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Introduction

The Tele-consultation product of company eVaidya Private Limited is called Dial UR Doctor. and it is available from 2019. The solution providers value accessibility to healthcare by patients across economic class the most. Their business model is B2B (Government). They provide only web based platforms.

Size of Healthcare Provider

a. Clinics

b. Rural PHC

Level of Specialization

a. Primary

b. Secondary

Expert Panel Evaluation

The solution basically models tele-OPD and is designed to provide healthcare in rural remote areas with the help of PHC and front line healthcare workers. The web based application allows doctors to access past records and records about follow up consultation and thus ensuring records of continued care. Video call and document exchange facility is integrated with EMR and clinical notes exchange. They have designed a user interface for frontline workers as prescription is supported in Hindi, Telugu, English. The platform provides referral options and pre-customized advice templates for doctors like bed rest and diet advice to save time. Consent is taken at the time of registering a patient. The solution has provision to exchange data in HL7 2.0 which is a lower version than required by EHR-SI 2016. It is claimed that the solution has integration of SNOMED CT for clinical finding, ICD-10 for diagnosis and LOINC for observations codes in diagnostic reports

One of the facilities to patients using their tele-consultation product is subscription based telemedicine solutions, where patients could give a missed call to a customer support number or schedule an appointment with a doctor. Patient can select their preferred language in which doctors could communicate

Additional Features
Digital stethoscope integrated

Solution Maturity Level

a. TPG complaint: 3b

b. Feature complexity: 3b partial

Introduction

The Tele-consultation product of company DocEngage Informatics PVT Ltd is called DocEngage Telehealth and it is available since 2013. The solution providers value clinical outcomes the most. Their business model is B2B, and also have option of white labelling the product. They provide both mobile and web based applications for the doctors.

Size of Healthcare Provider

a. Individual Clinician

b. Clinics

c. Nursing Home/Small Hospital (less than 100 beds)

d. Hospital

Level of Specialization

a. Primary

b. Secondary

c. Tertiary

Expert Panel Evaluation

The solution has an easy to use interface for doctors and has features to support basic consultation workflows for doctors during teleconsultation. Doctors can interact with patients in only synchronous manner and also synchronous file sharing is possible between doctor and patient and the user gets notification as soon as the file is uploaded. Doctors could interact with patients using audio/video call while simultaneously taking notes i.e. noting clinical conditions, writing prescriptions and entering data concurrently. Solution also has a drawing pad facility to explain to the patients with illustrations. This solution supports writing subjective details and objective clinical diagnosis along with assessment and planning as free text. No standard template is there and doctors can configure multiple forms and templates. Platform has a feature that enables doctors to restrict the access to prescriptions that they write. Doctors providing speciality specific consultation can customize the template. The platform is configurable as per hospital’s requirement (not having any standard workflow), consent form and also reminders, sent to mobile or email. Platform was mentioned to be FHIR compatible but providers had not done any integration. No standard coding was used to record data.

Any new appointment required consent before starting consultation, and doctor name could be part of consent if configured. Doctor is shown if the patient has signed a consent form. Feature to record audio, video call is available and organizations could form their own policy to maintain record of consultation. The clinical information audit trial is maintained.

Platform enables doctors to record consultations. Patient side of the interface provides login for booking appointments, keywords based doctor search facility. Patients could opt out of video consultation and take only audio. Patients could upload documents, once a consent form is signed. Patients get data in pdf form via email which they could use (valid for a limited time).

Prescription is shared with the patient and uploaded in the patient’s account for future use. Patient gets a link to access prescription records. Patients have the facility to upload documents and enter vitals which doctors can access. Platform also has IoT integration for capturing data that patients can use to share for more authentic monitoring. Patients could control access to PHR once uploaded within one organization, but this is contingent on the permission given by that organization (patient is not owner of the data, in their vision hospital is owner of patient’s data).

