In India, cardiovascular diseases (CVDs), specifically coronary heart disease and congestive heart failure, are leading causes of disability and death. The large projected population of patients with CVDs in the coming years poses one of the biggest threats to this fast developing nation’s future. The crushing magnitude of the problem is exacerbated in rural areas where a lack of diagnostic facilities, emergency services, and reliable emergency medical transportation add to the overburdened system’s woes. Further, the supply of cardiologists has not kept pace with the surging demand for cardiac care which is especially problematic in rural areas which in many parts of the country do not even have a working public health facility with a physician.
Fortunately, Indian physicians are not easily deterred by such resource scarcities. ‘Necessity being the mother of invention,’ they have been resourceful in finding innovative, low-cost workarounds. One such innovator is Dr. Padmanabh Kamath, the Chief Intervention Cardiologist at Kasturba Medical College (KMC), Mangaluru which is a well known Medical College in the Southern Indian state of Karnataka. Dr. Kamath uses WhatsApp, a popular free and secure messaging platform for consultations and to expedite services. Motivated by a tragic incident where a patient’s life was lost due to delayed diagnosis of a cardiac emergency, Dr. Kamath created a WhatsApp group called Cardiology At Doorsteps (CAD). This group consists of two cardiologists, family practitioners, and public and community health clinic based physicians from Mangaluru and neighboring areas. Whenever a patient is presented with cardiac emergency symptoms, the local clinician consults with the cardiologists in the CAD group and uploads medical records, test results, and images, if any. Based on the input of the cardiologists, the patient is either sent home with appropriate instructions or sent to the nearest acute care hospital. If the referred hospital’s clinicians are part of the group, then they will have access to preliminary diagnosis info through the CAD group before the patient arrives.
This seemingly simple idea utilizes commonly available technology namely smartphones and extremely popular WhatsApp platform. Being able to share data has reduced waste and delays associated with redoing tests and waiting for results and resulted in an efficient workflow in a system without access to electronic medical records or health information exchanges. Currently, this group is operating at full capacity with 256 members which is the maximum group membership allowed by WhatsApp. This is not an entirely new idea in Indian Cardiac Medicine as some other hospital systems around the country (including the famed Narayana Hrudayala in Bengaluru) use WhatsApp for cardiac care by sharing patient data within their multi-hospital systems. However, utilizing the concept to connect clinicians in rural communities to specialists brings down the barriers between public and private sectors, which is a unique feat in India that has the potential towards greater equity in healthcare.
I had the opportunity to sit down with Dr. Kamath and ask about the program. The following is a paraphrased excerpt from my conversation with Dr. Kamath:
Your project ingenious but straightforward. What was the motivation for this project?
Dr. Kamath: My motivation was the loss of a patient from a remote area due to lack of availability of ECG and other technology and subsequent delay in the diagnosis of a heart attack last year.
What is the composition of clinicians? Are they all cardiologists? Are there any others such as family medicine or general practitioners? Are there any nurses or other healthcare providers?
Dr. Kamath: We have 256 members (Doctors). The majority are doctors from government hospitals (Primary and Community Health Centers), a few are family physicians. Some are AYUSH (Ayurveda, Yoga, and Naturopathy, Unani, Siddha, and Homoeopathy – Indian Alternate Medicine) doctors and Regional Medical Officers (RMO) from local hospitals.
How do you recruit doctors into the group? Voluntary word-of-mouth or other ways?
Dr. Kamath: Voluntary recruitment and also by word of mouth. Doctors are screened, their email and telephone numbers and their credentials are verified.
Will every doctor in the group get all messages? If so, do you think checking WhatsApp messages may be distracting in other settings?
Dr. Kamath: All members get messages simultaneously. The discussion is moderated and unnecessary chitchat or indiscriminate posts are removed by the moderator.
In the United States, the patient data are protected by legislation and there is a proposal for patient data protection in India as well. How do you meet the requirements?
Dr. Kamath: We take written consent from all patients before posting patient data on WhatsApp. Patient identity is not revealed except data that are needed for consultation.
Is the CAD group strictly for sharing info and referring to the next level of care only or do you share experiences and outcomes?
Dr. Kamath: It is currently primarily used for patients info sharing.
What do you see as the future of this project? Do you envision local networks and for different specialties?
Dr. Kamath: It will be great to accommodate more physicians (WhatsApp cut off in 256 as of now). If government and NGO’s help to expand the network, I see a great future for these types of groups. We need support from print media to spread the word.
Sandhya Shimoga