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REPORT ON EMPLOYEE HEALTH MANAGEMENT SYSTEM
SUMMER PLACEMENT IN HINDUSTAN PETROLEUM CORPORATION LIMITED
NEW DELHI
INTERNATIONAL INSTITUTE OF HEALTH MANAGEMENT RESEARCH (IIHMR) NEWDELHI
1
SUBMITTED BY:
Dr. AMRITA SINGH
PGD HEALTH AND HOSPITAL MANAGEMENT
IIHMR DELHI
REPORT ON EMPLOYEE HEALTH MANAGEMENT SYSTEM
MMMxm cmxnv
1. N2. N
INTERNATIONAL INSTITUTE OF HEALTH MANAGEMENT RESEARCH (IIHMR) NEWDELHI
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Name of the Organization: Hindustan Petroleum Corporation Limited
Address : HPCL POL-Terminal, NH-8, Tikri Kalan, New Delhi-41
&
HPCL SHAKURBASTI INSTALATION
Duration of Training : APRIL 4th 2012 – JUNE 5th 2012.
Name of Project : EVALUATION OF EMPLOYEE HEALTH
MANAGEMENT SYSTEM
Department : TIKRI KALAN & SHAKURBASTI TERMINAL
Training Manager : SHRI KAMAL KUMAR
REPORT ON EMPLOYEE HEALTH MANAGEMENT SYSTEM
TABLE OF CONTENT
ACKNOWLEDGEMENT……………………………………………..……….5
THE ORGANIZATION……………………………………………..…………6
ORGANIZATION PROFILE...............................................................................7
EXECUTIVE SUMMARY……………….…………………………..……………8
INTRODUCTION…………………….………………………………..…………..9
STUDY OBJECTIVES……………..………..…………………………..……..…10
RATIONALE……..……………..…………………………………….….……….10
REVIEW OF LITERATURE…………..………………………..…….………….11
SAMPLE SIZE………………………………………..…………….…………..…16
METHODOLOGY…………………………………………………..……………….17
DETAILED STUDY OF EHMS AT HPCL………………………….…………..…22
ANALYSIS AND GENERAL FINDING………………………………..…………33
DISCUSSION…………………………………………………………………….....41
RECOMMENDATION…………………………………………………………..…48
LIMITATIONS……………………………………………………………………...48
CASE STUDY………………………………………………………………………51
BIBLIOGRAPHY……………………………………………..……………….……73
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LIST OF FIGURES
Figure 1.1 AGE DISTRIBUTION OF RESPONDENTSFigure 1.2 SATISFACTION WITH THE UPKEEP OF RECORDSFigure 1.3 MONITORING VITAL STATISTICSFigure 1.4 MAJOR ADVANTAGES OF EHMSFigure 1.5 AMOUNT OF HEALTH INSURANCEFigure 1.6 AGE AND NATURE OF WORKFigure 1.7 AGE AND AWARENESS OF EHMSFigure 2.1 BAR CHART OF NATURE OF JOB WITH INSURANCEFigure 2.2 BAR CHART OF NATURE OF JOB WITH AWARENESSFigure 2.3 AGE DISTRIBUTIONFigure 2.4 MEASURING THE VITALSFigure 3.1 HOURS SPENT OF INTERNETFigure 3.2 BAR DIAGRAM FOR COST-EFFECTIVENESSFigure 3.3 BAR DIAGRAM FOR SAVING TIME
LIST OF TABLES
Table 2.1 FREQUENCY TABLE OF AGETable 2.2 FREQUENCY TABLE OF GENDERTable 2.3 CROSS TABLULATION OF NATURE OF JOB AND INSURANCETable 2.4 CROSS TABULATION OF NATURE OF JOB AND AWARENESSTable 2.4 AGE DISTRIBUTION OF THE EMPLOYEESTable 2.5 MEASURING THE VITALSTable 3.1 NUMBER OF HOURS SPENT ON INTERNETTable 3.2 COST- EFFECTIVENESSTable 3.3 SAVING TIME
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ACKNOWLEDGEMENTS
I avail this opportunity to express my profound sense of sincere and deep
gratitude to those who have played an indispensable role in the accomplishment
of the project work given to me by providing their willing guidance and help.
Firstly, I express my sincere gratitude to Mr. Chhater Singh-Chief Manager,
HPCL-POL Terminal, Tikri-Kalan, New Delhi 110041 Delhi for allowing me to
carry out the project work in this Prestigious Organization and gain valuable
experience.
I am greatly indebted to Mr. Kamal Kumar Senior Installation Manager
Shakurbasti Terminal & Ms. Saroj Sharma Operations Officer for their support,
constant encouragement, consistent guidance and inspiration throughout the
project. Their constant interaction, expert guidance has helped me in learning
the whole system prevailing in the organization.
I am greatly indebted to Mr. A. K. Behra Manager Projects & Mr. Prabudh Jain
Project Engineer for their support, & consistent guidance throughout the project.
Their constant interaction & valuable suggestions helped me to complete this
project successfully.
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The Organization
HPCL is a Fortune 500 company having about 20% marketing share in India
and a strong market infrastructure throughout the country, company is one of
the major integrated oil refining and marketing companies in India. It is a Mega
Public Sector Undertaking (PSU) with Navaratna status.
Organization Profile
HPCL is a Fortune 500 company, with an annual turnover of Rs.
1,08,599 Crores and sales/income from operations of Rs 1,14,889
Crores (US$ 25,306 Millions) during FY 2009-10, having about 20%
Marketing share in India and a strong market infrastructure.
Consistent excellent performance has been made possible by highly
motivated workforce of over 11,360 employees working all over India
at its various refining and marketing locations.
I have taken up two marketing location to study the effectiveness of
health management system in HPCL & submitting my offering for
improvement in the system.
