with access to care
- Improving leverage of limited physician resources
- Reducing cost of care delivery
- Reducing hospital readmissions
- Improving specialist efficiency
- Providing access to new specialties
- Providing 24/7 access to specialists
Risk Management in Telehealth
Complying with Laws and Regulations
E-healthcare is a relatively new concept. While many people have come to accept and utilize it, state regulations have had trouble keeping up with the fast pace at which telehealth is evolving. As such, it is important to stay up to date on the latest developments to avoid performing duties outside of your legal scope of practice. The American Telemedicine Association has a helpful guide you can reference that provides information on state regulations.
Adhering to Basic Principles for Safe Practice
Overall, the clinical and ethical standards for telehealth visits are the same as in-person visits. Providers should exercise the same sound judgment when communicating with a patient over a webcam as they would if the patient were sitting right in front of them. It is also important to make sure that the patient’s request is appropriate for telehealth. Many conditions are unfortunately difficult to treat online and should be addressed face to face. As a provider, you can probably deduce this within a few minutes of speaking with the patient. In these cases, simply document that you advised the patient to go the Emergency Department, an urgent care clinic, their primary care physician, or elsewhere.
Privacy and Confidentiality
No one wants their private health information to be jeopardized by a lack of security. Telehealth platforms need to be HIPAA-compliant and adhere to the legal and ethical obligations of confidentiality that are present in all types of medical care, including the HITECH Act. A breach of patient privacy could prove dangerous for providers; so make sure the platform you use contains proper security measures, such as firewall control, authentication, and encryption capabilities.
Creating the Provider-Patient Relationship
While telehealth visits are often more accessible and convenient for patients, they still enjoy forming a relationship with their provider. There are many ways to establish this relationship with a patient. Prompting the patient to activate their webcam instead of just talking on the phone will give them a sense of connection and comfort. Communication problems may heighten an incident into a claim; therefore, adequate attention should be paid to make sure patients understand their treatment plans. In conclusion, using E-healthcare to expand patient access to medical care is a valuable tool that will undoubtedly continue to grow and develop. This new model presents risks that providers should consider when conducting telehealth consultations. Observing strategies that alleviate these risks will help you provide quality care to your patients.
Develop a Plan for Downtime & Data Loss
It might seem early to consider what could go wrong with an electronic health record(EHR), but now is the time to start contingency planning. At this stage, it is important to know the potential impact of different architectures and technologies on a contingency plan. This type of planning is required under the Health Insurance Portability and Accountability Act(HIPAA) security rule.
Circumstances to consider:
- Scheduled downtime
- Short-term system outage
- Long-term system outage
- End of life
- Backup and data loss
The issue here is understanding the amount of downtime the vendor expects for maintenance, upgrades, etc. Once you have a short list of a couple of EHRs, insist that each vendor schedule downtime that has the least impact on the practice (i.e., nights or weekends).
Short-term System Outage
This may be from either scheduled or unscheduled downtime. The issue here is what process and/or resources need to be in place to keep the practice functioning during the downtime. In a short-term outage (less than one day), workarounds can be put in place, such as stop scheduling non-acute visits until the next day or entering visit information on paper forms and entering it into the EHR when the system is back. It is important is for people to know what to do during downtime and how to handle emergencies.
Long-term System Outage
Not only are there the same issues as a short-term outage, but they are compounded by the length of downtime. Many of the stopgap measures successful in a short-term outage are not sufficient for a long-term outage (more than one day). This is where contingency planning can really pay off. The following should all be part of the contingency plan:
Alternative patient scheduling options
Alternative data access
Alternative data entry
The ultimate in system outages is the end-of-life of the EHR. This may come due to the collapse of the vendor and product or need to switch vendors or EHRs. The issue here is data migration. The contingency plan should lay out the responsibilities of the vendor to provide access to the data in a usable form.
Backup and Data Loss
Part of the contingency plan contains procedures to prevent data loss. The backing-up of data from an EHR is more complicated than copying the data to a disc. The type of EHR purchased will govern the number of resources needed to maintain adequate back-ups of the data. For example, the application service provider (ASP) based system requires the vendor to maintain the back-ups. With the ASP model, you must confirm that the EHR vendor has the resources and procedures needed to adequately back up the data. (To learn more about backup methods, check out the NIST guide listed below under “Resources.”) In contrast, with a client-server based EHR, the server resides in your office and you are solely responsible for backing-up the data.