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Introduction

The Tele-consultation product of company Best Doc Technology Pvt. Ltd. is called BestDoc Connect and it has been available since 2016. The solution providers value convenience of the user the most. Their business model is B2B. 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 categories of healthcare providers that this solution can cater to are:

a. Individual Clinician 

b. Small Clinics

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

d. Large Hospital

Level of Specialization supported by the solution:

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

a. Primary

b. Secondary

c. Tertiary

Expert Panel Evaluation

Doctors are onboarded using detailed preparation guidelines including audio and video training. Doctor registration details  are obtained from the hospital where they provide the service. The solution provides multimode interaction i.e., both audio and  video. There is  no specific template or format for note taking. Consultation interface is very basic and not  customised to support the online clinical workflow/templates.

Doctors could interact with patients using audio/video call while taking private notes in asynchronous manner i.e. noting clinical condition and data after they have finished consultation with the patient. Type of Interaction is not synchronous– doctor can either chat with a patient or take plain text notes (doctors are required to write prescription after video consultation is over)–the notes taken on call are available to the doctor which they can copy. Notes are written as free text and stored which could be shared with the patient as an image with the timestamp once the consultation process is completed. Platform has a feature that enables doctors to take an image of their handwritten prescription, preferably with the header having their details and it is shared with patients. Doctors have to upload the pdf/image to provide prescription as part of teleconsultation. The solution is not interfaced with any EMR.

Clinical notes written by the doctors are  stored for one year in encrypted format. The chats cannot be stored and consultation is not recorded. It has a limited audit trail functionality.

Patients are onboarded using a link with teleconsultation preparation guidelines. Patients are verified using hospital UHID and/or OTP on mobile number. Patients have the facility to upload documents and enter vitals which doctors can access during consultation. Patient has to be available 15 min before the call. Registration details of registered medical practitioners are displayed for patients. Appointments can be cancelled and refunds can be processed. SMS is sent for appointment and email link is sent to the patient. Platform has an admin role to manage appointment and queue management. This admin role login can be used for front office/ call center login to manage appointments.

Multiparty calling is not possible and only supports English language. They have explicit consent for every encounter in English language. 

Solution Maturity Level

a. TPG compliant: 3b 

b. Feature complexity: 3b [Partial]

Introduction

The Tele-consultation product of company BeatO is called BeatO and it has been available since 2015. The solution providers value cost reduction the most. Their business model is B2C (doctor and patient both as customers).  They provide both mobile and web based applications for the doctors. They also provide mobile applications for patients.

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

b. Secondary

Expert Panel Evaluation

The solution  is specialty specific (diabetes), minimum clicks and easy to use interface for doctors. The application is easy to use for patients once they are trained.  Patients are onboarded via call and the user-guide (pdf) is shared with them. Doctors are on-boarded via in-person demo. They have a dedicated team for helping customers (doctors only) and troubleshooting.

Doctors can book and manage appointments, check and update payment status. Doctors can access the history, logs and trend charts, patients’ previous case history   using the application dashboard. They can chat with patients while accessing the details of patients. It is not a synchronous solution as doctors cannot take notes or access records while being on video call with a patient. Doctors are expected to write prescriptions and upload a scanned copy of handwritten notes. Platform provides a facility to integrate the doctor’s signature as a footnote with every prescription given. Referral and sharing of records are not possible. Multi person video calling and dependent features are not there. 

Platform does not generate any EMR/PHR data apart from just uploading the prescription. The platform is designed to provide lifestyle advice (not medical), so ICD /SNOMED is not integrated. Although providers mentioned that the application is HL7 and DICOM compliant, we understand that these standards are not implemented and in actual usage.

At the time of appointment booking, the patient’s problem and medication history is asked. Patients can also add/share reports with doctors. Patients can select doctors from the list for booking appointments and choose voice (only) and video (only) consultation. The patient can access the history of past records, payment details and prescriptions from mobile application. Solution also has a proprietary device interface for patients. Device and product both are specific to diabetes care. Device is attachable to the cell phones. Patients can customise the reading appropriateness of blood sugar values, and a log is created associated with it [pre lunch, random, postprandial]. Alerts are in-built in the application based on reading. Hb1ac is estimated. 

In order to provide good consulting experience to patients, the doctor’s side of the interface has facilities to manage appointments, calendar scheduling. Platform provides facility to initiate refund to patients in case of appointment cancellation. It also facilitates features where doctors can share educational/promotional contents which includes health education, sharing research and news articles with the patient. Consent is implicit and is considered as part of platform use terms and conditions.

