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  Table of Contents  
MUSINGS, OPINIONS, TIPS AND EXPERIENCES
Year : 2020  |  Volume : 11  |  Issue : 5  |  Page : 812-815  

Brief technical guide for teleconsultation


1 Department of Physiology, Bhima Bhoi Medical College and Hospital, Balangir, Odisha, India
2 Department of Physiology, Raiganj Government Medical College and Hospital, West Bengal, India

Date of Submission12-May-2020
Date of Decision28-May-2020
Date of Acceptance22-Jun-2020
Date of Web Publication19-Sep-2020

Correspondence Address:
Himel Mondal
Department of Physiology, Bhima Bhoi Medical College and Hospital, Balangir - 767 002, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/idoj.IDOJ_373_20

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How to cite this article:
Mondal H, Mondal S. Brief technical guide for teleconsultation. Indian Dermatol Online J 2020;11:812-5

How to cite this URL:
Mondal H, Mondal S. Brief technical guide for teleconsultation. Indian Dermatol Online J [serial online] 2020 [cited 2020 Oct 26];11:812-5. Available from: https://www.idoj.in/text.asp?2020/11/5/812/295571




   Background Top


Teleconsultation in dermatology and other specialties is now allowed in India during the COVID-19 pandemic.[1] Further extension and approval of teleconsultation may come soon with a training module.[2] At this moment, we do not have proper training and resources to set-up a primary teleconsultation unit at an individual level. However, starting teleconsultation would benefit both the patients and the doctors.[3]

In this context, we have described how an individual doctor can set-up a teleconsultation unit without investing in hardware and proprietary software. In addition, patients do not need additional teleconsultation software to install and the doctors can bypass any intermediary. This may help the doctors to avoid saving patients data on the company's repository, avoid investing money on those services. However, this method may not be as robust as the typical telemedicine centers with dedicated hardware, software, and connectivity with facility to encrypt patients' data.[4],[5]


   Resources Top


For setting a basic personal teleconsultation unit, a doctor needs a few hardware and software. A personal computer (PC), a smartphone, and the internet connection are the essential requirements. For a better personal–professional life balance, a separate mobile number is better to use for teleconsultation. The PC should have WhatsApp application (https://www.whatsapp.com/download), word processing software (e.g., Microsoft Word), Acrobat Reader DC, and an internet browser (e.g., Firefox, Chrome). The smartphone should have WhatsApp and call recorder. A headphone-cum-microphone and tripod for mounting the smartphone may ease the operation.


   Carrying Out a Teleconsultation Top


A flow chart depicting a typical teleconsultation is shown in [Figure 1].
Figure 1: A typical teleconsultation without dedicated software application

Click here to view


At this moment, the Board of Governors (BOG) in supersession of Medical Council of India (MCI) suggests that when the patient calls the doctor for consultation, the consent is implied.[6] However, it is better to be future-proof to record informed consent from all the patients. This can be done by sending a text message containing the statement of informed consent to the patient and ask her/him to read, understand, and then record an audio narration of the text. An example of informed consent may be found at https://doi.org/10.6084/m9.figshare.12383606.v1. Furthermore, all the consultation video or audio should be preserved for any future reference. Video files are larger than audio files. Hence, when storage of video files is not possible, all the relevant images and audios should be stored. Audio calls can be recorded on the smartphone and audio of the video calls can be recorded by any secondary device (e.g., while consulting on a WhatsApp video call on the smartphone, record the audio with the help of the PC's audio recorder).


   Some Basic Techniques Top


The techniques which are worth sharing in this context are the process to make the prescription and keeping the files stored in the cloud storage.

Prescription preparation and dispatch

  1. Download the prescription template (https://doi.org/10.6084/m9.figshare. 12288488.v1) or make a similar one according to the suggestion of BOG in supersession of MCI.[6] Open the word file in Microsoft Word
  2. After entering text on the prescription template, save the file as Portable Document Format (PDF)
  3. Open the PDF with the Acrobat Reader DC (can be downloaded from https://get.adobe.com/uk/reader)
  4. Click on the “Sign document” icon [Figure 2]a, and click on the “Add Signature” [Figure 2]b for the first time
  5. Click on the draw icon [Figure 2]c and sketch your signature (an example is shown in [Figure 2]d) and tick mark “Save signature” [Figure 2]e and click “Apply” [Figure 2]f
  6. Put the signature at the desired place [Figure 2]g and save the file [Figure 2]h and i] with the number of the prescription [Figure 2]j
  7. From next time onward, just click on the “Sign document” [Figure 2]k icon and the previous signature will be shown [Figure 2]l, select it to insert at the desired place
  8. Send the PDF to the patient via WhatsApp and ask if it is opened on the smartphone or not
  9. If no, save a screenshot (a software for capturing screenshot can be downloaded from https://getgreenshot.org/downloads) of the prescription and send the image.
Figure 2: Process of signing a prescription (a) Click on the “Sign Document” icon, (b) Click on the “Add Signature,” (c) Click on the “Draw” icon, (d) Draw the signature, (e) Tick mark on the “Save signature,” (f) Click on the “Apply” button, (g) Place the signature at appropriate place, (h) Click on the “File,” (i) select “Save As,” and (j) save the file with a prescription number (k) For second time, just click on the “Sign Document” icon and (l) Select the already saved signature to insert.

