Presenting part 3 of the series. How SIR modelling helped in forecasting and the importance of these predictions for a remote, rural district COVID designated hospital in Jharkhand in taking proactive action successfully.Continue reading “Forecasting the capacity and predicting the patient load for COVID hospital – Part 3”
Continuing with part 2 of the series. Here we get into the modelling and show how it helped a district in Maharasthra in the past 5 weeks take pro-active steps. Ending with an interview with one of the administrators of that district COVID hospital.Continue reading “Forecasting the capacity and predicting the patient load for COVID hospital – Part 2”
As some of you are aware, one of the projects we have in DHIndia is Forecasting Capacity for designated select COVID hospitals up to 30 days in advance. We have successfully helped 3 districts with this service. In order to explain the service and to present the case studies I am sharing a series of 4 videos. Starting with Part 1 of the series which explains the IDSP program and the figures being published about positives and mortality rates. The remaining parts will take each of these 3 districts and explain what we did and how we helped them.Continue reading “Forecasting the capacity and predicting the patient load for COVID hospital – Part 1”
One of the major challenges in the battle against Covid for concerned hospitals is to anticipate the demand and capacity needed between a week to four weeks into the future . If this could be forecast even to a ballpark figure , it would give a heads up for the requirements of beds , ICU capacity , ventilators , PPEs, medications and most importantly Oxygen Supply . With the unpredictable behaviour of this pandemic , any sort of guesstimate forecasting would be of great help to the management and clinical team in these hospitals, to be ready and anticipate the requirements and be forewarned to the need of increasing capacity by having additional beds in ancillary set ups such as tents , empty schools and maybe even rail coaches. Additionally it would help in taking calls on clinical protocols for admission to hospitals , ICU and ventilating . If for example it is found that in a week or two the numbers could spike , then maybe the call to admit all patients tested Covid positive could be reassessed and maybe a call to admit only patients with symptoms could be taken. Adding to the unpredictability, the added complexity of returning labour migrants to their shanty homes in villages and infecting their elderly, especially in certain states would be extremely challenging .
To aid such hospitals – DHIndia Association (Digital Health India Association ) is offering pro-bono, the power of Information Technology by offering a service to select hospitals to provide them with somewhat accurate guestimate from a day to a month ahead. This is especially being offered to hospitals in underserved areas beginning with a select group of mission hospitals. All that is required from the hospitals is to provide some data such as admitted patients , patients in ICU , patients on Ventilators , date of the first hospitalised patient in the present wave etc on a regular basis like once in two or three days. While this is just a guestimate and trend – the case study below does show it to have some amount of reliability. It will at least be better than no forecast or guestimate.
Case Study of Forecasting for a district Covid Hospital in the interiors of Maharashtra:-
This hospital was set up in readiness as a dedicated Covid hospital in the District . There was a total of 120 beds with 40 ICU beds and 35 ventilators . The protocol was that all patients who tested Covid positive were to be admitted . They had their first Covid Positive patient admitted on April 6 . There after they have had admissions first as a trickle but later getting to be more regular and higher in numbers. We did a study whereby with information put into the modelling software of the population of the district , date of the first admission and a percentage for social distancing as it was a red zone and current admitted patients , taking an average hospitalisation time of a non icu patient as 7 days ( could not carry out forecasting of ICU and Ventilated patients as there were none ) , this modelling was carried out on May 14. We then compared the numbers as per the model with actual data from this hospital for 8 dates as data points between April 6 to May 14- there was over 90 percent accuracy. Thus – it did help this hospital then look at the guesstimates from a week to a month later , the model showing that they could run out of bed capacity by June 10th or so . Further more , recieving data on a regular basis , the modeling was redone for them on May 18, which showed an accelaration in their doubling time and showed that infact they would now run out of capactiy by June 4. This model of May 18 has been spot on till now as per data recieved till May 25th. Thus the hospital is now aware that they may have to rethink the protocol of admitting all patients who tested as Covid positive to maybe admitting only those who are symptomatic and then later if that also is over run, then maybe to only those who are severe. So in this way , if this hospital keeps providing data on their admitted patients on a two or three day interval regularly , an idea of the progression of the curve could be tracked and accordingly adjustments in forecasting would be done by the software to help the hospital be more on top of the pandemic and be better prepared with the admission protocols or increasing capacity by putting up ancillary units where less severe patients could be put up . Hoping this case study brings out the benefit of this guesstimate forecasting and on behalf of DHIndia Association , we are happy to provide this service to select deserving hospitals , that will be facing challenging times in the days ahead. It is in a small way providing DHIndia’s support to these heroes battling this pandemic in real remote areas of need. Jai Hind.
Dr Pramod D. Jacob
After completing his medical degree from CMC Vellore and doing his Master of Science in Medical Informatics from Oregon Health Sciences University (OHSU) in the US, Dr Pramod worked in the EMR division of Epic Systems, USA and was the Clinical Systems Project Manager in Multnomah County, Portland, Oregon. He went on to do Healthcare IT consultancy work for states and counties in the US and India.
At present he is CEO of DHIndia Association, an organization to champion and enable the digital health ecosystem in India. He was also a consultant for WHO India in the IDSP project and for PHFI for a Non-Communicable Diseases Decision Support Application. He is also a Director and Chief Medical Officer of dWise Healthcare IT solutions.
