key: cord-0907976-cwvw0wwp authors: Pataki, Chetan; Singhal, Parag; Dastidar, Amardeep Ghosh title: UK-India Telemedicine Project & COVID-19 date: 2021-07-16 journal: QJM DOI: 10.1093/qjmed/hcab199 sha: a953ed9f42ed6611ecb8aac49b52da0baf1dd563 doc_id: 907976 cord_uid: cwvw0wwp nan Health care workers across the globe were longing to lend a helping hand to the healthcare workers in India but were feeling helpless due to the lack of any provision to do so. The Indian doctors approached the global medical community to seek help; however, doctors worldwide were unsure about how to provide support in these circumstances. Some clinicians provided sensible clinical advice in their capacity while keeping in mind regulatory issues. British Association of Physicians of Indian Origin (BAPIO) organization was moved by the devastating situation and decided to help or support healthcare workers in India. The primary aim was to raise funds by appealing to the broader community through social media platforms for donations. These funds were utilized to procure and provide- oxygen concentrators, cylinders, other equipments  ventilators, pulse oximeters and CPAP/BIPAP machines  meals for those who were in distress and have lost livelihood due to the pandemic situation. BAPIO Training Academy (BTA) came up with a solution to support Indian physicians through the UK-India Telemedicine Project. However, many regulatory and governance issues were to be addressed before laying out the program's foundation. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Some of the challenges faced during the arrangement were:  Medico-legal implications and conduct of clinical governance  Consideration of GMC and WHO regulations while providing these consultations  Indemnity provision for clinicians involved from the UK  Selection of Cost-effective and reliable internet-based platforms to offer quick and timely advice  Consideration of difficulty while giving advice directly to patients or individual doctors in India After many rounds of meetings, we decided to involve established hospitals rather than individual clinicians to simplify the clinical governance. We appealed to clinicians in the UK to volunteer for this project. Within a short period, around 650 clinicians expressed their desire to help us with this project. This cohort of doctors included Intensive care physicians, Respiratory and acute care physicians, Anaesthetists, General Practitioners, Surgeons, Psychiatrists etc. Apart from doctors, nurses, pharmacists, and physiotherapists also approached us to offer help. Every one of them wanted to help Indian healthcare workers in this crisis. Keeping in mind medico-legal implications and GMC regulations, after initial checks through the paperwork of volunteers, the framework was designed to provide online support through telemedicine to help Indian doctors. The aim was to provide uninterrupted and quick advice through online platforms like WhatsApp, Microsoft Teams and Zoom meetings. Arian Tele-heal Charity from the UK had past exposure in global projects with WHO; they provided some support while setting up the system. Medical Defense Shield (MDS) agreed to provide indemnity to the UK Clinicians to cover the clinical work undertaken in this project. A Memorandum of Understanding (MoU) was signed between hospitals in India to make this process robust and legal. Rather than imposing UK Guidelines, it was decided that Indian clinical guidelines should be followed to manage Covid or non-Covid patients to avoid any confusion or mishaps due to sudden changes in clinical practices. Many clinicians with previous work experience from India were aware of the challenges to be faced while dealing with hospitals or clinicians in India. We hosted multiple meetings with volunteers to make them aware that Indian doctors needed help but not expert advice to cope with this crisis. Hospitals that had signed an MoU were briefed about the arrangements and limitations of the support which could be provided. The UK doctors had some apprehension that whether the advice given to Indian doctors would be taken in the right spirit. Moreover, due to tiredness, exhaustion or extreme work pressures, it was also thought that Indian doctors might not be in the right mindset to receive any 'expert 'advice from clinicians sitting in the UK. We developed a three-pronged approach- Quick and prompt response round the clock through WhatsApp groups for each hospital  Virtual ward rounds through Microsoft Teams or Zoom meetings  Radiology group on WhatsApp to provide prompt input on Chest X-rays or CT scans Clinicians from the UK started to conduct virtual ward rounds on a daily basis, including bank holidays and weekends. Indian doctors presented clinical cases and discussed patients during ward rounds while maintaining absolute patient confidentiality. Clinicians from both countries developed excellent rapport within a short period of time. These discussions helped Indian Clinicians to share the knowledge and make changes in their clinical practice after reviewing and validating the evidence-based medicine. The dialogue between the senior clinicians from either side broadened the scope of the discussion to a wide range of clinical problems or conundrums. Soon, it became a bilateral learning exercise. The Indian colleagues welcomed all the advice and inputs provided to them and made necessary amendments to local policies of a hospital, i.e. the use of antibiotics, antiviral, steroids etc. To date, more than 100 Virtual ward rounds have been conducted in 6 hospitals in India in the last couple of months. In addition, thousands of messages have been exchanged to share clinical opinions or expert advice. The core team of the project was monitoring the quality of the chats and discussions for quality and learning purposes through WhatsApp groups and video calls. This has been indeed a great learning experience for clinicians on either side. Clinicians have exchanged great quality feedbacks among themselves. Indian junior doctors were adequately supported and appreciated by UK clinicians. During this project, in hindsight, UK clinicians have learned about managing the new Delta variant currently spreading in the UK. We are hopeful that this experience will be helpful to those UK clinicians if the caseload by Delta variant goes up exponentially leading to hospital admissions. Thinking above and beyond, many of the senior clinicians from both countries have expressed interest in developing a learning platform to exchange bilateral clinical knowledge and wisdom. This will be undoubtedly helpful for the progression of trainees as well as senior clinicians in both countries. BAPIO Training Academy has already acknowledged the need and is providing a platform for webinars through the foundation laid by this project. Telemedicine can offer an innovative way for education, quality service provision and reducing the cost of healthcare. No conflict of interest. Reference: 1. https://www.worldometers.info/coronavirus/ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 The primary author for communication: We give the rights to the corresponding author to make necessary changes as per the request of the journal, do the rest of the correspondence on our behalf, and will act as the guarantor for the manuscript on our behalf. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Acknowledgement-I would also like to acknowledge the involvement of the following colleagues in the planning and implementation of the telemedicine project Telemedicine Project Co-Ordinator, Director BAPIO and BTA