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I have taken up two marketing location to study the effectiveness of employee
health management system in HPCL & offering improvement in system.
1. Tikrikalan Terminal
2. Shakurbasti Terminal
Tikri Kalan terminal is under construction whereas the Shakurbasti Terminal is
an operative terminal. There are more than 100 permanent employee working
in these location.
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Executive Summary
Health promotion programs have been in place within the employer sector since
the mid-1980s. Historically, the primary focus for health plans has been quality
medical services delivery with the hope of reducing costs. More recently, the
role of the health plan has been enhanced with the addition of health
management tools and programs. In general, the scientific evidence favors the
multidisciplinary care coordination model as most appropriate and effective
within the health plan environment. Multidisciplinary programs show
documented improvements in clinical outcomes and cost savings through
reduced hospitalizations. These EHM programs are defined as: health
promotion, self-care, disease management, and case management programs.
Thats why companies have jumped on the health and wellness wave,
understanding that keeping their employees healthy helps their bottom-line. In
HPCL like organization, employees are well inclined and predetermined. The
company members are often prepared about their health. Employees were cent
percent aware and very keen regarding their health. Organization provides more
than Rs 10 lacs of insurance to their employees who are working in field and Rs
7-10 lacs of insurance to those who work on tables.
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INTRODUCTION TO EHMSEmployees are the most important element of every business. Their
contributions play a significant role in determining the success of any
organization. The contravention within an administration is to promote a culture
that promotes a high-performing workplace.
Maintaining healthy employee in an organization is a pre-requisite for
organizational success. Healthy employees are required for high productivity
and human satisfaction. Employee health depends upon healthy and safe work
environment, cent percent involvement and commitment of all employees,
incentives for employee motivation, and effective communication system in the
organization. Healthy employees lead to more efficient, motivated and
productive employees which further lead to increase in sales level.
Successful companies realize the positive results realized from proven health
promotion and wellness strategies motivate employees to become better
healthcare decision makers, effectively reducing benefit money spent.
That’s why companies have jumped on the health and wellness wave,
understanding that keeping their employees healthy helps their bottom-line.
These days, it’s an oddity if an employer hasn’t encouraged participation in
a wellness program, encouraged employees to eat less trans-fat, eat more whole
foods, exercise thirty minutes a day, take time for relaxation, etc.
Websites like http://www.ehms.com provides online solution and management
of the health records. Hence even employees are getting more conscious and
updated regarding their health and inscribed themselves in various activities.
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Study Objectives
è Evaluation of execution of EHMS in HPCL
è Ascertaining employee awareness of EHMS in HPCL
è Creating orientation of employees towards effective EHMS in HPCL
Rationale
This study fundamentally aims to examine the EHMS in HPCL at two
locations where the system had been already implemented. This study
also includes company medical policies and benefits, health promotion,
wellness and fitness programs, industrial safety.
Also, the understanding and sustainability of an integrated health system
is as well included in the study. If employees aren't aware of their
employers' programs and how to participate, health behaviors won't
change. This is a traditional problem with how employee health and
wellness has historically been done.
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Review of Literature
I. Financial Impact of Employee Health Management Programs:
Studies were published after 2004. The delimiter of excluding articles
published before 2005 is derived from our observation that relevant
review articles and EHM related studies prior to this date were an
amalgam of worksite wellness or disease prevention-oriented programs.
The EHM programs evaluated in more recent studies have expanded to
include targeted disease management programs that have been integrated
with traditional worksite wellness offerings.
II. A review on systematic reviews of employee
health information system studies:
The purpose of this review is to consolidate existing evidence from
published systematic reviews on
employee health information system (EHIS) evaluation studies to inform
EHIS practice and research. Fifty reviews published during 1994-2008
were selected for meta-level synthesis. These reviews covered five areas:
medication management, preventive care, health conditions, data quality,
and care process/outcome. After reconciliation for duplicates, 1276 EHIS
studies were arrived at as the non-overlapping corpus. On the basis of a
subset of 287 controlled EHIS studies, there is some evidence for
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improved quality of care, but in varying degrees across topic areas. For
instance, 31/43 (72%) controlled EHIS studies had positive results using
preventive care reminders, mostly through guideline adherence such as
immunization and health screening.
III. Healthcare professionals' organizational barriers
to health information technologies:
This systematic literature review was carried out during December 2009
and January 2010. Additional on-going reviews of updates through
automated system alerts took place up until this paper was submitted. A
total of thirty-one sources were searched including nine software
platforms/databases, fifteen specialized websites/targeted databases,
Google Scholar, ISI Science Citation Index and five journals hand-
searched.
Results: The study covers seventy-nine articles on organizational barriers
to ICT adoption by healthcare professionals. These are categorized under
five main headings - (I) Structure of healthcare organizations; (II) Tasks;
(III) People policies; (IV) Incentives; and (V) Information and decision
processes. A total of ten subcategories are also identified. By adopting an
organizational management approach, some recommendations to remove
organizational management barriers are made.
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IV. Health Resource Information System for Health (HRIS):
The attainment of the health-related Millennium Development Goals
relies on countries having adequate numbers of wellness resources
for health and their appropriate distribution, global understanding of
the systems used to generate information for monitoring health resources
stock and flows, known as human resources information systems for
health (HRIS), is minimal. While HRIS are increasingly recognized as
integral to health system performance assessment,
baseline information regarding their scope and capability around the
world has been limited. We conducted are view of the
available literature on HRIS implementation processes in order to draw
this baseline.
Results: Ninety-five articles with relevant HRIS information were
reviewed, mostly from the grey literature, which comprised 84 % of all
documents. The articles represented 63 national HRIS and two regionally
integrated systems. Whereas a high percentage of countries reported the
capability to generate workforce supply and deployment data,
few systems were documented as being used for HRH planning and
decision-making. Of the systems examined, only 23 % explicitly stated
they collect data on workforce attrition. The majority of countries
experiencing crisis levels of HRH shortages (56 %) did not report data
on health worker qualifications or professional credentialing as part of
their HRIS.
