Monday 30 March 2020

Telemed - care for all

home care for all health issues by helping patients to avoid traveling far from home to get the clinical problem solved.

workflow ->

1) doctors who need CPS (clinical problem solving) emails case with records and patient contact to CBBLE email

2) A student check for deidentification takes online consent (from the patient) and post queries with case record on TR (a Facebook group of 2000 medicos)

3) TR network engages in solving problems, while student volunteer keeps track of it, and makes communication with a doctor and patient wherever any additional info required

4) summary with the whole discussion is forwarded to the doctor.



Demo Links-

1) Specific query and case details - http://classworkdecjan.blogspot.com/2016/12/69-year-old-female-having-liver.html

2) Progressive discussion with a case having multiple problems and diagnostic dilemma (with a copy of some part of discussion below)
http://classworkdecjan.blogspot.com/2016/12/70m-neck-mass-of-large-size-and-unknown.html


Detailed document ->
https://docs.google.com/document/d/19F5pLrkSFDUfR7J-gFdYzfiizuKHUTlq_VWMpMbnlAw/edit?usp=sharing

Video Tutorial -> https://youtu.be/5CO3FS26CS8 



Friday 27 March 2020

Telemed-all care

Group to plan and operationalize the training of 5,00,000 doctors to use GOI’s Telemedicine Practice Guidelines correctly and efficiently within a month from March 26, 2020 (Commence on April 1, 2020 and complete basic training by April 30, 2020 at the latest)

The scope:
We are talking of training doctors to do the three things.
We have to plan and coordinate the creation and implementation of an online training program to train 5,00,000 doctors in 30 days starting April 1, 2020 who at the end of it should be able to do three things:
(i) proper use of the telemedicine practice guidelines issued by MCI
(ii) doing proper triage of ALL types of telemedicine patients (not just suspected Covid 19), and
(iii) then these trained doctors be able to take care of ALL patients, (not just Covid 19 suspects) including medical advice and prescribing permitted medicines to all those who are not referred to a health facility for an in-person consultation.


Below is convo from one of the focus groups.


group invite link to join - https://chat.whatsapp.com/J1eM7uh9xZ5GIaCfrDqaB7

[1:28 pm, 27/03/2020] RB Sir: Which module would you and your students like to focus on? Module 2 or Module 3?
[1:28 pm, 27/03/2020] RB Sir: (i) proper use of the telemedicine practice guidelines issued by MCI (ii) doing proper triage of ALL types of telemedicine patients (not just suspected Covid 19), and
(iii) then these trained doctors be able to take care of ALL patients, (not just Covid 19 suspects) including medical advice and prescribing permitted medicines to all those who are not referred to a health facility for an in-person consultation.
[1:28 pm, 27/03/2020] RB Sir: iii) ALL
[1:28 pm, 27/03/2020] RB Sir: Great. Please create a separate group for it and invite anyone you want from this or any other group or place.
[1:28 pm, 27/03/2020] RB Sir: What does point 3 exactly entail ?
[1:28 pm, 27/03/2020] RB Sir: Training on Point (i) is the simplest (and yet not simple), and progressively becomes challenging under point (ii) and (iii) where further referral and consultation becomes necessary. Better ability to triage reduces load on point (iii)
[1:28 pm, 27/03/2020] RB Sir: Sharing the keywords from each group

i) Inform

ii) Triage

iii) Care
[1:28 pm, 27/03/2020] RB Sir: https://chat.whatsapp.com/J1eM7uh9xZ5GIaCfrDqaB7   -> Point (iii)