Additional Features
Medical devices integrated
Text to audio

Solution Maturity Level

a. TPG complaint: 3b

b. Feature complexity: 4 partial

Introduction

The Tele-consultation product of company Datamate Infosolutions (P) Ltd is called Ellíder Vconsult and it is available since 2013. The solution providers value cost reduction the most. Their business model is B2B. They provide both mobile and web based applications for the doctors.

Size of Healthcare Provider

a. Individual Clinician

b. Clinics

c. Nursing Home/Small Hospital (less than 100 beds)

d. Hospital

Level of Specialization

a. Primary

b. Secondary

c. Tertiary

Expert Panel Evaluation

The solution has features to support clinical consultation workflows for doctors during teleconsultation. Doctors can interact with patients in both synchronous and asynchronous manner. Call is initiated by the doctor. The solution provides multimode interaction i.e. Video, Chat. This solution supports basic clinical workflow in terms of writing subjective details and objective clinical diagnosis along with assessment and planning, including writing treatment / medication and other investigations as and when required. Alerts are available such as allergy alerts etc. English only for prescriptions are generated by platform. Doctors providing specialty specific consultation can customize the application dashboard and layout as per their prescription. Prescription is e-signed with a scanned signature. Pay later by link facility is there. Patient education and some other common information can be made available to patients in the local language.

Platform enables doctors to record consultations. The solution has provision to exchange data HL7 FHIR. It is claimed that the solution has integration of ICD-10 for diagnosis and CIMS drug database.

Patient side of the interface provides keywords based doctor search facilities.

Prescription is shared with the patient and uploaded in the patient’s account for future use. Patient can manage their own data (PHR). Patient gets a link to access prescription records. Patients have the facility to upload documents and enter vitals which doctors can access. Platform also has IoT integration for capturing data that patients can use to share for more authentic monitoring. Application supports multi party calling making it suitable for multiple doctors in the call simultaneously (for multidisciplinary care and discussions). It also allows them to take appointments on behalf of family members / loved ones. Multiple profiles can be created and they are password protected New appointments can be booked, Future appointments can be booked. Overall, the platform also respects family members / loved ones/autonomy as it gives them control over managing their records. Provision to take feedback from patients is available – Star rating/comment feedback and detailed feedbacks. Cancellation and rescheduling of appointments are based on hospital policy .
Integrated with medical devices

Solution Maturity Level

a. TPG compliant: 3a

b. Feature complexity: 4 partial

Introduction

The Tele-consultation product of company CureiOS is called Heal by SlahDr and it has been available since 2017. The solution providers value clinical outcomes the most. Their business model is B2B and B2C both, and also have the option of white labelling the product. They provide both mobile and web based applications for the doctors.

Size of Healthcare Provider

a. Individual Clinician

b. Clinics

c. Nursing Home/Small Hospital(less than 100 beds)

d. Hospital

Level of Specialization

a. Primary

Expert Panel Evaluation
The solution has an easy to use, symptoms driven data entry interface for doctors. The solution also supports the performance of doctors in terms of time-efficiency by providing a user interface which requires minimum clicks, guided data entry and easily navigable screens. The application is also easy to use for patients and has a multilingual user interface (four languages supported at the time of demo). It also facilitates features where doctors can share educational / promotional contents which includes patient education, sharing information with the patient.

Doctors can interact with patients in only synchronous manner; The solution provides multimode interaction i.e. Audio, Video. The platform provides bi-direction data sharing (files, images, etc.) synchronous to the ongoing consultation. Doctors do not have the facility to chat/share text with patients. Multiparty calling is not supported. Overall, the solution supports basic clinical workflow in terms of writing subjective details and objective clinical diagnosis along with assessment and planning. Platform is claimed to be providing a secure, scalable, Interoperable (HL7) secured information exchange. It is claimed that the solution has integration of ICD-10 for diagnosis.

Patient side of the interface provides application dependent access of consultation records, as no download and cross platform sharing is allowed. Prescription is shared with the patient over the platform for future use. Platform has a feature to take appointments on behalf of family members / loved ones. Rescheduling and appointment cancellation is not supported. When patients are in the waiting room doctors can keep them engaged by sending customized information on conditions like diabetes etc.