Unique Features

The solution also ensures following features:

a. Specific to diabetes management

b. IoT integration

Solution Maturity Level

a. TPG compliant: 3b 

b. Feature complexity: 3b

Introduction

The Tele-consultation product of company AMATRES Technologies Private Limited is called AMAHealth and it has been available since 2017. The solution providers value convenience of the user the most. Their business model is B2C. They provide both mobile and web-based applications for the doctors. They also provide mobile applications for 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)

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

Mobile number of the doctor is verified during onboarding and onboarding happens only after details of doctor are verified and the doctor profile is associated with their healthcare organisation. This is a mandatory step for doctor’s onboarding. They have individual on boarding training support for the doctors. The  email and video tutorial of steps are sent to the users.

The solution provides multimode synchronous interaction for both audio and video. Doctors could interact with patients using audio/video call while simultaneously taking notes i.e. noting clinical condition. 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 (popularly known as SOAP notes).

Consultation recording option is not available. Platform does not support the standards at relevant places as recommended by EHRSI-2016 and NDHB. No health data exchange standards supported. Platform is having in-built capability to support proprietary drug database interfaces. Individual patient records are shared with the consulting doctors only, and record sharing among doctors sharing of records is not facilitated (no cross-referral).

The patient side of the interface provides login for booking appointments. The patient can search for a doctor’s name and specialty wise doctors. Symptom based search was under development at the time of demo.

Role based login facility is there to manage appointments by support staff at organization level. Doctors can schedule appointments for patients, but to make the video call, a patient is required to give consent, before the doctor could make a video call (Implicit consent). In case of doctor initiated appointment, the patient has to agree for video consultation (considered as basic explicit consent).

In order to provide good consulting experience to patients, the doctor’s side of the interface has facilities to manage appointments, calendar scheduling and seamless appointments because of the waiting room facility. Appointment of doctors are viewable across organization and within organization but consultation is individual doctor to patient. Admin could add patients and create an account of patients. Token is allocated to patients and this can be used for scheduling appointments. Doctors could customise the slots allocation both in terms of time and in terms of token number. Appointment number (token number) getting serviced is shown on the screen of the patient and this helps in getting real time update of wait time.

In terms of compliance, the application provider has a mechanism associated with the platform to validate registration details of doctors by mapping them to the organization.  Platform also has a consent mechanism and the provider can take explicit consent for each encounter or if and when the patient initiates the call, it implicit consent.

Solution Maturity Level

a. TPG compliant: 3b 

 b. Feature complexity:  3a

Introduction

The Tele-consultation product of company Tia Tech Healthcare Solutions Private Limited is called Tia-Tele. The value proposition that the solution providers consider as priority is  improving clinical outcomes. Their business model is B2B along with the 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 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

b. Secondary

c. Tertiary

Expert Panel Evaluation

The solution  has  an  easy to use interface for doctors. Doctors can interact with patients in both asynchronous (e-mail, SMS) and synchronous manner and the platform supports multimode interaction i.e. audio, video, chat, and email. Doctors could interact with patients using audio/video call while simultaneously taking notes i.e. noting clinical condition, writing prescription and entering data concurrently. This solution supports  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. Features also include: prescription templates, chat based prescription, embedded signature on prescriptions, scan/image upload of prescription, speciality specific template  (when proprietary EMR is integrated), automating prescription in image to PDF format. Doctors providing speciality specific consultation can customize the application dashboard and layout as per their requirements. Application supports referral within organization. Doctors are supported with quick prescription writing by rule based access to frequently used (favorite) drugs and investigations ordered. The solution also augments  clinicians’ performance by providing an easily navigable screen.

Platform enables restrictions on prescribing some drugs as in schedule X drugs (when proprietary EMR is integrated). Alerts are shown to doctors. The solution has provision to exchange data using HL7/FHIR  and it is claimed that the solution has integration with ICD-10 for diagnosis (when integrated with EMR). Platform has the capability to support  the interface with  drug databases from India and other countries. Audit trail is maintained. Device (IoT) integration is there through EMR (not directly interfaced with the telemedicine solution).

Platform has an admin role login to support in managing consultation schedules and provides facility to initiate refund to patients in case of appointment cancellation. Payment customization is there, for the first time and follow up both. Help desk/secretary login to manage appointments and help patients.

Patient side application has the ability to support individual login, booking appointments and keywords based  search for doctors. It also allows them to take appointments on behalf of family members/loved ones, and have a family account. Patients  can upload documents and enter vitals which the doctors can access. Platform does not allow patients to control data sharing, as all records are accessible within the organization. Patients also do not have control to share data across organizations. Patients are having features to rate and provide feedback about doctors. Doctors’ profiles are available to patients in multiple languages, but overall user interface and prescription translation is not there.

The application providers have mechanisms associated with the platform to validate registration details of doctors either with the help of support team, oral confirmation by doctor, manual (personal) confirmation of ID/credentials with support team or from state/ national registry of doctors or mobile number/e-mail ID. Platform also has a consent mechanism and providers can take consent from the patient for the use of their telemedicine platform. The solution allows for explicit consent for every doctor-patient interaction and they also provide the feature to upload consent. Platform ensures that the consent taking process also provides guidelines on tele consultation preparation to patients.