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V. Impacts of e-health on the outcomes of care in low- and middle-
income countries: where do we go from here?
E-health encompasses a diverse set of informatics tools that have been
designed to improve public health and health care. Little information is
available on the impacts of e-health programmes, particularly in low- and
middle-income countries. We therefore conducted a scoping review of the
published and non-published literature to identify data on the effects of e-
health on health outcomes and costs. The emphasis was on the
identification of unanswered questions for future research, particularly on
topics relevant to low- and middle-income countries. Although e-
health tools supporting clinical practice have growing penetration
globally, there is more evidence of benefits for tools that support clinical
decisions and laboratory information systems than for those that support
picture archiving and communication systems.
Community information systems for disease surveillance have been
implemented successfully in several low- and middle-income countries.
Although information on outcomes is generally lacking, a large project in
Brazil has documented notable impacts on health-system efficiency.
Meta-analyses and rigorous trials have documented the benefits of text
messaging for improving outcomes such as patients' self-care. Automated
telephone monitoring and self-care support calls have been shown to
improve some outcomes of chronic disease management, such as
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glycaemia and blood pressure control, in low- and middle-income
countries. Although large programmes for e-health implementation and
research are being conducted in many low- and middle-income countries,
more information on the impacts of e-health on outcomes and costs in
these settings is still needed.
VI. Do employee health management programs work?
Current peer review literature clearly documents the economic return and
Return-on-Investment (ROI) for employee health management (EHM)
programs. These EHM programs are defined as: health promotion, self-
care, disease management, and case management programs. The
evaluation literature for the sub-set of health promotion and disease
management programs is examined in this article for specific evidence of
the level of economic return in medical benefit cost reduction or
avoidance. The article identifies the methodological challenges associated
with determination of economic return for EHM programs and
summarizes the findings from 23 articles that included 120 peer review
study results. The article identifies the average ROI and percent health
plan cost impact to be expected for both types of EHM programs, the
expected time period for its occurrence, and caveats related to its
measurement.
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Sample sizeFor the base line study, two locations of HPCL were chosen. First being the Tikrikalan Terminal at tikri border New Delhi and other being the Shakurbasti Terminal in New Delhi.
Calculation of the sample size:
ss =Z 2 * (p) * (1-p)
c 2
Where:
Z = Z value (confidence level) p = percentage picking a choice, expressed as decimal c = confidence interval, expressed as decimal
In my research study I considered:
Confidence level as 95%,
Confidence interval as 10 and,
Percentage of 50,
Hence the sample size is 50.
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METHODLOGY
Departmental/ sectionalwise orientation
Orientation of administrators for EHMS
Distribution of the questionnaire
Forms collection
Data compiling
Detailed study of EHMS at HPCL
Analysis/inference
Recommendation
Final Presentation
REPORT ON EMPLOYEE HEALTH MANAGEMENT SYSTEM
Employees are categorized into three segments:
1. Managerial Segment
2. Non-managerial Segment
3. Service assistant/labor Segment
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Managerial Segment
Non-managerial Segment
Service Assistant Segment
REPORT ON EMPLOYEE HEALTH MANAGEMENT SYSTEM
Methodology
1. Departmental/section wise orientation towards the EHMS:
I have covered study and analysis of two locations which covered Tikri kalan
and Shakurbasti Terminal thus departments like production, project, human
resource, operation, finance, information technology, etc were informed.
2. Orientation of administrators for EHMS
A Power Point presentation was made abbreviating about Health, Information
Technology and EHMS. A detailed presentation was carried out for the
employees signifying the importance of EHMS in the organization and its
benefits for maintaining a healthy workforce and general betterment of the
employees. Response of the employees was encouraging in general but few
were enquiring on the general concept of health management in other
organizations.
Presentation on EHMS and its effective implementation in the organization
Few key points of the presentation are given below:
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BENEFITS of EMHS
Benefits to Physicians:
Reduced overhead costs due to streamlined efficiencies
Billing claims are checked prior to submission to reduce rejections and
errors
Browser-based means anytime, anywhere access (Office, Nursing Home,
or home)
Access through any device (handheld, tablet, laptop, desktop)
Electronic/Paperless Employee Health Record
Benefits to Office Staff
Minimal time to enter patient information and easy retrieval of patient
information
Billing has never been easier
Provide patient information at the click of a button
Privacy and Security of the patient's personal information is ensured
Lower healthcare cost trends
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3. Distribution of questionnaire/declaration formsA questionnaire on State of Employee Health Management System
(EHMS) was circulated among the employees and was asked to fill-up
the questionnaire form for scrutiny.
Sample of the declaration form is attached in last of the report.
4. Forms collection
The filled up forms were collected and inputs were assembled for further
analysis of the data.
5. Data compilingThe opinion regarding EHMS was arranged and transferred to SPSS and
Microsoft Excel for the further analysis.
6. Detailed study of EHMS at HPCL
a. Periodical medical examination
b. Health portal
c. Occupational health centers
d. Physicians and pharmacist
e. Personal safety
f. Employee training-training conducted on safety
g. Medical insurance of all employees through NIAC- limits
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Detailed study of EHMS at HPCL:
a. Periodical medical examination:
Yearly health check-up for hazardous locations like terminals, depots,
LPG plant, etc. for all employees, once in three years in non-hazardous
locations like Head offices Zonal office & Regional Office. Compulsory
annual examination of employees of more than 50 years of age.
b. Health portal:
Maintaining of health records like ECG reports, blood-sugar, lipid profile
report of all the employees on the portal. The report can be viewed/access
by the employees as and when required using their employee id and
password. Thus the information is safe protected.
c. Occupational health centers:
An occupational health centers with trained physicians and pharmacist is
available in all the factory locations of HPCL. The employees can
undergo free of cost consultation from the physician.
d. Physician and pharmacist:
Weekly visit of the general physician and check up of the employees and
consultation if required.