Click here to view
Figure 3: Saving and retrieving essential documents (a) Click on the plus icon to start a new form, (b) Click on the plus icon to add a question, (c) Select the “File upload” option, (d) Click on the “Send” button, (e) Click on the link icon, (f) Copy the link and open the link on browser (g) Save the form bookmark on Bookmark Bar/Toolbar, (h) For opening the form, just click on the bookmark, (i) After entering data, click on the “Submit” button, (j) Open the form file from the Google drive, (k) After clicking on the “Responses” click on the spreadsheet icon, (l) Response spreadsheet in the Google drive.

Click here to view


Save the documents

  1. Create a new Google account at https://accounts.google.com/signup. This would help to balance personal and professional email and other services. Keep this account logged in on the smartphone. Keep the smartphone locked with password
  2. Download and install Google Drive (https://www.google.com/drive/download) on your PC. Login to your Google account. There will be a dedicated Google Drive folder in your PC hard disk. All the files kept in this folder will be synced with the cloud storage
  3. Open Google forms (https://docs.google.com/forms) and start creating a new form [Figure 3]a with essential data entry options (patients' id, name, sex, age, contact number, address, photo, date of visit, new or follow-up patient, provisional diagnosis, consent audio, consultation audio, prescription, images) as questions by adding new questions [Figure 3]b. For the data entry with file upload (e.g., prescription), select the response option as “File upload” [Figure 3]c. A quick guide for the creation of Google form is available elsewhere[7]
  4. After creating the form, click on the “Send” button [Figure 3]d and click on the link icon [Figure 3]e. Copy [Figure 3]f the link and paste it on the browser address bar and open the form. Save the bookmark (Click Ctrl + D) on “Bookmarks toolbar” [Figure 3]g of the internet browser for ease of access [Figure 3]h
  5. After completion of a consultation, transfer relevant audio files from the smartphone to the PC. The files sent by the patient can be easily saved from the WhatsApp application of the PC. Open the Google form by clicking on the form bookmark [Figure 3]h. Enter the data and upload files (most importantly, name of the patient, consent audio, consultation audio, and prescription) on the form and finally “Submit” [Figure 3]i the form to save the entry.


Retrieve the documents

  1. From the Google drive folder, open the form [Figure 3]j. It will be opened on the default internet browser
  2. For the first time, click on the “Responses” and the green spreadsheet icon [Figure 3]k. It will open the spreadsheet on your browser. You can check the entered data and access the files. If you want to add any data further for follow-up patients, go to the right most cell of the patient's data row and type your entry or click “insert” to add image
  3. Next time, there will be a response sheet [Figure 3]l in the Google drive. Click on the file and the spreadsheet will be opened on the browser.



   Frequently Asked Question Top


BOG in supersession of MCI has released a collection of the frequently asked question for teleconsultation.[2] We have extracted the most common questions from the document and presented here according to the context of this article with three additional questions [Table 1]. Practitioners may refer to the full document for further answers.
Table 1: Common questions and answers on teleconsultation

Click here to view
[9]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ashique KT, Kaliyadan F. Teledermatology in the wake of COVID -19 scenario: An Indian perspective. Indian Dermatol Online J 2020;11:301-6.  Back to cited text no. 1
  [Full text]  
2.
Confused about new Telemedicine guidelines? MCI releases FAQs on telemedicine practice, Details. India: Medical Dialogues. Available from: https://medicaldialogues.in/news/health/mci/confused-about-new-telemedicine-guidelines- mci-releases-faqs-on-telemedicine-practice-details- 64637. [Last accessed on 2020 May 12].  Back to cited text no. 2
    
3.
Pasquali P, Sonthalia S, Moreno-Ramirez D, Sharma P, Agrawal M, Gupta S, et al. Teledermatology and its current perspective. Indian Dermatol Online J 2020;11:12-20.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Thomas J, Kumar P. The scope of teledermatology in India. Indian Dermatol Online J 2013;4:82-9.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Ozair FF, Jamshed N, Sharma A, Aggarwal P. Ethical issues in electronic health records: A general overview. Perspect Clin Res 2015;6:73-6.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Telemedicine Practice Guidelines. India: Board of Governors In supersession of the Medical Council of India. Available from: https://www.mohfw.gov.in/pdf/Telemedicine.pdf. [Last accessed on 2020 May 12].  Back to cited text no. 6
    
7.
Mondal H, Mondal S, Ghosal T, Mondal S. Using Google forms for medical survey: A technical note. Int J Clin Exp Physiol 2019;5:216-8.  Back to cited text no. 7
    
8.
Bali A, Bali D, Iyer N, Iyer M. Management of medical records: Facts and figures for surgeons. J Maxillofac Oral Surg 2011;10:199-202.  Back to cited text no. 8
    
9.
Rayhan RU, Zheng Y, Uddin E, Timbol C, Adewuyi O, Baraniuk JN. Administer and collect medical questionnaires with Google documents: A simple, safe, and free system. Appl Med Inform 2013;33:12-21.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

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