Three Points about Medical Informatics in India.

As knowledge expands and requires better management, role of I.T in health care can only become more important. India has a large number of trained I.T professionals and is in a position to leverage its Brain power to take Health informatics to new heights. As i have argued before, smart use of health informatics can also help us attain Health rights for all in many ways (lower costs, better quality, better informed patients, e.t.c). Here, i have tried to showcase a few points about Use of Health Informatics in India as well as the various educational courses available within India.

The Three major uses of Health informatics in India
1) For better training of Health care professionals ( includes Doctors, Paramedicals and Non-medicals)- e.learning
2) For improved delivery of high quality health care services to the remote areas.- Telemedicine,EMRs, CDSS.
3) To bring about a transparency in public health care delivery system.(e-governance)- Public participation

The three major obstacles to Health Informatics in India.
1) Inadequate Skills of health care personnel/others
2) Inadequate Physical infrastructure
3) Inadequate access to I.T ( Digital divide).

The Three major Post Graduate Health care Informatics courses in India
1) Medvarsity online P.G Diploma in Medical Informatics. , associated with Apollo group of Hospitals
2) Amrita Institute of Medical sciences MSc/ P.G.Diploma in Medical Informatics , at Kochi,India.
3) Post Graduate Programs at BII (Bioinformatics Institute of India), Noida, with good industry integration.

The Three short Online courses for Medical Informatics in India-
1) eHCF School of Medical Informatics, Delhi provides Certificate course in medical informatics
2) IAHI online course on Health Informatics
3) BII provides various online/distance educations courses in Health care Informatics.

In view of the fast changing world of medical informatics, it is essential to formulate a flexible syllabus rather than a rigid one for incorporating into the regular curriculum of medical and paramedical education. Only after that one may expect all members of the health care delivery systems to adopt and apply medical informatics optimally as a routine tool for their services.
Suptendra Nath Sarbadhikari

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-Why American healthcare is so expensive?

Image via Wikipedia

drneelesh@Raksha: -Why American healthcare is so expensive?
That the American healthcare delivery system is out of control and wasteful is a no-brainer.

Needless battery of investigations and over diagnosis, branded drugs, impractical insurance laws, free-markets approach to health care and sedentary lifestyle are all major factors in creating the current scenario.Its like a bad spiraling black hole which only sucks you into unnecessary and wasteful consumption of health services.

Keeping the whole machinery ticking seems to be the raison d’itre de patient existence.

This video below touches on a few reasons on why health care is so expensive in America. Features like this convince that India must be doing something right in its public health policy. I have been a member of Public health delivery system for about 10 years, in a wide range of positions and institutions. I fully appreciate Indian obstacles (population) and limitations (poverty) in public health delivery. A good step has been taken with the Swasthya bima (govt. sponsored health insurance with private partners). This Indian central govt scheme for BPL (Below poverty line) families is built on sound understanding of indian conditions and mindset. Eighteen states, including Rajasthan, have already launched this scheme. What is needed now is to make sure ALL BPL families OBTAIN an insurance smartcard. NGOs need to come forward to ensure all BPL families get their smartcards. The cost of the insurance is Ruppees 750/- annualy, 75% paid by central govt. and 25% state govt. The consumer would have to pay an annual Ruppees (Thirty) 30/- as registration/renewal fees. Then they would be able to use services at all public hospitals, many private hospitals and most specialist health care institutions all over the country with the help of a single smartcard!! The claims section of the scheme still has to show efficiency. But all in all, its a very well thought out scheme and should work wonders in more ways than one.

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- Imaging techniques in Pathology-

Israel’s ASI gives pathologists a vital second opinion – ISRAEL21c

-I have written previously about the subjectivity involved in the practise of Pathology. Its difficult to get two pathologists to agree on any one diagnosis if both pathologists insist on looking at the case through the prism of their own experiences.Besides, it is always tough disputing any one”s diagnosis as it is merely an opinion and reflects the Pathologists own “view” of the case.

Now, ASI (Applied Spectral Imaging), a privately held company in Israel has come up with a colorful solution for the problem. Instead of depending totally on the “morphology”, ie shape and size, it provides a way to visualize the antigenic proteins present in the tissue. Using their Spectracube family of products, It allows researchers to distinguish between
different materials on a chromosome by highlighting its features with
unique colors, instead of the black dye that had been used previously. This leads to better identification in suspicious cases and the test also lends itself to reproducibility.

The company has already launched “ TB Finder” in the market.In addition to TB Finder, ASI is already selling
or planning to market additional tools for pathologists, including
PathEx, as well as for morphologists, who examine protein structures
and alterations in cell structures.

The company presently promotes its products only as a backup / second opinion. But this seems to be more out of its desire not to rub the so-called “Specialists” the wrong way. Being able to corroborate one”s opinion by a scientific and a reproducible test is a tool sorely needed in the practise of Pathology. I shall not be surprised if such corroboration of opinion of a pathologist soon becomes a norm rather than an option.

All in all, a very very useful service to improve accuracy of diagnosis.

- Telepathology made simple-

MEDTING – MedicalTube, medical meeting; exchange video and image



As a pathologist, I know the importance of collaboration and second opinions. The practice of pathology is sometimes very subjective and its not unusual to get three different diagnosis for the same tissue sample/ histopatholgy slide from three different pathologists.Besides, all pathologists at one institute tend to think along similar lines, further increasing chances of bias. But getting distant doctors to review any one case and histopathology slide has been difficult till date. The best we could do was “store-and-forward” telepathology, where the images of a histopathology slide were forwarded to known experts via email for second opinion. A very primitive means of practicing telepathology, if i may say so!


Enter Medting.