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e. Personal safety:
Emergency medical kit with all essential medicines, stretcher, Personal
Protective Equipments (PPE) like safety belt, safety shoes, helmet,
goggles, hand gloves, oxygen cylinders, etc. are available at all time for
use in case of any emergency.
f. Employee training-training conducted on safety:
Initiative on employee training on health and safety are carried out from
time to time an example of first aid training imparted at Shakurbasti
Terminal on First Aid by National Safety Circle is attached below
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g. Medical insurance:
Medical insurance is through New India Assurance Company Ltd.
Nominal monthly contribution is given by the employees and employees
and their dependents are covered under this scheme. Employees can avail
medical benefits up to Rs 7 lack yearly per family member and Rs 15 lack
per family member for life time depending upon their eligibility.
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7. Analysis/inferenceThe data obtained was analyzed SPSS and Microsoft Excel was used to
determine the awareness level regarding EHMS.
8. RecommendationRecommendations were given for the outcome from the study.
9. Final presentationVarious dept. like safety, M&R, Purchase etc are there in these terminals.
Orientation towards EHMS was provided to all employees in these
departments and the employees were asked to attend the Presentation on
EHMS.
The general feedback from the employees in various sections was
positive and encouraging.
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A screenshot of the main website of Hindustan Petroleum Corporation Limited is taken.
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This is the wellness portal for the employees.
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After entering the wellness portal employees have to add their details for log in.
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This screenshot tell about the online medical claim system in the organization.
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This screenshot tell about the employee details and the general medical information considered.
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ANALYSIS AND GENERAL FINIDINGS
Age Distribution
There had been a wide range of age in the location. Study consists of division
into
a. 25-30
b. 31-35
c. 36-40
d. 41-45
e. 45-50
f. 51-55
g. 56-60Figure 1.1 AGE DISTRIBUTION OF RESPONDENTS
12%
16%
10%
24%
20%
14%
4%
Age Distribution
25-3031-3536-4041-4546-5051-5556-60
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Satisfaction with the upkeep of medical records
96% of the sample said ‘YES’ they were satisfied with their upkeep of
medical records.
Whereas only 4% of them were unsatisfied with their track of medical
records.
Figure 1.2 SATISFACTION WITH THE UPKEEP OF RECORDS
YES NO0
10
20
30
40
50
60
Satisfaction with the upkeep of records
Series1
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Monitoring medical vital statistics
86% of them said they keep healthy track record of their vital statistics.
And, 14% said they don’t keep a track of their vital statistics.
Figure 1.3 MONITORING VITAL STATISTICS
YES
NO
05
1015202530354045
Series1 7
Monitoring medical vital statistics
Axis Title
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Major advantages of EHMS
Six options were given to the employees to choose the advantages for the
EHMS.
a. Will save time
b. Reduce cost of care
c. Improve quality
d. Reduce errors in lab
e. Reduce errors in medication
f. Others (specify)
Majority i.e 33% of the employees said that it reduces errors in
medication.
27% said that it reduce errors in lab.
20% stated that it will improve the quality
13% stated that it reduces the cost of care
While 7% said that EHMS will save time
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Figure 1.4 MAJOR ADVANTAGES OF EHMS
7%
13%
20%
27%
33%
Major Advantages
12345
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Amount of health insurance
In this section five alternatives were given to the employees to opt for
their health insurance.
a. Rs 1-3 lacs
b. Rs 3-5 lacs
c. Rs 5-7 lacs
d. Rs 7-10 lacs
e. More than 10 lacs
48% of the employees have more than lack rupees insurance
30% of the employees have Rs 7-10 lacs rupees insurance
20% of the employees have Rs 5-7 lacs rupees insurance
Only 2% of them have Rs 3-5 lacs rupees insurance
Figure 1.5 AMOUNT OF HEALTH INSURANCE
1 2 3 4 5
0
5
10
15
20
25
AMOUNT OF HEALTH INSURANCE
Series1Series2
Axis Title
Axis Title
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Age and nature of work
Two type of job nature was being determined, Field and Table
Figure 1.6 AGE AND NATURE OF WORK
25-30 31-35 36-40 41-45 46-50 51-55 55-600
1
2
3
4
5
6
7
8
4 4
3
7 7
3
22
4
2
5
3
4
0
FIELD TABLE
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Age and awareness of EHMS
Cent percent awareness regarding EHMS within the employees was found
of every age group.
Figure 1.7 AGE AND AWARENESS OF EHMS
12%
16%
10%
24%
20%
14%4%
12%
16%
10%
24%
20%
14%
4%
AGE AND AWARENESS OF EHMS
25-3031-3536-4041-4546-5051-5556-60
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Discussion
The rationale of this study was to evaluate the EHMS in HPCL and to detect the awareness of the employees for the same.
Employees in HPCL have a broad age distribution and in this study they are sorted into seven groups:
i. 25-30ii. 31-35iii. 36-40iv. 41-45v. 46-50vi. 51-55vii. 56-60
Frequency Table
Table 2.1 FREQUENCY TABLE OF AGEAGE
Frequency Percent Valid Percent
Cumulative
Percent
Valid 1 6 12.0 12.0 12.0
2 8 16.0 16.0 28.0
3 5 10.0 10.0 38.0
4 12 24.0 24.0 62.0
5 10 20.0 20.0 82.0
6 7 14.0 14.0 96.0
7 2 4.0 4.0 100.0
Total 50 100.0 100.0
The result says that maximum group of employees belong to the 4th group i.e. 41-45 years of age group. Next group which has the most number of employees is 46-50 years.
