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May 17, 1999


The online patient: A Bangalore hospital has put Web cams in the wards so that friends and family are only a click away. M D Riti in Bangalore

Bangalore has lost its young to the Great Gold Rush in Silicon Valley. So what happens when calamity like heart disease strikes a family back home?

Email this story to a friend. Until recently, long-distance calls and emails would swiftly inundate the staff of Wockhardt Heart Hospital India.

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"My cousin Gajendranath is a patient at your hospital," reads an email from Satish K Rao, director of operations of software, PSW Technologies, Austin, Texas. "Can you please give me the status of his condition?"

Staffers had no choice but to pour words of assurance into the mouthpiece or pack them in an email over the Internet. And much of this activity was at the expense of routine.

The need to find a solution hit home with the case of Srinivas. The only child of a widow, Srinivas called the hospital hourly from the US when his mother was undergoing emergency bypass surgery.

Sometime then, WHHI had commissioned a project to set up a Web site.

It was Marketing Manager Vijayaratnam, a hospital administration graduate from Madurai, who first thought of including patient information on the WHHI's site so that relatives and friends could look it up directly, reducing the load on doctors and the general staff.

As far as Vijayaratnam knew, this had not been done anywhere else in the world, so would it work? The idea caught the fancy of General Manager Vishal Bali who was discussing the site with Web designers Thinkahead.

Thinkahead chief Bharat Gera told Rediff "I knew a lot of people who came back to India for good only because their parents were not well. I too thought it would be a great value-added service to enable patients and relatives to be in touch with each other without any extra cost."

Were they targeting only targeting non-resident relatives or Bangaloreans too? "Both," claims Gera. "I would say we were basically addressing professionals and Internet users spread across the globe including those in India."

Finally, the 'Virtual Family Visit' pages are up on the Wockhardt site.

A simple drop-down menu lists the names of patients who have consented to put their reports online.

On selecting a name, the surfer is served a page with the photograph of the patient, taken anywhere between a few hours to a day after the medical procedure she had been hospitalised for. Then you have the option of clicking through a few more still pictures, often featuring a close relative by the bedside.

A video link allows the download of a small clip, mostly featuring the patient himself, talking about how he has been feeling lately. Sometimes, the operating doctor is included on the clip. The doctor usually has a few words on the procedure that was performed, how successful it was, what the prognosis is and when does she expect to discharge the patient.

"This patient had bypass surgery four hours ago," says Dr Vivek Javali, standing at the bedside of a still obviously unconscious Bhagyamma. "She is not on a ventilator now. She had two grafts and had no problems with either. She has been off the respirator for the past two hours. We hope to shift her out of the cardiac intensive care unit by this evening."

As of now, such a video capsule takes almost an hour to download in India. However, Vijayaratnam assures that it takes barely two to three minutes in places like the United States where the infrastructure is better.

There is also a brief doctor's certificate that one could access. As of now, the information in the certificate is really brief, usually just a single line about the procedure that the patient has undergone and when she can be expect to go home.

"When the message on the video clip is from the doctor, its content is medical," says Bali. "When it is from the patient, it obviously is more social. Relatives seem to prefer to hear from their family members directly in person than from the doctors," he explains.

"I am doing fine," says retired government officer P Jagadish Rao. He is speaking into a handheld microphone soon after he underwent a mitral valve replacement surgery. "I ate some mangoes today and drank mosambi (sweetlemon) juice. I went for a walk inside the hospital. Don't worry about me."

Daughter Sahana Rao, who lives in the Sultanate of Oman, is reassured. "I wanted to be beside him when he was operated on but could not arrange to do that because it was all so sudden. Thanks to the Internet, we could see Papa and Mummy on our computer screens." Infotech department engineers Herbert and Santosh have been sending Sahana emails with medical updates on her father's health.

The case of Mecon General Manager N K Gupta is the most dramatic. He had a massive heart attack when he was alone in Bangalore. His children all live abroad and his wife had been visiting the US to help their daughter with her delivery.

"A neighbour called us and helped in getting him to the hospital," remembers Bali. "Gupta was in terrible shape and we almost lost him. We had to use a defibrillator repeatedly on him."

They reached his family in the US, and Gupta's wife and his son Avininder left at once for Bangalore.

"Unfortunately, this Virtual Family Visit facility had not been set up then," says Avininder regretfully. "I myself work in Silicon Valley and it would have been tremendously helpful to us if we could have seen real-time just how my Dad was. Still, it would pacify my brother and sister, who are still in the US, if they can access this facility."

Gupta became the first patient to feature on Virtual Family Visit facility. "I'm fine," he says, in his video clip. "Before I even realised it myself, I was out of danger, thanks to these dedicated doctors."

"It was so nice to see Papa on the Web," say Gupta's grandchildren from the US. "Looked like we just saw him in person." Adds son Ashay "He looked just great."

The feedback that the hospital has received from the families of patients is mostly positive. "Can there be more pictures and probably an online talk with the patient for a brief time?" asks one anxious family member. "Can the doctor's report be more detailed as to what other tests need to be done and their results?"

Responds Gera: "As of now, we are not including too many medical details because the security feature of this Web site has not yet been implemented and we don't want to compromise the privacy of the patient."

Today, anyone can enter the Virtual Family Visit feature on the site and patients have been receiving get-well e-cards from complete strangers! Somebody called Manohar sent and e-card to Bharathan who is just recovering from surgery: "I am from Bangalore, am now in Ottawa, and was just going through this Web site. Thought I would wish you a speedy recovery."

Eventually, each patient whose data goes up on the Web will be assigned a password, which they can communicate (or the hospital will communicate) to specific relatives or friends.

The records and photographs of that patient will then be accessible only to users of that password.

The entire project cost Wockhardt about $15,000 (about Rs 600,000). This was designed and developed by Thinkahead purely for Wockhardt. The service comes completely free to patients, and is available to anyone who asks for it.

"Investment in technology was low because we just used existing equipment like my own personal laptop," says Bali.

The service was started in February, but is still in its experimental phase.

That is why it is completely open to every visitor and also contains clips and data on many patients who have already been discharged. The hospital is now overhauling the facility and hopes to streamline it fully very soon.

Patients will be given a pamphlet at the time of surgery, which they will fill in and submit if they wish to feature on the Web site.

Gera explains that "The programme provides for easy updates. But doctors tell us that the most critical phase for a patient is from right after surgery until discharge from the ICU. Updates lose much of their meaning once this period is over."

"This facility is a great boon for the large number of Indians who travel or live abroad, for whom the health of parents is a major concern," says BFL Software International Operations Group Senior Marketing Manager Radhakrishna. "Its not always possible for children to come and be at the bedside of parents, and the large amount of interaction that this Web site provides makes it most helpful."

The future potential of this system is limitless. It could be extended, for example, into telemedicine, whereby the hospital could run a quick bulletin board on a patient, seeking the advice of a panel of specialists selected from anywhere in the country or the world.

But this may take a while to attempt. At present, the hospital might content itself with setting up a general medical discussion board, not a live chat, through which its cardiologists could interact with other colleagues in medicine.

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