“MEDTING is a clinical web portal that provides a platform for exchanging clinical cases, images, and videos. Physicians can post clinical cases with associated images or videos for discussion among colleagues. In addition, independent images or videos can be sent to the Atlas space for other to review. Other members of the community can then vote and write comments on the cases and images posted.”

Medting allows doctors from around the globe to offer their opinions on any histopathology slide (or any other clinical image). Any doctor can upload the facts and images related to any case for second opinions from experts all over the globe.Patient privacy is not compromised as names are not revealed and the site claims to be 100% HIPAA compliant.


The images uploaded presently on the site were of very good resolution. One could easily scan the whole slide, Zoom in on interesting areas of the slide, leave comments, tag images, share them, etc. It provides an excellent collaboration platform and can serve as an excellent educational tool. At present, it boasts of 1840 cases and 15760 images and videos. Cases and images are tagged with keywords using the SNOMED CT terminology.


Medting also offers premium membership and individual institutional support.


I like their service, though it is still very BASIC and has tremendous scope for improvement.

Related articles

• Medical consultation on the Move (medical-communication.blogspot.com)
• Web 2.0 in health (neeleshbhandari.blogspot.com)
• Using Cellphones to diagnose Malaria and Blood disorders (meducationtechnology.blogspot.com)

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-Characterstics of a medical blogger-

Examining the Medical Blogosphere: An Online Survey of Medical Bloggers | Kovic | Journal of Medical Internet Research
Blogs are the major contributors to the
large increase of new websites created each year. Most blogs allow
readers to leave comments and, in this way, generate both conversation
and encourage collaboration. Despite their popularity, however, little
is known about blogs or their creators.This was a study on 197 medical bloggers, their backgrounds, blogging habits, reasons for blogging, etc.
Majority of medical bloggers were highly educated, white, American males, between the ages of 30 and 49 years.Almost half of them had a personal website before they started blogging. Most had been blogging for more than two years. More males offered news via RSS than female bloggers.
Major motivations for blogging were sharing practical knowledge or skills with others, influencing the way other people think, and expressing oneself creatively. Making money and staying in touch with friends and family were not reasons to blog for a majority of the participants.
All in all, a very informative study. Read it here.

Health wisdom , not just information

I am always on the look out for web services delivering knowledge services in the field of health. I run a non-profit organization, RAKSHA, for exactly this purpose and seek new ways of achieving democratization of knowledge in health.

Organized wisdom is a well thought out web service. This interview with the team at Organized wisdom clearly spells out their views and visions for this knowledge service. The talk with their Chief Medical Officer, Dr. Howard Krein and Esther Dyson , one of the investors was very interesting.

The service claims to be ” a free service that provides patients with easy access to the best information available in easy to navigate Wisdomcards, helps patients to prepare for their appointments and helps streamline some to the conversations that must take place.”
So, I decided to explore this service logged in as a patient searching for information about my imaginary headache. The first thing i noticed was the cleanliness of the welcome page. Simple, no unnecessary multimedia ( as is VERY often the case with medical information sites) and therefore, fast navigation between pages.

The fonts were friendly, the letters bold and easily legible. It didn’t intimidate me, as a patient, with its vastness of information. There was a large search box in a major location with built in prompts via a drop down menu. So far so good.

What really won me over was the neatly laid out information. Not too deep on the first page, just plain English medical speak for an average person.There were links to more scholarly items, but everything i could possibly want to know as a patient was easily available within 2 degrees of separation. There were links to support forums, foundations and drug information ( again in plain English).There were chat rooms, message boards, personal blogs, every useful service i can think of today. They were also initiating a” LIVE chat with a doctor” service, which is now in a beta phase.

All in all, I really liked this service and i am sure something like this will soon be up and running in India, preferably in the Hindi language.
Amen.

An open letter to the Physicians of the world

Open Letter to the Physicians of the World « ScienceRoll

I am attaching a link to an open letter published on the internet.

That we doctors need to use Web 2.0 applications to ease our burden and improve the quality of our work is given. I have never come across any colleague or senior who disputes the usefulness or necessity of using these applications.

The biggest hurdle is achieving relevant computer skills. No doctor who wants to continue practicing even for next 5-10 years can shy away from regular use of computers and the internet to ease and improve work. But the inbuilt inertia of our seniors is hard to overcome.I should know that. I had this teacher during my pathology post graduation who didn’t allow me to introduce evidence based practices in our department. He insisted that HIS opinion was the final and the best opinion and to think of using information retrieval technology for improving diagnostic skills and education was not encouraged ( Frankly, i would say ” actively discouraged”. He flunked me in my exams a few times after that, from spite or otherwise).

But i sincerely hope and KNOW that there is a vast majority of doctors out there who require and seek appropriate training in the use of the Internet for medical practice. What is required is a method to tap into this enthusiasm and train all currently practicing doctors in proper use of Web 1.0 and Web 2.0 applications like email lists,blogs, social networks, bookmarking, wikis, medical search engines, instant messaging, podcasts, vodcasts…. the list could go on.

Anyways, read this letter here.

E-learning in Medical education

The use of elearning in medical education: a review of the current situation — Choules 83 (978): 212 — Postgraduate Medical Journal

Computers are increasingly used in medical education. Electronic learning (elearning) is moving from textbooks in electronic format (that are increasingly enhanced by the use of multimedia adjuncts) to a truly interactive medium that can be delivered to meet the educational needs of students and postgraduate learners. Computer technology can present reliable, reusable content in a format that is convenient to the learner. It can be used to transcend geographical boundaries and time zones. It is a valuable tool to add to the medical teacher’s toolkit, but like all tools it must be used appropriately. This article endeavours to review the current “state of the art2 in use of elearning and its role in medical education alongside non-electronic methods—a combination that is currently referred to as “blended” learning.

Read the full article on BMJ health intelligence.

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