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Table 2.2 FREQUENCY TABLE OF GENDERGENDER
Frequency Percent Valid Percent
Cumulative
Percent
Valid 1 46 92.0 92.0 92.0
2 4 8.0 8.0 100.0
Total 50 100.0 100.0
Gender percentage in HPCL is very extensive. 92% of the candidates of the study were male and only 8% of the candidates were female.The study has been divided into two types of nature of job. 1st is being the field and 2nd being the table job. With regard to insurance, the study is sorted into
i. Rs 1-3lacsii. Rs 3-5lacsiii. Rs5-7lacsiv. Rs 7-10lacsv. More than 10lacs
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Case Processing Summary
Cases
Valid Missing Total
N Percent N Percent N Percent
NATURE * INSURANCE 50 100.0% 0 .0% 50 100.0%
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Table 2.3 CROSS TABLULATION OF NATURE OF JOB AND INSURANCE
NATURE * INSURANCE Crosstabulation
Count
INSURANCE
Total2 3 4 5
NATURE 1 0 1 7 22 30
2 1 9 8 2 20
Total 1 10 15 24 50
The outcome of the study came like 60% of the employees have field type of work and 40% have table work. 73.3% of the employees having field nature of job are having more than 10 lacs of insurance and 23% of the employees are having insurance between 7-10 lacs. While 45% of the employees having table nature of job are having 3-5 lacs of insurance and 40% of the employees are having insurance between 5-7 lacs.
Figure 2.1 BAR CHART OF NATURE OF JOB WITH INSURANCE
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This study also found that there is cent percent awareness regarding the EHMS. 100% of awareness is present in the employees with field as well as table type nature of job.
Table 2.4 CROSS TABULATION OF NATURE OF JOB AND AWARENESS
Figure 2.2 BAR CHART OF NATURE OF JOB WITH AWARENESS
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NATURE * AWARENESS Crosstabulation
Count
AWARENESS
Total1
NATURE 1 30 30
2 20 20
Total 50 50
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The age of the employees in this study was grouped into 7 headings:
1. 25-30 years2. 31-35 years3. 36-40 years4. 41-45 years5. 46-50 years6. 51-55 years7. 56-60 years
Table 2.4 AGE DISTRIBUTION OF THE EMPLOYEESAGE
Frequency Percent Valid Percent
Cumulative
Percent
Valid 1 6 12.0 12.0 12.0
2 8 16.0 16.0 28.0
3 5 10.0 10.0 38.0
4 12 24.0 24.0 62.0
5 10 20.0 20.0 82.0
6 7 14.0 14.0 96.0
7 2 4.0 4.0 100.0
Total 50 100.0 100.0
Maximum employees with 24% belong to the 4th group i.e. between 41-45 years
of age. Next with 20%, employees belong to the 5th group i.e. 46-50 years.
Employees within 31-35 years of age constitute 16% and 51-55 years of age
group constitute 14%. 12% of the employees belong to 25-30 years of age group
and only 4% form the 7th group i.e. 56-60 years.
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Figure 2.3 AGE DISTRIBUTION
Table 2.5 MEASURING THE VITALS
VITALS
Frequency Percent Valid Percent
Cumulative
Percent
Valid 1 43 86.0 86.0 86.0
2 7 14.0 14.0 100.0
Total 50 100.0 100.0
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Figure 2.4 MEASURING THE VITALS
This study also let out the result regarding the measurement of the vitals. 86%
of the employees measured their vitals regularly while 14% of the employees
said they didn’t measure their vitals so regularly.
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Recommendations
Conversion of health record into personal health record
Achievability of uniform online communication
Coverage for the non-management employee
Better link data/information to resource allocation
Visiting Doctors should be more trained for EHMS
The employee health data should be easily communicable to the
incorporated hospitals
Limitation
Limited access to the non-managerial staff
Limited access about the data
Sample of the questionnaire is attached to the next page:
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Survey: EMPLOYEES HEALTH MANAGEMENT SYSTEM
Purpose and Scope
The objective of administering this questionnaire is to write a Whitepaper on State of Employee Health Management System (EHMS) through the collection and analysis of the views and inputs from the key stakeholders. A major strength of this whitepaper lies in the ability to display the challenges and opportunity in EHMS and ways for better health management and to transform the Healthcare in the HPCL with the use of Information Technology
By: Dr. Amrita Singh (Student of IIHMR)
1.0General
1.1 Name of the Respondent
1.2 Address
City
Contact numbers (with STD Code)
1.3Age
1.4Gender
1,5Nature of job(Table/Field )
Signature of the Interviewers:(Note: please leave this blank if self executed)
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2.0 Maintenance of Electronic Health Record
2.1 Are you aware of Employee Health Management System
1. Yes2. No
2.2 Do you monitor your medical vital statistics periodically?
1. Yes 2. No
2.3 Are you satisfied with the upkeep of your physical health Records?
1. Yes 2. No
2.4 If no? Would you like to maintain your regular health records in electronic Information System?
1. Yes 2. No
2.5 If yes what has been the major advantages? a. Will saves timeb. Reduce cost of carec. Improve qualityd. Reduce errors in labe. Reduce errors in medicationf. Others (specify)
2.6 Do you believe that “ What health records get measured , gets improved”
1. Yes2. No
2.7 Would you like to monitor regular health records and maintain in EHMS?
1. Yes2. No
2.8 If No, Why?
3.0 Information on Health Insurance3.1 Do you understand the importance of Health
Insurance?1. Yes2. No
3.2 How many health insurance policies have your enrolled?
3. 20124. 2011 2. 2010 3. 2009 4. 2008
3.3 What is the amount insured for health insurance in your family
1. Rs. 1 – 3 lacs2. Rs.3 – 5 lacs3. Rs.5 – 7 lacs4. Rs.7 – 10 lacs5. More than 10 lacs
3.4 Do you think that Healthcare Insurance groups can leverage on IT to reduce the cost of healthcare?
1. Yes 2. No
3.5 Any further recommendation for the betterment of the system..
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CASE STUDY
TELEMEDICINE IN DENTAL HEALTHCARE
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INTRODUCTIONTelemedicine is the use of telecommunication and information technologies in
order to provide clinical health care at a distance. It helps eliminate distance
barriers and can improve access to medical services that would often not be
consistently available in distant rural communities. It is also used to save lives
in critical care and emergency situations.
