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Experience with telehealth to increase follow-up rates?

By Andrea Ippolito | 24 Apr, 2014

I am doing a project with a plastic surgeon in Varanasi, India on how to improve follow-up rates with his patients that underwent cleft palate surgery. Traditionally, he has seen poor follow-up rates after surgery and this has lead to further complications for his patients down the line. We are looking into setting up telehealth centers in local clinics in Northern parts of India to help improve follow-up rates.

Does anyone have any advice or know of any studies/research papers/literature that I could refer to as we evaluate telehealth and other mobile health options?

Thank you!



John Sung Kim Replied at 10:28 PM, 24 Apr 2014

Hi Andrea, your post caught my eye.

While DoctorBase.com has not done a formal study on plastic surgery follow up rates in the US, one of our engineers lves in Delhi and is passionate about telehealth in India. Our platform is currently in use by over 400 plastic surgeons in the US for a mobile based (desktop PC as well) telehealth option.

If you would like a deployment at no cost, please let me know at and I'm sure we could give you some local support.


Radha krishna Behara Replied at 11:37 PM, 24 Apr 2014

Hi Andrea
The solution of "telehealth centers in local clinics " might work to a certain extent only because of the profit motto of the local health centers in each and every village. As long as there is profit sharing between the main clinic which did the surgery and the support staff at the grass root (telehealth centers in local clinics ) are aligned on mutual interests and benefits; your solution will work. This will fail to do justice 100% if some other doctor or clinic enters the fray to capture the village level markets. This untapped market of health care at grass root level is a huge opportunity to corporate hospitals whose motto is business than true healthcare.
My suggestion is as follows.
1. The clinic should have a mobile health van which can visit the villages according to a schedule to check on the patients well being. It will also help in creating brand recognition and brand awareness to penetrate deeper in to the rural market of health care for the hospital.
2. Since the above effort needs investment of time and money I also suggest that they should talk to other businesses such as tractor manufacturers or some other entities that have business interest with village people so that by clubbing their business with health care will compliment each others interest and helps in sharing the costs and benefits together.
These are two ideas that can sustain the clinics and help patients enjoy health after operations.
I'm a corporate professional with international experience in implementing ERP software for global corporations and presently teach students and write blogs for them at http://skillsnest.wordpress.com
Rural India , towns are not ready for technology solutions and people are still in the nascent stages of knowing that they can use mobile phones for other than talking and listening to music. So technology has to wait for healthcare to use services of what John mentioned above

Laura Lewis-Watts Replied at 10:10 AM, 25 Apr 2014

Hi Andrea,

My organization, Transforming Faces, supports a cleft lip and palate program based in Chennai with Sri Ramachandra University. They have a network of trained community-based health workers in the surrounding rural districts who follow up with cleft lip and palate patients over the long term to ensure that they have access to services such as dental care, orthodontics and speech therapy. We looked into monitoring via telehealth but had difficult implementing this since the technology at our partner institution was in such high demand by many different programs.

Since then our local partners have been experimenting with a simple mobile app for their community workers to track patient progress in speech therapy. Please visit us at www.transformingfaces.org or email me at if you'd like more information.

Mark Boots Replied at 11:44 AM, 25 Apr 2014

Hi Andrea,

Do your patients (or their parents) have access to mobile phone networks? One channel that has proven effective in similar situations is to send follow-up reminders and key information via patients' own mobile phones . You would simply collect their phone numbers during initial contact, and then automatically send reminders as needed before follow-up visits. I work at Voto Mobile (www.votomobile.org) and we have partnered with many organizations to set this up, and even included follow-up survey questionnaires. The web-based tool allows all of this to be automated, so there is no ongoing effort. Pre-recorded voice messages can be used for low-literacy patients, and SMS reminders for literate patients. We have one existing organization (a center for tropical medicine research in Ghana) reporting increased follow-up visits after patients receive phone reminders in a fever management study.

There is some published evidence that mobile based reminders can create better health outcomes, for example, in ensuring adherence to ART for patients with HIV. This paper (http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009756/pdf/abstract) states that "There is high-quality evidence from the two RCTs that mobile phone text-messaging at weekly intervals is efficacious in enhancing adherence to ART, compared to standard care. There is high quality evidence from one trial that weekly mobile phone text-messaging is efficacious in improving HIV viral load suppression."

Let us know if you'd be interested in trying this out!

Mark Boots, PhD | Executive Director,

Stacey Pulk Replied at 7:25 PM, 26 Apr 2014

This is interesting. I think this type of followup would also work well in the inner city where few people have access to computers or internet. Many of this population are poor at maintaining health care access until more critical care is needed.. this would be a good way to maintain medical follow up.

Andrea Ippolito Replied at 9:20 PM, 29 Apr 2014

Thank you all for your thoughtful responses! This is truly wonderful! I am going to process all your feedback and bring it to our physicians to try to figure out next steps! I greatly appreciate your comments!

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