Organization and Management of Telemedicine Program
Sample of Telemedicine Program
Organization and management of telemedicine program between several clinical networks involved many steps. Simply installing hitech, sophisticated videoconferencing and medical diagnostic equipment is not sufficient to start and run a telemedicine program. Organization of successful telemedicine program is a product of thoughtful planning (short and long term), sound management, dedicated health care and information technology professionals and support staff.
It is a fact that telemedicine technology is the cheapest and economical solution to bridge the gaps prevailing between the primary and tertiary level health care system with in country and across the continents. Realizing the potential of telemedicine and to serve the motto of health for all, Government of India is planning many telemedicine network in which the primary and secondary level hospitals will be connected to a tertiary level hospital. SGPGIMS, Lucknow, a tertiary level medical institution is connected to 3 secondary level medical colleges in Orissa state and 2 primary level district hospitals in Uttarakhand and one in Uttar Pradesh under different projects sponsored by various government agencies and state governments.
The aims and objectives of the program are well defined. We started our telemedicine program with distance medical education for the postgraduate students of the SCB Medical College of Orissa state situated 1500 km away from Lucknow. The nodal officers of both the departments held meetings and identified the departments interested to participate in the program of distance education. Then a day and time is selected that was convenient to the doctors on both side i.e.after their OPD and OT commitments got over. But before starting the program we had to make the doctors of both the sides aware of this new technology for which we called them at our telemedicine center and showed them how to digitize their radiological and pathological images and transfer them to the other end. They also saw how the real time videoconferencing happened and what was the audio and video quality.
The center, which is planning to start Telemedicine activities with other centers, has to first assess its needs as to whether it is going to play the role of provider or consumer. If you are a provider then the person who is responsible for the management and co-ordination of the Telemedicine program, between theses centers should have knowledge of the infrastructure, organization, administration and staff at both the center. He should have communication skills to make a personal rapport with the healthcare workers and technical staff at both ends. Familiarity with technical and medical terms will be an added advantage to communicate and express the situation to medical and technical professionals. He should be well aware of the working schedules of the health center workers at both ends. Here at SGPGIMS we are linked to three Medical Colleges of Orissa and two District Hospitals of Uttaranchal. The doctors at SGPGIMS are very busy till 2 o’clock with their routine work. After 2 o’clock they can take part in the telemedicine activities with these Medical Colleges. The Scheduled time for telemedicine activities was fixed 3-4pm as it suited to the both sides. But the working hours of the doctors of District Hospitals of Uttaranchal are 8.00am-2.00pm so we have to work hard and after lot of persuasion, timing of 1pm-2pm was fixed with those departments of SGPGIMS which have enough human resource and relatively free at that time.
It is desirable to make a fixed schedule well in time keeping in mind the convenience of the doctors at both ends. So the schedule should be made keeping in mind certain things such as availability and convenience of the doctors, holidays at both the centers etc. The schedule should be sent to the other centers and also distributed among the faculties of all the Departments of your own centers both as hard copy and also through email. Prior to one week of the scheduled sessions, a telephonic reminder should be sent to the concerned department, then again one day before and on the day of the session. So the person who is looking after these activities should have the contact numbers (Phone & Mobile) and e-mail addresses of all faculties which are supposed to participate in the telemedicine activities. If due to technical reasons or unavailability of doctors at other ends for some reason the scheduled session is going to be cancelled, it is the responsibility of the co-ordinator to inform the concerned person in advance about the cancellation. Co-ordinator should also see that all the activities and events that are taking place at the telemedicine center should be well documented and recorded for the periodic evaluation.
Clinical and technical documents should be prepared separately and updated regularly. A sample that we practiced at SGPGIMS for documentation is given below
Date/ Day |
Telemedicine Sessions (Name of the network partner) |
Time |
Departments |
Participants |
Participants |
Subject |
Technical details (media used /bandwidth/ audio-video quality/ interruption |
Signature of the participants | Remarks |
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A sample of documentation of clinical and technical records practiced at SGPGIMS
Contents of all the sessions should be stored as soft copy and the proceedings of the sessions should also be video recorded for further transmission to other places if needed. Still photographs of the sessions are also desirable for presentation at various scientific meetings and workshops. It is also the duty of project coordinator to see that all these records should be periodically reviewed by the nodal officer. The clinical and technical evaluation should be done for the proper assessment of outcome of the project.
In case of tele-follow up and tele-consultation sessions the patient’s satisfaction and cost effectiveness using this telemedicine technology should also be evaluated.
Thus organization and management telemedicine program within existing network needs smooth communication, proper planning, timely execution, documentation and evaluation.