Telemedicine may be as simple as two health professionals discussing a case
over the telephone, or as complex as using satellite technology and video-
conferencing equipment to conduct a real-time consultation between medical
specialists in two different countries. Telemedicine generally refers to the use of
communications and information technologies for the delivery of clinical care.
Care at a distance (also called ''in absentia'' care), is an old practice which was
often conducted via post. There has been a long and successful history of in
absentia health care which, thanks to modern communication technology, has
evolved into what we know as modern telemedicine.
Telemedicine is employed in various segments of healthcare like
i. Telenursing
ii. Telepharmacy
iii. Telecardiology
iv. Telepsychiatry
v. Teledentistry
vi. Teleradiology
vii. Telepathology
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STUDY OBJECTIVE
Review on the use of telemedicine in dental healthcare
Review of Literature
According to a study on Teledentistry-assisted, affiliated practice for dental
hygienists: an innovative oral health workforce model found that The 2010 U.S.
Patient Protection and Affordable Care Act (PPACA) calls for training
programs to develop mid-level dental health care providers to work in areas
with underserved populations. In 2004, legislation was passed in Arizona
allowing qualified dental hygienists to enter into an affiliated practice
relationship with a dentist to provide oral health care services for underserved
populations without general or direct supervision in public health settings. In
response, the Northern Arizona University (NAU) Dental Hygiene Department
developed a teledentistry-assisted, affiliated practice dental hygiene model that
places a dental hygienist in the role of the mid-level practitioner as part of a
digitally linked oral health care team. Utilizing current technologies, affiliated
practice dental hygienists can digitally acquire and transmit diagnostic data to a
distant dentist for triage, diagnosis, and patient referral in addition to providing
preventive services permitted within the dental hygiene scope of practice.
Another study on Reliability of Telemedicine Examination was conducted and
found that For ophthalmology, physical therapy, and cardiac auscultation,
91.2% of the conventional findings and 86.5% of the telemedicine findings
were identical or similar to the criterion standard. The kappa coefficient on
matched-pair analysis was 0.66. For pulmonary auscultation and reading of INTERNATIONAL INSTITUTE OF HEALTH MANAGEMENT RESEARCH (IIHMR) NEWDELHI
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chest films with a telemedicine camera and monitor, abnormalities were
suppressed at default settings but subsequently revealed with extensive
manipulation of system settings. For tracings and images, both conventional and
telemedicine findings showed 92% reliability, with a kappa coefficient of 0.87.
On the basis of these observations and the methods used, reliability varied with
the type of examination, clinician experience with telemedicine, and participant
knowledge of system limitations. Clinicians without experience or knowledge
of system limitations missed findings of clinical importance. Improvements in
equipment since the clinics were conducted in 1994 may have resolved some of
these problems. Our findings raise doubts about the reliability of occasional
telemedicine consultations by clinicians inexperienced in the technology.
Also a study is done on the challenge to delivering oral health services in rural
America through teledentistry. It stated that rural populations have lower dental
care utilization, higher rates of dental caries, lower rates of insurance, higher
rates of poverty, less water fluoridation, fewer dentists per population, and
greater distances to travel to access care than urban populations. Improving the
oral health of rural populations requires practical and flexible approaches to
expand and better distribute the rural oral health workforce, including
approaches tailored to remote areas. Solutions that involve mass
prevention/public health interventions include increasing water fluoridation,
providing timely oral health education, caries risk assessment and referral,
preventive services, and offering behavioral interventions such as smoking and
tobacco cessation programs. Solutions that train more providers prepared to
work in rural areas include recruiting students from rural areas, training students
in rural locations, and providing loan repayment and scholarships. Increasing
the flexibility and capacity of the oral health workforce for rural areas could be INTERNATIONAL INSTITUTE OF HEALTH MANAGEMENT RESEARCH (IIHMR) NEWDELHI
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achieved by creating new roles for and new types of providers. Solutions that
overcome distance barriers include mobile clinics and telehealth technology.
Rural areas need flexibility and resources to develop innovative solutions that
meet their specific needs. Prevention needs to be at the front line of rural oral
health care, with systematic approaches that cross health professions and health
sectors.
According to one more study done on The Use of the Teledentistry for Dental
Science Information . The findings of the survey include that a majority of the
dental teachers and students (73.7%) under study have their own personal
computers or laptops; A majority of the respondents (70.8%) access the Internet
from the college or workplace, while 19.3% also access from home; and, 42.6%
of the respondents use the Internet and electronic resources for finding
health/dental sciences information, followed by patient care with 26.5%
responses.
One more study on Teledentistry in General Dentistry was conducted and the
authors successfully screened 1,039 of 1,159 randomly sampled U.S. general
dentists in active practice (89.6% response rate). Two hundred fifty-six (24.6%)
respondents had computers at chair side and thus were eligible for this study.
