S K Mishra, MS, FACS - GARUDA Medical college... · S K Mishra, MS, FACS Head, ... Sushila Tewari...

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www.sgpgi-telemedicine.org | www.stbmi.ac.in

National Medical College Telemedicine Network

S K Mishra, MS, FACSHead, Dept. of Endocrine Surgery &

Faculty I/C, SGPGI Telemedicine Program

Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) Lucknow, India

Email: skmishra@sgpgi.ac.in

National Network of Medical CollegeNeed

Diversity in the standard of

Quality of Teachers

Availability of Educational Tools (slide projectors,

projecting microscope, still and moving digital images)

Books and Journals

Quality and type of patient materials (geographical

difference in the incidences of various diseases)

Rural, Urban and Semi urban patients

Diversity in the quality of students because of entry and

exit parameters

2

Introduction

• Networking of medical colleges can bridge distance

between Student & Teacher

• Quality of Postgraduate education in Indian Medical

colleges needs improvement

• Tertiary academic medical centers can provide

additional inputs through networking

3

Objectives 1

• Improving quality of medical / paramedical education

and meeting the educational needs of the students

despite paucity of teachers

• Facilitating cognitive component of learning by

providing interactive teaching material online

developed by a group of competent teachers at

undergraduate, postgraduate and super-specialty levels

• To promote psychomotor skill development through

tele-mentoring4

Objectives 2

• To link Medical Libraries with adequate stock of books and

journals for access to all thereby reducing state expenditure on

medical college libraries (Digital Library Network)

• To promote medical research by providing infrastructure for

quick exchange of ideas and co-ordination with group of

researchers involved in collaborative multicentre studies and

facilitating current information access through digital library

network

• Online Continuing Medical Education (e CME) to enhance

knowledge and teaching skill and possible Accreditation of

Medical Teachers and Health Care Professionals

5

Objectives 3

• Implementing uniform examination pattern and evaluation.

Coaching students with online and offline in MCQs

• Enhancing computer literacy among medical students and teachers

• Facilitating eHealth Governance

• Sharing of resources and establishing effective communication

between the medical colleges and its faculty

• Providing educational material & tools to medical teachers

• Improving quality and reducing the cost of health care delivery by

tele-consultation and tele-follow up

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• Identification of a National Telemedicine Resource Center which

will be connected with high speed fiber network with few

selected apex medical institutions which in turn will be

networked with medical colleges in the region

• Identification of few apex medical academic institutions region

wise (Regional Telemedicine Resource Center) and networking

each with medical colleges in the region covering few states.

• MPLS-VPN Network backbone to provide bandwidth 10 Mbps to

start with (ultimately 1G) at Regional & 2 Mbps at medical

college telemedicine nodes.

• Each medical college telemedicine node to be linked with district

hospitals in their perimeter.

Road Map 1

7

Road Map 2

• One lecture theatre of each medical college will be

converted to digital integrated medical lecture theater

providing necessary infra structure.

• Each resource center will have facility for multimedia

education content development.

• All the medical education knowledge content will be

stored in the central repository located at the data

center of national resource center with a backup

facility at disaster site.

8

Expected Outcome 1

• The network will support multimedia data

exchange, multi-point video conference, both in

interactive and video broadcast mode.

• Central Repository of Medical Education

Content will do live transmission of the content

on day to day basis.

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Expected Outcome 2

• Entire network will provide a platform for interactive

distance learning and adaptive environment for

medical students, teachers and health care

professionals.

• It will also support digital library network.

• Ultimately Virtual Medical University can be

established at National Level.

10

Orissa Telemedicine

Project (ISRO) - Sept’03-

Sept’09

SCB Medical College Cuttack

(1500) kms

MKCG Medical College,

Berhampur (1800 kms)

VSS Medical College, Burla

(1500 kms.)

Technology – Real time

Telecommunication link-

VSAT

Tele-consultation – Case Study-1Medical Colleges of Orissa State (n=620pts)

11

Balrampur and Civil Hospital, Lucknow

(20 kms) – Year 2000 using PSTN

Pithoragarh District Hospital,

Pithoragarh (500 kms. Hilly area) &

Sushila Tewari Forest Hospital,

Haldwani (250 kms base of the hill) in

Northern India

– Year 2000 (n=30 pts as Proof of

Concept using PSTN)

Uttaranchal Telemedicine Network –

Apr’04-Mar’08-(Two district hospitals:

n=265 pts using ISDN)

Raebareli Telemedicine Network

Project – Oct’06-ongoing (n=50 pts)

Technology - Store & Forward

Technology,Real time (On demand)