...then these trained doctors be able to take care of ALL patients, (not just Covid 19 suspects) including medical advice and prescribing permitted medicines to all those who are not referred to a health facility for an in-person consultation.
[1:28 pm, 27/03/2020] RB Sir: In creating the Scope or Terms of Reference of Sub-Groups (i), (ii) and (iii) keep in mind the following: 1. Learning Outcomes 2. Curriculum 3. Structured modular lesson contents linked to each module and submodule: Text, PPT, Training videos, etc 4. Validation and verification of learning contents 5. Create MCQs fir formative self-assessment of each submodules within each module 6. Tracking training progression, 7. Summative Assessment through MCQs 8. Online certificate issued if 90% questions answered correctly, after unlimited attempts.
[1:28 pm, 27/03/2020] Avinash Kumar: good noon @sridhar sir sir
[1:28 pm, 27/03/2020] sridhar sir: Good afternoon.
[1:29 pm, 27/03/2020] sridhar sir: Kindly let me know what is the purpose of the group
[1:30 pm, 27/03/2020] RB Sir: 👆purpose trail
[1:30 pm, 27/03/2020] Avinash Kumar: sir above msgs are coming from telemed group where you joined. this group is focused for above points. and telemedicine group is focused for this overall.. (sharing below)
[1:30 pm, 27/03/2020] Avinash Kumar: The scope:
We are talking of training doctors to do the three things.
We have to plan and coordinate the creation and implementation of an online training program to train 5,00,000 doctors in 30 days starting April 1, 2020 who at the end of it should be able to do three things:
(i) proper use of the telemedicine practice guidelines issued by MCI
(ii) doing proper triage of ALL types of telemedicine patients (not just suspected Covid 19), and
(iii) then these trained doctors be able to take care of ALL patients, (not just Covid 19 suspects) including medical advice and prescribing permitted medicines to all those who are not referred to a health facility for an in-person consultation.
[1:32 pm, 27/03/2020] sridhar sir: Course content and Delivery of content are 2 aspects .
[1:33 pm, 27/03/2020] sridhar sir: The points listed have to be put under these sub headings
[1:34 pm, 27/03/2020] sridhar sir: PPTS,Articles,MCQs are all content.
[1:35 pm, 27/03/2020] sridhar sir: I have some knowledge of the delivery aspect as I run an E-Learning company.
[1:36 pm, 27/03/2020] RB Sir: Our content delivery is also related to real patient care delivery
[1:37 pm, 27/03/2020] sridhar sir: Let me put it this way. The content delivery tools , such as Moodle  are just tools. They will deliver whatever we add there. Patient care, Telemed, ENT whatever.
[1:37 pm, 27/03/2020] sridhar sir: The intent is to tech Telemed to doctors
[1:37 pm, 27/03/2020] sridhar sir: teach
[1:38 pm, 27/03/2020] RB Sir: Our intent is care and then support the information framework necessary for doctors to deliver current best care
[1:41 pm, 27/03/2020] sridhar sir: Can i say specifically that you want to teach Telemedicine using E-Learning tools?
[1:43 pm, 27/03/2020] RB Sir: No we want to involve doctors in learning medicine using tools that have been sometimes acknowledged to belong to Telemedicine
[1:45 pm, 27/03/2020] sridhar sir: Sorry, still a bit confused. So, its going to be about Telemedicine tools plus other techniques to learn healthcare .
[1:45 pm, 27/03/2020] sridhar sir: Anyway, the first thing to deal with it how the course material would be structred
[1:46 pm, 27/03/2020] sridhar sir: Structure, outcomes, how to asesss.
[1:46 pm, 27/03/2020] sridhar sir: e.g PPT of content, followed by MCQs.
[1:46 pm, 27/03/2020] sridhar sir: Or Video followed by MCQs
[1:48 pm, 27/03/2020] sridhar sir: Many tools and techniques are available. Once a teacher can state what is the intention of a course, how the content can be presented can be discussed.
[1:49 pm, 27/03/2020] sridhar sir: One thought, start with a free Moodle and create something. It could be a prototype and other can comment. Else this will be a never ending theortical discussion
You added Tamoghana sir
[2:06 pm, 27/03/2020] RB Sir: We already have lot of our own published information about our proposed workflow that we have shared in the past
[2:06 pm, 27/03/2020] Tamoghana sir: Hi. Since am new to the group, what is this group all about

Sunday 22 March 2020

Covid Project

Covid Project


The most important part is our project document - Documentation - https://bit.ly/covidprojectdocs


Flutter based mobile app for Covid quarantine tracking, to be connected with rest API to send data on the web.

Mentors 

We started from discussions for tackling the Covid-19 disaster as we always get to discuss and learn from the discussions of various experts in CPS group. After pitching for the solution of enforced quarantine (and self-quarantine also as a possibility).

I made separate focused group and found developers  


We started discussion and planning, coding, and documentation and kept doing it parallelly giving maximum energy together.

We came up with these deliverables-


Image by - Bharat Gera


Our Online Pitches to beat corona-


to FoundersVsCovid-19 

they received, retweeted and appreciated.

the dev team made this already to a good level, starting the same day as this team of 70 founders and VCs started, also we were 2 days before govt. of Poland launched a similar app.
https://play.google.com/store/apps/details?id=pl.nask.droid.kwarantannadomowa

we kept everything free and open access/source. 





to W.H.O. by raising the issue on a similar open-source project that just started a day before our team, requested them to have a look at our project and it may be useful for them as they are yet to build the geolocation features which were our specific priority target to do very well.

Waze for COVID-19 App made by W.H.O.  (under development)


We also ran 2 virtual simulations of enforced quarantine of 7 hours each in WhatsApp groups with the help of volunteers. for helping with that, thanks to Joyoti (Mukherji) Goswami https://www.linkedin.com/in/joyoti-goswami-3aa0028/




Some interesting stats of this project while we were racing against time -
Twitter



Github


Demo - 









Progress- We pitched to few governments and had a meeting with Secretary of a State govt. CM. Happy to see similar app just launched by the Govt. of India and more coming ahead by other state governments.

Avinash Kumar
avi33tbtt@gmail.com
+918840653960 


CPS group = A WhatsApp network of excellent HealthIT experts.


Monday 2 March 2020

Fever Charts (part 1) - extracting data from fever charts and making digital graphs

Why - because these fever charts (and many more charts) are easily available everywhere and once digitized this will help to collect a huge amount of data and explore it for medical and AI research. So starting small with fever charts to explore the possibility.

Collaborating with friends having an engineering background, because just medical school itself is tough to manage for me so can't get hands dirty nowadays on coding (I like python). Names of collaborators and links to project updates will be updated here later.


A sample fever chart -



This is how I started doing it manually and made a tutorial in the hope that other medicos and patients can also do it after following the steps
http://classworkdecjan.blogspot.com/2017/08/using-fever-chart.html






It was tiring to do manually so I could not manage to do frequently.



I tried the above sample image with google OCR (vision API) and here are the screenshots







A simpler way could be that just in table form write date time and temp. and a chart generated automagically by OCR, but let see how far this idea goes for using the real world available and regularly generated paper records.

Problem statement shared with engineering folks - generate a graph from this image. without manual inputs. if better handwriting, or legends or anything can improve then humans may try that, but best if the algorithm does more work and less expectation from the human. it's ok to make a very inefficient project, we can improve. only need the legend values + graph + date. (rest all data can be ignored for now)

Solutions:
1- one easy hack can be, writing temp. values as legends on graphs.

comments are welcome!

Sunday 1 March 2020