With the hopes for COVID-19 vaccine within reach is soaring high, there is still a population that continues to remain extremely vulnerable with large scale challenges in infectious, non-communicable diseases, malnutrition and addictions mostly complicated by poorly health seeking behaviour.
Our two-day health screening camp organized in a remotely located tribal village in Dhansol High school, 40 Km from Bhasragat, Kharagpur was for many their first meeting with the doctors in their lifetime.
While engaging with them over a research survey, I witnessed the ignorance and inequalities of healthcare access that they live with and found for many, Hypertension was the new word in their dictionary and Thalassemia was a foreign borne disease.
iKure team attended the patients and screened their vitals; high BP, low Haemoglobin count, Blood Glucose and cataract like conditions were alarming high as these conditions are known risk factors for complications, deaths and lifelong disabilities, however, exacerbating this reality is the fact that access to healthcare in such tribal areas is still widely unmet and inadequate.
Our effort to start afresh in areas that remain largely dislocated and remote is driven by the unmet demand of primary healthcare, unavailability of medicines and huge distance between healthcare facilities. In the aftermath of Covid-19, low immunity, lack of medical facilities and compromised health conditions are at higher risk and tribal communities amongst others remain highly exposed.
While our efforts are ensuring awareness and health sensitization, adequate supply of essential care and community health workers driven healthcare model can be a sustainable option to minimize the inequalities posed by our healthcare system.
Dr Tirumala Santra Mandal
Research & Communications Analyst
Covid-19 and the adaptation by iKure in the service offerings……with hints in the way ahead….
Covid-19 has churned out the whole human civilization into an abyss of indefinite uncertainty..withapalling incidents and consequences ,including an unacceptable record of deathsand sufferings worldwide, which has thrown mankind out of gear and the uphill struggle for a safe survival continues, with no sight of a vaccine yet and no definite medical guidelines to resort to, in order to tackle this pandemic in a manageable framework of confidence…within the medical fraternity.
Coupled with this disease menace, is the scenario of economic gloom arising out of job layouts,downsizing of companies, lack of new job prospects etc which is bringing in an enormous amount of despondency and negative affections of mind and body ,unheard of this kind earlier.
iKure being a population service provider enabled by Technology and research oriented objectives,has made an attempt to be a forerunner in the sector of healthcare in rendering its services, during such difficult times, to all stake holders…in more than one novel ways…backed by the skills and expertise of our employees from all walks of training and experience.
Ways in which iKure stood out to adapt to the current unprecedented crisis ..
• Based on the three prongs of prevention…ie..social distancing/usage of barrier tools like masks & hand sanitizers..to say the minimum, iKure has embarked on a path of remote consultation for patients..through the new concept of Telemedicine..which has enabled a large no. of clients/patients to seek medical attention from the safe confines of their homes and the Physicians feeling safe at their point of presence.
• In the events of some subjects/patients approaching our hubs/clinics, the safety measures have been strictly put in place,(with PPE-s etc) to ensure safety of all concerned and a smooth play of operations to continue as earlier…within the norms of recommended prevention guidelines.
• Special measures have been put in place to render door step services( albeit with mutual protection of subjects & staff) to deliver medicinal items/ related consumables and any other medical attention/advice that may need at any point of time…through our field workers ( CHW-s).
• Our Doctors have been attuned to the call of the times , to be sensitive towards our patients, at the same time being on guard to detect suspicious infected cases and do the needful as per the advised protocol of the health authorities.
• Special projects are being undertaken with big business sectors ( such as realty and housing industry) to screen the blue collar workers for Covid-19 by means of well decided clinical vital parameters at site and follow the recommended protocols of suspicion of the infection in any of the persons screened. Our ground staff are physically attending such events with due precautions ,almost on a daily basis,thisfar,and providing a social service in a proactive approach to healthcare.
• A good number of projects for population screening for the Covid-19 infection are on the way, across several locales in the nation, to provide such services with impunity.
• Since a second resurge is feared in this country, as well as elsewhere,theGovt would need more and more private sector operators to enter a PPP in order to tackle the growing menace of this crisis.
• Modalities could be……..allowing screening in the semi-urban areas on a request basis/enabling testing by the private sector liberally without much regulatory protocol and paperwork/leasing ground workers for day to day support to an organization like us, for more community approach to reach out the needy and non-privileged/helping in a proactive manner to set up small check up kiosks in prominent areas where most of the population are expected to visit…etc.
• A recent glaring example of a PPP may be cited by mentioning the launch of a Telemedicine collaboration with theGovt of Nagaland, in joint efforts with another prominent Indian association, to serve the community of Nagaland,which is a hilly terrain basically, in seeking medical attention from Doctors at Govt Health Centresthere.,,by means of remote consultations on general and specific health issues.
• To boost the morale of our staff, iKure had arranged a whole remote session with a ‘clinical psychologist’,to address the common feelings of our employees during this pandemic season, where ‘work from home’ has been the norm, so that alongwith their psyche the productivity does not sag and they can adapt themselves to cope up with any such mental issues in their stride.