Solution Maturity Level

a. TPG complaint: 3a

b. Feature complexity: 4 partial

Introduction

The Tele-consultation product of company Clinivantage Healthcare Technology is called CliniQ and it has been available since 2017. The solution providers value the cost reduction the most. Their business model is B2B and the product is also available with the option for white labelling.

Size of healthcare provider

a. Individual Clinician

b. Clinics

c. Nursing Home/Small Hospital (less than 100 beds)

d. Hospital

Level of Specialization supported by the solution

a. Primary

b. Secondary

c. Tertiary

Expert Panel Evaluation

The solution comprises features that facilitate remote clinical consultation workflows for doctors during teleconsultation. Doctor-patient interaction is synchronous and the solution provides audio Video calling. The doctor always has to initiate a video call. Secure whatsapp and skype and trello for video consultation (part of subscription model).This solution supports basic clinical workflow in terms of writing subjective details and objective clinical diagnosis along with assessment and planning, including writing treatment / medication and other investigations as and when required. It also allows doctors to take private notes. Platform features include easy to use prescription formats that are available as preconfigured templates. Patients can choose their own template for providing history and medical history is also transcribed from audio. Examination, diagnosis and orders are noted by doctors in SOAP format and it is used for case sheet generation. The doctor case sheet is broken into three subsections (case history, prescription and order), and the doctor can send each section individually (topatient, pharmacy and diagnostic center). Prescriptions generated using platform features are designed to capture details like Registered medical Practitioner’s name, Doctor’s signature stamp. Doctors can keep private notes for themselves. Doctors are supported with quick prescription writing by rule based access to frequently used (favorite) drugs. Devices integrated can measure: Spo2, blood pressure, blood glucose, ECG, temperature and pulse rate. Rule based clinical history taking is present as an advanced trial feature.. Consent is one time during application usage, for every video call consent is implicit

It is claimed that the solution uses .SNOMED CT & ICD-10 standards are implemented for clinical data capture at relevant places recommended as per EHRIS-2016 & NDHB. Application is FHIR implemented for exchange of information. Also the privacy & security standards are implemented. Platform is capable of interfacing with standard, having in-built capability to support Drug databases. CIMS database has been implemented for recording medication.

Patients can upload x-rays, and associate the date label with the uploaded documents. Patients can enter data in their own language. Patients can enter vital and other details (manually enter can use their integrated devices, they have their device which can be integrated). Device is easy to use for proactive (abled) patients.

Patients can add family members, each member gets their own ID and control over records, 140 languages and records in those languages and send voice records (all this is pushed in EMR). Patient is given a form for entering data (history) in regional language and it is translated for patent. Case sheet is in english. Patient application requires password (two factor authentication), patient can restrict what they can share / unshare (control over records. Patients can share records and have control over format and manner that they can share / upload records.

Additional Features

The solution also ensures following features:
Drug Database Integrated (Doctor Need to have license)
Voice Typing
CDSS
Rule-Based Suggestion
Integration with device at home
PHR
Remote monitoring IoT

Solution Maturity Level

a. TPG compliant: 3a

b. Feature complexity: 4partial

Introduction

The Tele-consultation product of company ABHAYA INFORMATION TECHNOLOGY LLP is called Advait Home Health (lung and heart monitor) and it has been available since 2016. The solution providers value cost reduction the most. Their business model is B2B, and also have white labelled products. They provide both mobile applications for patients.

Size of Healthcare Provider

a. Individual Clinician

b. Clinics

c. Nursing Home/Small Hospital

d. Hospital

Level of Specialization

a. Primary

b. Secondary

Expert Panel Evaluation

The application is easy to use for patients and suitable for follow up consultations and remote monitoring. This is more a device monitoring solution ( focused on ECG monitoring). Patients can search by doctor’s name and appointment slots with timings can be selected by patients. Link of appointment and prescription is sent as Email.