The authors successfully interviewed 102 respondents (39.8%). Clinical
information associated with administration and billing, such as appointments
and treatment plans, was stored predominantly on the computer; other
information, such as the medical history and progress notes, primarily resided
on paper. Nineteen respondents, or 1.8% of all general dentists, were
completely paperless. Auxiliary personnel, such as dental assistants and
hygienists, entered most data. Respondents adopted clinical computing to
improve office efficiency and operations, support diagnosis and treatment, and INTERNATIONAL INSTITUTE OF HEALTH MANAGEMENT RESEARCH (IIHMR) NEWDELHI
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enhance patient communication and perception. Barriers included insufficient
operational reliability, program limitations, a steep learning curve, cost, and
infection control issues.
METHODOLOGY
This case study is basically based on the primary as well as secondary data. The
primary data collected was on the criteria of the scope of teledentistry,
requirements regarding the teledentistry, basis of teledentistry, current evidence
for teledentistry and the ethical and legal issues regarding the same. Also, a
questionnaire was prepared to know about the teledentistry perception.
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SCOPE OF TELEDENTISTRY
REQUIREMENTS
BASIS
CURRENT EVIDENCE FOR TELEDENTISTRY
ETHICAL AND LEGAL ISSUE
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TELECONSULTATION
Teleconsultation through teledentistry can take place in either of the following
ways - "Real-Time Consultation" and "Store-and Forward Method". Real-Time
Consultation involves a videoconference in which dental professionals and their
patients, at different locations, may see, hear, and communicate with one
another. Store-and-Forward Method involves the exchange of clinical
information and static images collected and stored by the dental practitioner,
who forwards them for consultation and treatment planning. Dentists can share
patient information, radiographs, graphical representations of periodontal and
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hard tissues, therapies applied lab results, tests, remarks, photographs, and other
information transportable through multiple providers.
SCOPE OF TELEDENTISTRY
Teledentistry has the ability to improve access to oral health care, improve the
delivery of oral healthcare and lower its costs. It also has the potential to
eliminate the disparities in oral healthcare between rural and urban
communities. Teledentistry may turn out to be the cheapest, as well as the
fastest, way to bridge the rural-urban health divide. Taking into account the
huge strides in the field of information and communication technology,
teledentistry can help to bring specialized healthcare to the remotest corners of
the world. Telemedical services were helpful for cases related to dental trauma
and provided valuable support where a specialty dentist was not available.
Teledentistry permitted distant, cost-effective specialist dental consultations in
rural areas.
If the projections on the shortages of dentists in the next decade come to pass,
teledentistry will be important not only for rural areas but also for our urban and
suburban populations. Inter-professional communications will improve
dentistry's integration into the larger healthcare delivery system. The use of
teledentistry for specialist consultations, diagnosis, treatment planning and
coordination, and continuity of care will provide aspects of decision support and
facilitate a sharing of the contextual knowledge of the patient among dentists.
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Second opinions, pre-authorization and other insurance requirements will be
met almost instantaneously online, with the use of real images of dental
problems rather than tooth charts and written descriptions. Teledentistry will
also provide an opportunity to supplement traditional teaching methods in
dental education, and provide new opportunities for dental students and dentists.
BASIS OF TELEDENTISTRY
Internet is the basis of modern systems of teledentistry, being up-to-date and
fast, and able to transport large amounts of data. All new systems of
teledentistry are Internet-based, as well as all kinds of distant consultation.
Information and communication technologies used in conjunction with Internet
have become a central part of academic life in colleges and campuses. Internet-
based teledentistry education enables students to choose themselves the place,
time, and mode of learning. In continued professional dental education, modern
Internet systems also offer on-line video-conferencing, broadcasting operations
and treatments, and on-line training courses. In continued professional dental
education, modern Internet systems also offer on-line video-conferencing,
broadcasting operations and treatments, and on-line training courses.
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REQUIREMENTS
For most dental applications, store-and-forward technology provides excellent
results without excessive costs for equipment or connectivity.
Telemedicine equipment can broadly be divided into the following components:
Information Technology (IT) hardware Connectivity Hardware Video conferencing hardware Medical Hardware
IT Hardware
i. Computersii. Multimedia devices
iii. Scannersiv. Security devicesv. Daughter boards
vi. Hand held devices
Connectivity Hardware
i. Modems ii. VSATS, routers
iii. Switches
Video Conferencing Hardware
Full screen TV, plasma TV or Projection TV, live two way audio and video conferencing.
Medical Hardware
This would comprise all the clinical instrumentation that would be attached to the Telemedicine system to capture data from the patient.
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CURRENT EVIDENCE FOR TELEDENTISTRY
a. Role in Oral Medicine and Diagnosis:
The use of teledentistry in oral medicine in a community dental service is being
successfully proved using a prototype teledentistry system. Distant diagnosis is
an effective alternative in the diagnosis of oral lesions using transmission of
digital images by email. Summerfelt FF reported a teledentistry-assisted,
affiliated practice dental hygiene model developed by the Northern Arizona
University Dental Hygiene Department that allowed dental hygienists to
provide oral healthcare to underserved populations by digitally linking up with a
distant oral health team.
b. Role in Oral and Maxillofacial Surgery
The diagnostic assessment of the clinical diagnosis of impacted or semi-
impacted third molars assisted by the telemedicine approach was equal to the
real-time assessment of clinical diagnosis. According to Rollert MK et al.,
telemedicine consultations, in adequately assessing patients for dentoalveolar
surgery with general anaesthesia and nasotracheal intubation, are as reliable as
those conducted by traditional methods and that telecommunication is an
efficient and cost-effective mechanism to provide pre-operative evaluation in
situations in which patient transport is difficult or costly.