This page may not be getting updated regularly. The regularly updated version is available at this link.
This project attempts to provide centralized clinical decision support to front line doctors in COVID-19 screening. It is being developed in collaboration with EHRC@IIITB & HealtheLife. You may read more about the project in this post.
This page contains a collection of all the resources associated with this project and is intended to help the user learn more about it, join and contribute or make use of the service.
- Beta tester logins – We maintain an updated list of beta testing logins here. All users are requested to use their own logins so that we are able to simulate real situation. In case you do not have a login, please use the link below to signup and request one.
- Feedback to improve the application – If you are beta testing the CDSS application, please post your feedback to this google sheet : https://docs.google.com/spreadsheets/d/1awnbOQvNNsksy2_0akM4ecdhrVU3x8bKXbn-BPRlo6w/edit?usp=sharing.
- Scoring protocol reference– The following link contains the details of the scoring used in the current protocol. The proposed sheet includes more factors that are being considered. https://docs.google.com/spreadsheets/d/1I_y15bz1AC2wsqn2QXq9IpO_fRkFr7eBWUzxaoq95H4/edit?usp=sharing
- Guidance document – This document gives an outline of factors to consider and question to answer while looking at defining the protocols https://docs.google.com/document/d/1Nm7g5exYVpJo6QQ8pCLVxSHH9H3N0VEDFNY-TjvGVCk/edit?usp=sharing
Join & contribute
- Join as a beta tester – We are looking for volunteers to test the application(s) and give us feedback to make it better. Please let us know if you are interested
- Commitment level – 1-2 hrs/week
- Volunteer to join – https://forms.gle/oEYea6xS2Aw4MEBQ9
- Join our Physician expert panel – Our protocols will be designed and validated by an expert panel of physicians to give credibility to this service. If you willing to contribute, please let us know using the form below
- Commitment level – 4-5 hrs/week
- Volunteer to join – https://forms.gle/RQCuzSa7UxruvSASA
- Project page in EHR.Network website – https://ehr.network/clinical-decision-support-solution-for-covid-19-on-ehr-network/
- Project link in EHRC website – https://ehrc.iiitb.ac.in/project/clinical-decision-support-solution-cdss
BOARD OF GOVERNORS IN SUPER SESSION OF MEDICAL COUNCIL OF INDIA NOTIFICATION
New Delhi, the 12th May, 2020
No. MCI-211(2)/2019(Ethics)/100659.— In exercise of the powers conferred by Section 33 of the Indian Medical Council Act, 1956 (102 of 1956), the Board of Governors in Supersession of the Medical Council of India with the previous sanction of the Central Government, hereby makes the following Regulations to amend the “Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002:-
1. (i) These Regulations may be called the “Indian Medical Council (Professional Conduct, Etiquette and Ethics) (Amendment) Regulations, 2020.”
(ii) These regulations shall deemed to have been effective from 25th March 2020 which is the date on which the Central Government has accorded approval to these Regulations.
2. In the “Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002”, the following addition shall be made:-
3.8 Consultation by Telemedicine
3.8.1 Consultation through Telemedicine by the Registered Medical Practitioner under the Indian Medical Council Act, 1956 shall be permissible in accordance with the Telemedicine Practice Guidelines contained in Appendix 5.
3.8.2 Telemedicine Practice Guidelines are designed to serve as an aid and tool to enable Registered Medical Practitioners to effectively leverage telemedicine to enhance health services and access to all in India.
3.8.3 Telemedicine Practice Guidelines are not applicable to the use of digital technology to conduct surgical or invasive procedure remotely.
3.8.4 Any of the drugs lists contained in Telemedicine Practice Guidelines can be modified by the Board of Governors in super-session of the Medical Council of India/Medical Council of India from time to time, as required.
3.8.5 The Board of Governors in super-session of the Medical Council of India may issue necessary directions or advisories or clarifications in regard to these Guidelines, as required.
3.8.6 The Telemedicine Practice Guidelines can be amended from time to time in larger public interest with the prior approval of Central Government
[Ministry of Health and Family Welfare, Government of India].
Dr. RAKESH KUMAR VATS, Secy.-General
Shared by Dr. Guriqbal Singh Jaiya, Member – DHIndia Association
Continue reading “DHIndia initiative to create a clinical decision support solution for COVID-19 screening”
DHIndia is happy to announce the collaboration with EHRC@IIITB & Healthelife to create a Clinical Decision Support System (CDSS) for COVID-19 screening. The collaboration will also include the creation of a minimal triage application for front-line doctors.
An alliance of healthcare associations in India including CAHO, CHIME and HIMSS India are partnering with DHIndia to establish a Telemedicine Registry for India. The objective is to guide healthcare providers in India on technology solutions for telemedicine as proposed in the National Digital Health Blueprint (NDHB) and Telemedicine Practice Guidelines (TPG).
If you are interested to enlist yourself as a Telemedicine solution provider for hospitals and doctors in India, kindly fill up the survey
Half of medical science goes wrong in 5 year, but nowadays that’s happening within days and hours, and information distributed via various channels with various biases and not appraised well are a risk to populations. The goal of care providers should be not only to do no harm but also to do better care for every patient.