Doctors can interact with patients in only synchronous manner; The solution provides limited features in UI, and that makes it easy to use for audio and video interactions. Doctors can digitally sign the prescription. The prescription form has simple text-based fields to record notes and medication details. The platform generates e-prescriptions which are also browser based and automatically emailed to the patient doctor and Admin of the hospital. No EMR\PHR is present. Not supported the standards at relevant places as mandated by EHR Standards for India. This solution supports basic remote consultation workflow in terms of writing prescriptions and monitoring patients. Doctors can do multi-party calls during consultation.

Platform also has IoT integration for capturing data that patients can use to share for more authentic monitoring. Abhaya Tele-Consulting platform is a browser based Application which provides direct connection between Doctor and patient. Advait Home Health is their mobile application. Advait is connected via Bluetooth to a Wearable ECG monitor and Lung monitor to provide remote and real time monitoring of the patients from wherever they and the doctor are located. Data is stored in a HIPAA certified cloud and the doctors can view the data historically and real time. Platform is claimed to be providing a secure interface.

Additional Info

Rule based (Machine learning) for prescription text generation

Solution Maturity Level

a. TPG complaint: 3a

b. Feature complexity: 4partial

Introduction

The Tele-consultation product of company Sidqam Technologies Private Limited is called Eventus Talk and it has been available since 2016. The solution providers value cost reduction the most. Their business model is B2B  and also has an option of white labelling the product. They provide both mobile and web based applications for the doctors. They also provide mobile applications for patient and/or web based patient portals.

Size of Healthcare Provider

The solution is useful for the following categories of healthcare providers: 

a) Individual Clinician

b) Clinics

Level of Specialization

The solution can be used in the following settings of specialisation of clinical services:

a) Primary care

Expert Panel Evaluation

Basic workflow was SOAP format, doctor controlled application, doctor can customize the template for note taking (pre filled notes template, save favorite templates), doctor can customize workflow screen during onboarding for speciality consultation (antenatal consultation was part of demo). The UI is not easy to work with as screens are cluttered screens for writing notes and generating diagnosis. SMSs and emails are used for communication with patients for consultation with doctors and for sharing prescription notes also. Cross consultation options are available. Doctors can generate referral letters for patients. Admin module had two factor authentication (role based access). Permissions of various roles can be modified, such as, the secretary can note vital and other activities based on permission, send reminders, and customize timeslots. Doctors can note a few instructions in Hindi, but overall it is not multilingual. This tele-consultation solution has capability for digital signature.

Appointment could be fixed either by the doctors or by the patients. Appointment notifications are sent to the patient and the duration is customizable. If the clinic/doctors take this solution as a holistic package then it comes with an application and patients could fix appointments. Healthcare providers share mobile applications with patients.   All the past records are available within the application. Patients can give feedback to the doctor after the consultation.

If the health care provider  opt for (purchase) only the tele consultation module of their solution, then the patient side of the solution does not allow management of profile or their  health record (PHR not there). In such a module, the communication with patients is only through SMS or Email or both. Prescription links after the consultation is sent via mail or SMS and can be accessed by the patient indefinitely. The caregiver role is not there but the facility to have chaperons is there for video consultation.

The solution has SNOMED CT integrated. It also supports ISO-13606, HL7,  FHIR, and C-CDA structure and exchange standards. The drug list is integrated from the US FDA. The solution has sufficient data security standards and arrangements in place. It is claimed that the solution takes care of requirements in Indian IT Act, Patient Data Protection Bill and TPG 2020 guidelines. The software has one integration with clinical trials software management.

This solution allows doctors to take individual consent for every consultation. They have detailed consent management based on speciality and digitized signature there.

