Digital Health Care in Public Private Partnership Mode.

Background: Health care is provided in developing countries, in a milieu of acute shortages of health care infrastructure and personnel. Governments are realizing that digital health through public private partnerships (PPPs) could address this issue. Literature review did not reveal reports on primary use of telemedicine or Technology-enabled Remote Health care (TeRH) in a PPP mode. Materials and Methods: The authors report using digital health in a mega PPP project in nine districts in Andhra Pradesh, a state in South India, where millions are benefiting from TeRH. Strategies deployed to address operational, technical, and clinical challenges in virtually reaching the unreached deploying technology are described. A detailed analysis was made of services provided in 183 Urban Primary Health Centres (UPHCs) over 47 months. Results: 2,648,322 unique patients had quality digital health care. Of 11,055,936 consultations, 1,013,996 were specialist teleconsultations, including cardiology, endocrinology, general medicine, orthopedics and OB/Gynecology. 7,408,283 laboratory tests were done. Costs for laboratory tests was 28.84% of that in private laboratories. Cost per specialist teleconsultation was [Formula: see text]165 (Rupees). Quality control of laboratories was ensured through remote monitoring. Discussion: Implementing digital health in PPP projects requires expertise across clinical, technology, contract management, financing, data standards, information security, project planning, and cost-effective implementation. Conclusions: This successful mega project has confirmed that given a dedicated cooperative team e-health in a PPP mode in a developing country is eminently doable. Digital health care records were introduced and maintained for 100% of the beneficiaries (2.6 million in this study). TeRH can now bridge the health care divide.

Tele-Emergency Services in the Himalayas.

Introduction:Nonavailability of emergency healthcare services in mountainous, isolated, and sparsely populated regions is a universal problem. In a first of its kind initiative, Tele-emergency services (TES) was provided in Keylong and Kaza in Himachal Pradesh in Northern India, at an altitude of 3,353 meters with temperatures of -30°C during winter months.Methods:Existing rooms in regional hospital (Keylong) and community health center (Kaza) were converted into tele-emergency centers by connecting them, to a state-of-the-art emergency department at the Joint Commission International-accredited Apollo Main Hospital at Chennai, 2,925 km away. Training was carried out at both ends. Average turnaround time for an emergency teleconsult was less than 12 minutes. Tele-ECG, Spirometry, and Point-of-Care Diagnostics for blood biochemistry were made available.Results:In the first 35 months, 753 teleconsults were given in the 24/7 TES, out of a total of 10,213 teleconsults constituting 7.4%. Out of a total of 6,442 telelaboratory tests, 431 tests were done in an emergency setting constituting 6.7%. Of the 16 cases of myocardial infarction remotely diagnosed, 4 were thrombolysed through telementoring. Of seven patients with Supra Ventricular Tachycardia, six patients were stabilized through electrical cardioversion and one through chemical cardioversion through telementoring. Ten deaths were documented, of which one occurred at the site. One hundred ninety-six were stabilized and transferred to higher centers. Thirteen required helicopter evacuations. Detailed analysis revealed that the total average cost for a single emergency teleconsult during this period was US$208.Conclusions:Preliminary analysis confirms that delivering TES in inhospitable terrains in a Public Private Partnership mode is doable and is welcomed by the community.