Tele-consultations and electronic medical records driven remote patient care: Responding to the COVID-19 lockdown in India

Abstract

Purpose: To describe the experience of tele-consultations addressed at the centre of excellence of a multi-tier ophthalmology hospital network in India during the ongoing novel coronavirus (COVID-19) lockdown.

Methods: This cross-sectional hospital-based study included 7,008 tele-consultations presenting between March 23^rd and April 19^th 2020. A three-level protocol was implemented to triage the calls. The data of patient queries were collected using a Google Form/Sheets and the tele-calls were returned using the patient information retrieved from the electronic medical record system.

Results: Overall, 7,008 tele-calls were addressed, of which 2,805 (40.02%) patients where a clinical-related query was answered were included for analysis. The most common queries were related to redness/pain/watering/blurring of vision (31.52%), closely followed by usage of medications (31.05%). The majority of the queries were directed to the department of cornea (34.15%), followed by retina (24.74%). Less than one-fifth of the patients were from the lower socio-economic class (16.08%) and one-fourth were new patients (23.96%). The most common advice given to the patient was related to management of medications (54.15%) followed by appointment related (17.79%). Emergency requests requiring further evaluation by an ophthalmologist accounted for a small percentage (16.36%) of patients.

Conclusion: Tracking of tele-consultations and access to patient information from the electronic medical records enabled a timely response in an ongoing lockdown due to the COVID-19 pandemic. The current experience provided valuable insights to the possibility of managing patient follow-up visits remotely in the future.

Keywords: COVID-19; India; electronic medical records; tele-consultation.

Figure 1

Triage protocol of the tele-consultation calls into 3 levels. Triage performed by the tele-counsellors to the tele-consult team of ophthalmologists

Figure 2

Use of a Google Form to input the information of the tele-calls. The form documented the information of the patient medical record number and contact details with a brief description of the query

Figure 3

Leader board of the Eye Tele-consults League (ETL). The teams were grouped into 7 teams as per the day of the week and the performance parameters were shared akin to a sports league dashboard

Figure 4

Trend of patient categories among the calls over 4 weeks. There was increasing trend seen in calls from new patients (19.02%; week 1 to 27.02%; week 4) and a decreasing trend seen in calls from lower socio-economic patients (18.50%; week 1 to 14.47%; week 4)