Additional Features

The solution also ensures following features:

a) Instructions for patients in Hindi language

Solution Maturity Level

a) TPG compliant: 3a

b) Feature complexity: 4 (Partial)

Introduction

The Tele-consultation product of company Moxie Labs Private Limited is called Moxie and it has been available since 2017. The solution providers value clinical outcomes the most. Their business model is B2B and B2C, both, and also have white labelled products. They provide both mobile and web based applications for the doctors. They also provide mobile applications for patient and web based patient portals.

Size of Healthcare Provider

The solution is useful for the following categories of healthcare providers: 

a) Individual Clinician

b) Clinics

c) Nursing Home/Small Hospital (less than 100 beds)

d) Large Hospital

Level of Specialization

The solution can be used in the following settings of specialisation of clinical services:

a) Primary care

b) Secondary care

Expert Panel Evaluation

This tele-consultation solution  has  an  easy to use interface for doctors and has features to support clinical consultation workflows for  doctors during teleconsultation. The solution also supports performance of doctor in terms of time-efficiency by providing a user interface which requires minimum clicks and has easily navigable screens. Doctors could access prescriptions and previous records while doing video consulting (synchronous, interaction and communication both are possible). The solution provides multimode interaction i.e. audio, video, text/SMS, chat and Email. This solution supports basic clinical workflow in terms of writing subjective details and objective clinical diagnosis along with assessment and planning. Including writing treatment/medication and other investigations as and when required. Note taking is in SOAP format. Doctors providing speciality specific consultation can customize the application dashboard and layout as per their requirements and prescription like immunization, antenatal care, ophthalmology. Synchronous multiple calls are not possible. Data entry of diagnosis and findings by a doctor is adaptive and it learns it based on previous medicine prescriptions. Those are available as a suggestion. Prescription is time stamped and e-signature is available, digital signature not available. Doctors could create proforma for research purposes also. 

In order to provide good consulting experience to patients, the doctor’s side of the interface has facilities to manage appointments, calendar scheduling. Doctors can create custom slots for patients for immediate consulting needs and in some situations could forgo payment as mandatory (if doctor selects). Admin role based access is there for managing and booking appointments. Platform provides facility to initiate refund to patients in case of appointment cancellation. 

Patient side of the interface provides login for booking appointments, keywords based doctor search facility, guided searching of doctors. Each appointment booked by patient consent is flagged and is available in metadata. Doctors’ identity is visible to patients, including their registration details, affiliation. Patients could share records, details images etc. while doing interaction. The patient could access prescription and download prescription. Patients have a choice to share records across doctors by downloading.

Dependent profile management is there as multiple profiles can be created and used in one installation. Minor profiles can be a part of the parent user and details can be viewed by the parent user. Platform allows them to take appointments on behalf of family members / loved ones. Platform also respects family members / loved ones/autonomy as it gives them control over managing their records. Patients have control over sharing and accessing their records. If the profile is created as an independent user, then the details are secured with user ID and password for each user. Family member is the main owner of all profiles (for minors, with one common mobile number owner has access to records).

Platform is claimed to be providing a secure interface.  Apart from ICD-10 for diagnosis, no other EHRIS-2016 standard is implemented. Planning to implement SNOMED CT and FHIR standard as per NDHB guidelines. Security standards are supported. (drug database interfacing and device integration is undergoing clinical trial). Exceptions in the drug are not identified, as drug database integration was not completed at time of demo.

Platform also has a consent mechanism and providers can take consent for every encounter (patient booked appointment).

Solution Maturity Level

a) TPG compliant: 3b

b) Feature complexity: 4 Partial

Introduction

The Tele-consultation product of company KareXpert Technologies Private Limited is called KareXpert Telemedicine Digital Platform and it has been available since 2014. The solution providers value care delivery the most. Their business model is B2B and also has an option of white labelling the product.