The way ahead………
• iKure wishes to plan with foresight ventures involving our service offerings in other states and may be beyond Indian shores based on the success of our initiatives this far.
• More and more Technological advances in the form of devices and tools are being incorporated in our operations, to assist the ground workers for a quicker and better screening with results approaching to the 100th percentile. A robust Telemedicine platform is fine tuned, to enable Physicians to get universal access to an easy going software for navigation and patient prescribing…with maintenance of EMR.
• Work in the Non-communicable Disease area ( NCD) which is the need of the hour in this country ,keeping the Covid-19 affection in mind, is being planned, since this particular virus affects the CVS in a major way, along with other co-morbidities, as surfacing from those who contracted the disease and those who recovered from the illness !
• Some critical research areas are also been looked into, which engages the data acquired in re-guiding us through AI and/or ML mechanisms,
on few members of NCD-s..as the scope may be obtained…such as Diabetes/Hypertension etc.
• Stake holder partnerships are being explored by our business associates for more and more Govt/Pvt. Collaborations and grant providers ,based on our track record of success and innumerable accolades that theOrganisation has achieved by dint of merit amidst tough competitions.
Since the pandemic is far from over yet…we do not know what is in store for mankind ,once the Virus leaves civilization !
Whether we have really achieved Herd Immunity..whether we have managed to eradicate the virus for good..what are the residual signs/symptoms of those who have been affected by the Virus..are only issues that time will tell..and help us unfold..but till then, iKure shall continue with its offerings in healthcare in all possible ways….both traditional and innovative…in nature…to mitigate the health issues in the post-pandemic era.
Dr. Lalmohan Banerjee
Sr. Medical Adviser & Medical Director, iKure
COVID-19 pandemic has created significant disruptions globally and presented multiple challenges for healthcare providers. We at iKure, have been working on multiple initiatives to address some of these challenges.
This article briefly presents some of the initiatives from iKure.
The solution from iKure involves creating mass awareness through a combination of IVR (Interactive Voice Response) and iKure Health App. The information shared is in strict compliance with Government protocols and available in the local languages. The contents focus on the following areas:
• Measures on social distancing
• Hand washing hygiene & procedure
• Understanding symptoms of COVID-19 and taking adequate measures
• Awareness building to seek doctor’s consultation
• Addressing phobia around quarantines and self isolation
• Address mental distress & anxiety
• Questionnaire for self assessment based on symptomatic behavior
• Questionnaire to assess awareness level
In order to drive the mass awareness and counseling, iKure has developed an initiative to train frontline health workers on a Train-The-Trainer approach. These Trainers will in turn train area volunteers/ representatives. These trained members will be deployed in the identified areas for awareness, counseling and identification of high risk members. The Train-The-Trainer training can be done remotely using iKure Health App.
iKure Telemedicine App will enable patients to schedule consultations with remote Doctors. Frontline health workers who visit the patients at their homes can facilitate this engagement. A typical workflow of the Telemedicine App from iKure is briefly described below:
• The patient registers on the App either on his own or with assistance from the Community Health Worker (CHW) visiting his home.
• Patient can request an appointment for doctor consultation on his own. The CHW can also request an appointment with the doctor. This will generate a queue.
• The doctor gets a notification of the call request in his App and based on his availability can accept/reject the request for the telemedicine call
• For a follow-up consultation for an existing patient, the Hospital might already have access to the patient’s medical records. If not, the patient can scan and upload his last prescription and test results.
• For a new patient, a CHW can visit the patient’s place on a scheduled time, collect basic vitals, enter them in the iKure App and then schedule a call with the doctor. The patient or CHW can check the status from their App.
• Internal triggers in the App can send notifications for medicine and vital alerts to the patient.
• The Doctor will be able to view patient details before, during and after the call. This includes demographics, vitals and clinical information such as prescriptions and results.
• The doctor can enter the prescription in the App and this can be viewed by the patient or CHW.
• Patient registration
• Measurement of patient vitals – Body Temperature, Blood Pressure, Height, Weight, Body Mass Index, Pulse Rate, SpO2
• Patient screening & identifying high risk patients for COVID-19
• Referring high risk patients for further laboratory tests
• Doctor consultation (face-to-face or through telemedicine)
• Providing medicines to patients as per the diagnosis made by Doctor
• Patient counseling & awareness on COVID-19
• Issuing iKure Health Screening Card
iKure has a proprietary population health management system called WHIMS (Wireless Health Incident Monitoring System). WHIMS is a medical collaboration platform and can integrate the various stakeholders in the primary healthcare ecosystem including patients, doctors, frontline health workers and primary healthcare clinics.Deploying WHIMS in a region can provide a framework for predicting disease outbreaks, notifications to seek medical help and tracking the spread of diseases.