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c. Role in Endodontics
Remote dentists can identify root canal orifices based on images of
endodontically accessed teeth. Teledentistry based on the Internet as a
telecommunication medium can be successfully utilized in the diagnosis of
periapical lesions of the front teeth, reducing the costs associated with distant
visits and making urgent help available. And there was no statistical difference
existed between the ability of evaluators to identify periapical bone lesions
using conventional radiographs on a view box and their ability to interpret the
same images transmitted on a monitor screen by a video teleconferencing
system.
d. Role in Orthodontics
Interceptive orthodontic treatments provided by sufficiently prepared general
dentists and supervised remotely by orthodontic specialists through teledentistry
are a viable approach to reducing the severity of malocclusions in
disadvantaged children when referral to an orthodontist is not feasible. Also,
general dental practitioners generally supported a teledentistry system to screen
new patient orthodontic referrals. Patients were referred through a "store and
forward" teledentistry link and were later evaluated clinically, to assess whether
the same decision to accept the referral was made. It was seen that clinician
agreement for screening and accepting orthodontic referrals based on clinical
photographs was comparable to that reported for clinical decision making.
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e. Role in Pediatric and Preventive Dentistry
Teledentistry is as good as visual/tactile examinations for dental caries
screening in young children. It offers a potentially efficient means of screening
high-risk preschool children for signs of early childhood caries. The intraoral
camera is a feasible and potentially cost-effective alternative to a visual oral
examination for caries screening, especially early childhood caries, in preschool
children attending childcare centres.
f. Role in Periodontics:
The Web-based teledentistry consultation system developed for dental clinics
showed that referrals to oral surgery, prosthodontics and periodontics had the
highest number of consults. The use of videoconferencing for diagnosis and
treatment planning for patients requiring prosthetic or oral rehabilitation
treatment and stated that video-consultation in dentistry has the potential to
increase the total number of dental specialist services in sparsely populated
areas.
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ETHICAL AND LEGAL ISSUES
Concerns about the confidentiality of dental information arise from the transfer
of medical histories and records as well as from general security issues of
electronic information stored in computers. The practitioners of teledentistry
should take utmost care to ensure that patient privacy is not compromised by
unauthorized entities. However, patients should be made aware that their
information is to be transmitted electronically and the possibility exists that the
information will be intercepted, despite maximum efforts to maintain security.
Concerns also may arise about the proper method of informing patients of the
potential transmission of their data. Informed consent in teledentistry should
cover everything that exists in a standard, traditional consent form. The patient
should be informed of the inherent risk of improper diagnosis and/or treatment
due to failure of the technology involved.
In teledentistry practice, medico legal and copyright issues also have to be
considered. These problems arise primarily due to a lack of well-defined
standards. Currently, there is no method to ensure quality, safety, efficiency, or
effectiveness of information or its exchange. There are privacy and security
issues as well as remuneration, fiscal and taxation issues associated with
electronic commerce. Many of the legal issues, such as licensure, jurisdiction,
and malpractice, have not yet been definitively decided by legislative or judicial
branches of various governments. Inspite of this, information on teledentistry
licensure does not appear to be readily available today.
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ResultsTime spent on internet
Time spent on the internet is categorized into three sections.
i. 1-3 hrsii. 3-5 hrsiii. More than 5 hrs
Approximately 67% of the sample size spent between 1-3 hours per day on the computer and Internet. Overall, the majority of the participants were positive towards teledentistry, stating that teledentistry has a potential and has to be integrated into current dental services.
Table 3.1 NUMBER OF HOURS SPENT ON INTERNETHOURS
Frequency Percent Valid PercentCumulative Percent
Valid 1 10 66.7 66.7 66.7
2 4 26.7 26.7 93.3
3 1 6.7 6.7 100.0
Total 15 100.0 100.0
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Figure 3.1 HOURS SPENT OF INTERNET
Cost Effectiveness
The responses of the participants show that the majority of the participants thought teledentistry would be cost-effective.
Table 3.2 COST- EFFECTIVENESSCOSTEFFECTIVE
Frequency Percent Valid PercentCumulative Percent
Valid 1 12 80.0 80.0 80.0
2 3 20.0 20.0 100.0
Total 15 100.0 100.0
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Figure 3.2 BAR DIAGRAM FOR COST-EFFECTIVENESS
80% of the sample thought teledentistry will be very cost effective. And 20% thought that it will not be that cost effective.
Time Consumption
86.7 % have anticipated that teledentistry would save time. While 23.3% of the sample didn’t agree on it.
Table 3.3 SAVING TIMESAVINGTIME
Frequency Percent Valid PercentCumulative Percent
Valid 1 13 86.7 86.7 86.7
2 2 13.3 13.3 100.0
Total 15 100.0 100.0
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Figure 3.3 BAR DIAGRAM FOR SAVING TIME
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Sample of the Questionnaire
Demographic
Name:
Age:
Sex:
Years of Experience:
Active area in dentistry:
Computer and Internet Use:
Computer and Internet Use for Health Related Purposes:
Teledentistry perception
1) A telehealth assistant can provide me a good understanding of the patient’s oral health problem over the Internet
2) Teledentistry can violate the patient’s privacy
3) Teledentistry is a convenient form of oral health care delivery
4) Teledentistry can reduce costs for the dental practices.
5) Teledentistry makes it easier for me to contact the patient
6) Further recommendations....
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CONCLUSION
With all the technological developments taking place in the field of
teledentistry, practitioners may eventually link up to virtual dental health clinics
and an entirely new era of dentistry can be created. The future might also see
distant telemedical control of robotized instruments in situations with long-term
unavailability of dental care, e.g., during space flights, on transoceanic ships,
and in various rural areas. The results achieved so far are very encouraging,
setting the road signs for future investigations. However, a number of things
have to be addressed before teledentistry can rise to its peak. Further studies
involving greater number of participants will be required to validate the various
aspects of teledental applications.
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17.www.wikipedia.com
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19.www. jamia.bmj.com
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21.www.digitalcommons.unl.edu
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