Size of Healthcare Provider

The categories of healthcare providers that this solution can cater to are:

a) Clinics

b)Nursing Home/Small Hospital (less than 100 beds)

c) Large Hospital

Level of Specialization

The solution lends itself to use in the following levels of clinical specialisations:

a) Primary care

b) Secondary care

c) Tertiary care

Expert Panel Evaluation

Doctors can interact with patients in a synchronous manner, but it is not easy to use as seamless tele-consultation workflow is not supported. The solution provides multimode interaction i.e.  both audio and video. Doctors could interact with patients using audio and video calls while simultaneously taking notes. This solution does not provide any template for writing clinical diagnosis and assessment and planning. Platform supports writing prescriptions with basic requirements mandated by TPG guidelines that have scanned signatures along with the doctor’s registration ID. Group call is possible. Platform enables doctors to record consultation.

It also allows patients to take appointments on behalf of family members or loved ones and manage family or dependent accounts. Appointment cancellation and refund facility is there. They have cancellation and refund for appointments.

The solution has provision to exchange data as HL7 standards for health data exchange are supported, security standards like encrypted connection, access control, digital certificate etc. are implemented. It is claimed that the solution has integration of SNOMED CT for clinical finding, ICD-10 for diagnosis. 

Consent is part of platform usage guidelines, implicit consent is there.

Solution Maturity Level

a) TPG compliant: 3a

b) Feature complexity: 4 (partial)

Introduction

The Tele-consultation product of company Navia Life Care is called Navia e-Consult and it has been available since 2016. The solution providers value cost reduction the most. Their business model is B2B and does not have white labelling of the products. They provide both mobile and web-based applications for the doctors. They also provide mobile applications for patient and web-based patient portals.

Size of Healthcare Provider

The solution is useful for the following categories of healthcare providers: 

a) Individual Clinician

b) Clinics

c) Nursing Home/Small Hospital (less than 100 beds)

d) Large Hospital

Level of Specialization

The solution can be used in the following settings of specialisation of clinical services:

a) Primary care

b) Secondary care

Expert Panel Evaluation

The application UI/UX interface for doctors and patients has a steep learning curve and a little bit of technology knowledge is required. Once familiarized the platform is easy to use and supports data entry with advanced features like voice typing. The application has an automated chatbot facility to guide patients, and a call center facility is available.

Doctors can interact with patients in only synchronous manner. The tele-consultation solution provides multimode interaction i.e. audio, video, Email and link sharing. Doctors could interact with patients using audio and video call while simultaneously taking notes i.e. noting clinical condition, writing prescription and entering data concurrently in the interfaced Electronic Medical Record (EMR) (if present). Doctors can write free text notes. The speciality templates of notes are not available, but doctors can store favorites (prescription and notes). This solution supports basic tele-consultation clinical workflow well. Digital signatures are not supported, the application supports adding image (scan) signature in prescription.

Phone number is used as a unique ID for patients. The patients need to know clinic code/ doctor code and then only they can book appointments. Admin role is there but it cannot initiate the video call. Doctors are required to accept appointments, i.e., doctors control the booking of appointments, initiation of video calls. Rescheduling and cancellation of appointments possible. Payment related guidelines for patients are customizable by doctors. Consent is taken at time of making payment. Multiparty video conferencing and referral feature is not available.

Patients get communication messages and links on whatsapp (appointment alert). To provide good consulting experience to patients, the waiting room facility is there on the patient side of application. Patients have the facility to upload documents and enter vitals which doctors can access. Patients can access prescription and booking access without application download (whatsapp integration) so the installation of mobile application is not mandatory for patients. Pill reminders and follow up reminders features are there.

It is claimed that the solution has integration of SNOMED, ICD-10 for diagnosis and LOINC for observation codes in diagnostic reports. No data exchange standards are supported.

The solution design ensures that the patient has control over past records in terms of sharing data across providers. Patients can unlink doctors if they do not want to share any report with them. Care-giver and family member accounts supported in application as doctors can consult multiple people on the same mobile number. Caregivers can book appointments on behalf of patients. Guidelines on preparation of calls are available for patients.

Unique Features

The solution also ensures following features:

a) Chat bot

b) Voice typing

Solution Maturity Level

a) TPG compliant: 3a

b) Feature complexity: 5 (Partial)