Teleconsulting using Bahmni as an EMR

Hi All,

Thanks for your attention in yesterday’s PAT call (29th Jul) . With the intent of supporting the frontline workers in these critical times and reduce the risk and exposure to Covid19 patients and making care available easily without the need of co-location. ThoughtWorks team had proposed Tele-consulting feature using Bahmni , primarily leveraging Bahmni appointment scheduling

Here is the flow

@angshuonline @adhavan @praveenad @buvaneswariarun @pradiptakundu @vmalini @pkanchankar

Thanks for early thoughts and feedback @akhilmalhotra ,Vivek Gupta

1.Consideration around legal and privacy issues for Tele-consultation

2.Cost impact of SMS integration

3.How to share prescription post consultation

Couple of questions here -

  1. In prevailing video consultation workflow [As seen in couple of hospitals] Payment is done after the patient requests for an appointment and only after it succeeds, the appointment is scheduled. How are we planning to handle this in this flow?

  2. Patient is able to view scheduled appointments via Webapp --> We can leverage this webapp , add a separate prescription tab and enable him to see the prescription? and if permitted mail them too??

  3. What is your fallback in case there is not proper diagnosis made during that video consultation?

Some questions

  1. A rural patient is not very likely to be able to use this method to book a teleconsultation appointment. This flow suits the urban/better off patient persona better. Also, poor patients in rural areas may not have smartphones. What do you think is the minimum infrastructure a patient needs to have to be able to use this feature? I would suggest talking to a few Bahmni users in rural areas to take input

  2. Would teleconsultation be audio or video-based? Video teleconsultation would need high and reliable bandwidth which is a challenge in a lot of places. how are thinking of resolving this?

  3. A typical Bahmni installation is in the premise but I’m assuming a teleconsultation tool would need to connect to the internet from within the app. How would that work?

  4. What does the hospital site need to have to be able to use this? e.g How does a doctor know that its a teleconsultation and not physical consultation? How will the hospital process be different for such a visit?

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Can a open source telemedicine solution or just a video conferencing tool be integrated with Bahmni? It needs to have video consult option.

@pradipta - Can we use bahmni connect to cater to rural patients? might be improvise it so that the health worker can go to the patient’s location and enable tele consultation through his/her device so that the doctor is able to connect with the patient?

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We are looking at integrating Bahmni with an open source Tele-consulting tool (with video capabilities) rather than building a video conferencing capabilities within Bahmni

Whilst the administration of video conferencing apps is non-trivial, it is fairly easy to integrate Jitsi with any third party identity provider. In this case I’d view the work flow along the lines of emailing a URL to the patient or referring them from a dashboard with a JWT containing their name and signed by the booking backend to keep the conference secure.

I can’t find the docs at the moment, but I know from personally implementing such a system that it is possible.

Thanks Tom for your inputs. Team is exploring Jitsi as well.

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Thanks for all the inputs .

We have been working through the initial scope

  1. Appointment module changes required for the Tele-consulting features Appointment Mockups

  2. Also currently for release 1 , we have identified features for below mentioned target audience (with access to email and smartphone) . We will extend functionality in next releases

@buvaneswariarun gave a wonderful use case scenario. Appointment location could actually be at the health center with a experienced provider connecting remotely to a bahmni version installed at the health facility. So, patients who want some specialized services/care would arrange/appointment with the remote provider through the health facility’s bahmni installation. This way, patients in rural communities could benefit from this innovation.

This could be achieved when we develop this teleconsulting module as a separate application, could be designed such that it can be installed in a low resource environment with minimum internet requirement and probably installed in a community center/healthcare center where patients can consult doctors who sit in different locations through video calls. The patient app can have a separate tab, where the doctor’s prescription gets delivered to the patient after the consult and a print out can be taken at the patient’s location. A doctor sitting at a proper hospital will have access to bahmni, where he/she could key in the details of the patient against the patient’s id along with the prescription and save the data which can be retrieved later.

@jaghatise @buvaneswariarun

I think the scenario “Appointment location could actually be at the health center with a experienced provider connecting remotely to a bahmni version installed at the health facility” can still be handled marking the appointment as Walk in and tele consulting and once the link is generated. The Provider will connect from his/her login remotely and the receptionist/ health worker will access the link from appointment and join the call via appointment location system.

Health worker would need to have access to create appointment in above scenario.