The key features of WHIMS include the following:
• Create a clinical database (Electronic Medical Record) of the population in the identified area
• Provide a technology platform for primary healthcare players in the identified area and enable them to provide better healthcare services focusing on continuum of care
• Enable Community Health Workers (CHWs) in data collection from the patient’s home, arrange telemedicine calls and get prescription alerts
• Doctor’s can view patient details including clinical history and enter details of consultation and prescription
• Patients can view reports, book services online and get consultations through telemedicine
• Integration with medical devices and wearables
• Integrate with 3rd party AI (Artificial Intelligence)/ML (Machine Learning) applications for predictive analytics
• Serve as a technology platform for stratification of population, identification of high risk patients and prioritize testing & screening for the most vulnerable population
• Provide a platform for implementing priority health intervention programs
About iKure: iKure (https://www.ikuretechsoft.com/) is a healthcare technology startup that delivers primary healthcare, wellness, and prevention services to communities in India through digital technologies, trained frontline health workers, a network of Hub & Spoke Clinics and focus on a continuum of care. iKure focuses on addressing the primary healthcare needs across all settings – rural, semi-urban and urban areas.
Chief Growth Officer, iKure
What is Continuity of Care?
“Continuity of Care” is concerned with quality of care over time. It is the process by which the patient and his/her physician-led care team are cooperatively involved in ongoing health care management toward the shared goal of high quality and cost-effective medical care.
Continuity of care is the primary objective of family medicine and is consistent with quality patient care provided through a patient-centered medical service. The continuity of care approach helps family physicians gain their patients’ confidence. It also facilitates the family physician’s role as a cost-effective coordinator of the patient’s health services by making early recognition of problems possible. This is rooted in a long-term patient-physician partnership in which the physician knows the patient’s history from experience and can integrate new information and decisions from a whole-person perspective efficiently without extensive investigation.
[The above is a lightly edited version of the definition of Continuity of Care from the American Academy of Family Physicians (“AAFP”) website.]
Continuity of care has several dimensions:
Management continuity is relevant whenever a patient is receiving care from more than one clinician or healthcare provider. It concerns the processes involved in co-ordinating, integrating and personalising care to deliver a high-quality service. The General Physician’s (GPs) clinical responsibility as coordinator of care for patients includes helping patients to understand and plan their treatment, navigate unfamiliar services successfully and remain engaged with their care. Good relationship continuity can contribute substantially to achieving this. Having one principal care provider with a holistic view of the patient is central to patients’ experiences of good management continuity and provides a sense of security and confidence about the future.
Benefits of Continuity of Care
Continuity of care approach has significant benefits and will result in better care at a lower cost over a period of time. Some of the specific benefits include:
Use of Technology in Continuity of Care
Technology is a major enabler towards ensuring continuity of care. Some of the key technology elements that are widely used for this purpose are:
Challenges in Continuity of Care
While there are significant benefits of the continuity of care approach, there are a few challenges that we need to recognize.
1. Patients with acute problems (like a chest infection), don’t really care which doctor they see. They are looking for someone who can see them in a timely fashion and will treat them.
2. Need specialised care from another member of the team
3. Wish to discuss a problem they find embarrassing to discuss with their regular doctor
4. Chose to consult a GP of the same gender
“Continuity of Care” does not necessarily mean that the patient will consult with the same doctor each time. This might not be possible. In such cases, we will need to ensure continuity using technology and services of other clinicians in the network. When it comes to continuity, the patients are really looking for the following:
We need to ensure that the patient does not experience the above.
However, we should endeavour to provide “Continuity of Care” through the same doctor during an “episode of care” (healthcare services for a specific medical problem, condition or illness) for each patient.
At iKure, “Continuity of Care” is a key focus area and our primary healthcare delivery model is built around this theme. For us, continuity of care involves integrating patient care in his home with our Clinic services through the following:
This Day is observed on 29th September every year, to commemorate the great role this organ plays in the human system.
On this day …we must make a pledge to create and sustain a heart-healthy environment, by adopting healthy choices in our day to day lives,supplemented with a basic knowledge profile,in order to live longer with a happily beating heart, free from disease but loaded with a zest for life !
The Global Scenario…….more than 17.3 million deaths occur every year from cardio-vascular diseases. Acute Coronary Syndromes(ACS)….the lead members being Acute MI and Unstable Angina…cause a vast No. of unprepared and sudden strikes….with high morbidity and mortality..in spite of getting the best state of the art treatment facilities today…which are largely preventable !
The recent trends in the cardio-vascular morbidity profile are Coronary Artery Disease ( Ischaemic Heart Disease) and complications of Diabetes/Hypertension causing Heart Failure and ultimate gloomy prognosis..physically and financially.
With the above frightful picture in the backdrop, one should follow a guided lifestyle to keep the cardiovascular diseases at bay. ..in spite of a few latest diagnostic modalities and medicines arriving in the scene, to address some of these complicated issues.
Some of the commonly recommended day to day practices/ knowledge based activities could be…
Wishing all a heart healthy Life today and beyond………