Additional Features

The solution also ensures following features:

a. Rule-Based Suggestions

b. Integration with EMR of hub Hospitals

c. Alerts for allergy

d. Family account

Solution Maturity Level

a. TPG compliant: 4 [Partial]

 b. Feature complexity: 5 [Partial]

Introduction

The Tele-consultation product of company JIYYO INNOVATIONS PRIVATE LIMITED is called Jiyyo App and it has been available since 2017. The solution providers value care delivery the most. Their business model is B2B. They provide both mobile and web based applications for the doctors. They also provide kiosk facilities for patients.

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

a. Primary

b. Secondary

c. Tertiary

Expert Panel Evaluation

The solution  is a Kiosk/ e-clinic model has to be managed by an administrator. The administrator acts as an interface between doctors and patients, facilitating the communication and interactions (consultation). Patients connect with doctors with the help of Kiosks (operator model,/e-clinic). Administrators require training in taking patient history and operating Kiosk / platform.

Doctors interact with patients in a synchronous manner and patients require pre-registration. The solution provides multimode interaction i.e. Video, and Audio. Doctors could interact with patients using audio/video call while simultaneously taking notes i.e. noting clinical condition, writing prescription  and/or entering data concurrently. The notes and prescription are printed by the administrator and handed over to the patient. This solution supports basic teleconsultation clinical workflow. Doctors can record consultation. Prescriptions and all clinical notes are written as plain text, there is no template or format. Doctors are supported with quick prescription writing. Each prescription has the doctor’s registration number but is not signed. Platform also has IoT integration for capturing data that patients can use to share for more authentic monitoring.

Kiosk administrators can search doctors and connect on behalf of patients. Before consultation patients are required to sign a consent. The consent form in vernacular language. Application  also facilitates sharing case records (referral) by providers.  Platform encrypts critical information and medical records are stored in the encrypted format. Solution maintains an audit trail. Platform has a payment gateway and facility to initiate refund to patients in case of appointment cancellation. Overall in terms of features this solution is having usability for functionally illiterate patients.

Solution Maturity Level

a. TPG compliant: 3a [partial]

b. Feature complexity: 3b

Introduction

The Tele-consultation product of company Inkblot Labs Private Limited is called vCliniq and it is available from 2019. Their business model is B2B. They provide only mobile based applications for the doctors. They do not have a dedicated product for the patient.

There is also an option for white labelling the solution.

Size of Healthcare Provider

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

a. Individual Clinician

b. Small Clinics

Level of Specialization supported by the solution

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

a. Primary care

It has been mainly deployed in urban and peri-urban regions.

Expert Panel Evaluation

The platform has an easy to use interface for doctors that supports basic teleconsultation session workflow.  The application provides a mechanism associated with the platform to validate registration details of doctors either with the help of support team, oral confirmation by doctor, and validation from state/ national registry of doctors. Installation of a specific provider’s application is not mandatory for patients. Platform creates unique ID for patients using a mobile number as an identifier. 

Doctors can interact with patients in only synchronous manner. This solution supports basic clinical workflow in terms of writing subjective details and objective clinical diagnosis along with assessment and planning. Doctors can write notes simultaneously on a separate tab for their personal reference; not shared with patients directly. Prescription (with scanned signature) is generated and shared with patients  as a pdf over whatsapp .

Interface is such that doctors might prefer to write prescriptions on paper having their registration and qualification which can be scanned thereafter to share with patients. Platform does support writing prescriptions with basic requirements mandated by TPG guidelines that have scanned signatures. Prescriptions could also be generated by the platform using the template that facilitates inclusion of details like registered medical practitioner’s name, registered medical practitioner’s qualification, registration number, address, contact details, date of consultation, and patient’s demographics. Doctors can customize the dashboard.  

Patients get a link on their phone  using which they can access their prescription and consultation notes after the consultation is over. There is no facility to record the consultation. Application supports multi party calling making it suitable for multiple doctors in the call simultaneously (for multidisciplinary care and discussions). Platform provides customisable advance appointment management. The “Super Admin role” is separate and can manage role based access. Secretary role user could manage registration of patients, change status as waiting and send a reminder etc. Whatsapp is integrated for sending reminders to patients.

With integrated EMR, the platform also supports advanced features including customizability of prescription template, vital parameter charting, ordering drug, lab, procedure, to develop own formulary (mark favorites) and cross  referral. Platform is having the capability to support drug database formulary and / or drug database interface. This implies that specific drug prescription (Schedule X) can be restricted (if using the integrated EMR). Doctors can search for  patients by disease and name as keywords and this feature is useful for research purposes.  

TPG (partial compliant): Consent from patients ( mentioned during the demo ) is taken on whatsapp, e-prescription (image over Whatsapp), platform generated prescription allows drug restriction and integration of scanned signature.

Solution Maturity Level

a. TPG compliant: 3a

b. Feature complexity: 4 [Partial]