Tele-consultation – Case Study-2

District Hospitals

Screen Shot of one of the Tele-radiology Opinion transmitted to one of District

Hospital in Uttaranchal region

12

Tele-follow up – Case-study-3

(March 2004 ~ Ongoing)

• Patients from the Orissa

state ( Eastern Coast)

• Technology - Real time

• Telecommunication -

VSAT

• Departments

– Endocrine Surgery (n=50 pts)

– Nuclear medicine (n=127 pts)

– Rheumatology(n=60 pts)

• Average visit – 1-12

Anjali Mishra , Lily Kapoor, Saroj Kanta Mishra, Post-operative care through tele-follow up visits in patients undergoing thyroidectomy and parathyroidectomy in a resource-constrained environment, J Telemed Telecare; 2009,15:73-76 13

Tele-follow up – Snap Shots

Dept of Endocrine Surgery

Dept of Nuclear Medicine

Dept of Rheumatology14

Case Study-1Post-graduate Students of

Medical Colleges Sept 2001-ongoing

• Orissa Telemedicine Network

Project

• Funding Agency - Indian Space

Research Organisation

• Network Partners

– SCB Medical College, Cuttack

– MKCG Medical College, Berhampur

– VSS Medical College, Burla

• No. of Tele-education sessions –

720 sessions

Clarified problems in management

of difficult and complicated cases

Guidelines for management of

complicated cases

Good interesting and illustrative

cases

Keep them abreast of the recent

advances in medical field

Optimal utilization of existing

resources

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Post-graduate students of medical colleges-Snap

shots - Virtual Classroom

16

Case study-2 -Medical Education for District

Hospitals doctors -

n=293 National Informatics Centre

(NIC) (Jul’03 –Oct’04) (n=13)

, Point to multipoint

Uttaranchal Telemedicine

Network Project (Apr04-

Mar08) (n=104), Point to

multipoint

Raibareli Telemedicine

Network Project (Apr06-

Aug’09) (n=176)

Getting expert opinions

Enhancing medical

knowledge in the

management of common

medical problems

Improving consultation

skill

Continuing education

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District Hospital Doctors – Snap shots

18Mahapatra AK, Mishra SK, “Bridging the Knowledge and Skill Gap in Healthcare: SGPGIMS, Lucknow, India Initiatives”

Journal of eHealth Technology and Application; 5(2):67-69, , June 2007

Para-medical Healthcare Professionals-Case

Study-3 - n=106 sessionsOrissa Telemedicine Network

Project

Uttaranchal Telemedicine

Network Project

Raebareli Telemedicine

Network Project

Participants - Nurses,

Hospital Administrators, Lab

Technicians, Dieticians,

Physiotherapists

Enhancing nursing skills

Better patient care

Continuing education

Exposure to new

techniques and

equipments

Better hospital

administration

19

Para-medical Healthcare Professionals

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Case Study-4 Knowledge Sharing

• Amrita Institute of Medical

Sciences (AIMS), Kochi, Kerala

(n=132)

• All India Institute of Medical

Sciences, New Delhi &

Postgraduate Institute of

Medical Education and

Research, Chandigarh (n=23)

• Christian Medical College,

Vellore (n=83)

• Sri Ramchandra Medical

College, Chennai (n=6)

• Regional Institute of Medical

Sciences, Imphal (n=2)

Share interesting and

complicated cases

Peer opinion and

consultation

21

Knowledge Sharing - Snap Shots

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Case Study-5- Tele-mentoring

• Emergency situations

• Skill development

– Laparoscopic surgery

– Complex surgical procedures

• Institutions Involved – SGPGIMS, Lucknow

– AIMS, Kochi

• Telecommunication link– VAST – 512 kbps

23Telementoring in Endocrine Surgery, Mishra SK, Mishra A, Pradeep PV; Chapter 11,Telesurgery Book, Edited by

Kumar S/ Marescaux J Springer-Verlag GmbH, Heidelberg/Germany. ISBN no. 978-3-540-72998-3, 2007

LocalCablenetwork

Video conferencing unit

512 Kbps

512Kbps

Tele-mentoring

AIMS, Kochi

2500 Km

SGPGIMS, Lko

Tele-mentoringSnap shots of surgical field

Case Study-6 Sub-specialty Development

Endocrine Surgery

• Rare specialty

– Few centers

– Few faculty

– Few opportunity

• SCB Medical College, Cuttack

• Tele-communication link – VSAT

• To assess the feasibility and impact of telemedicine in

reinforcement of endocrine surgery training at distant places to

develop this subspecialty in a developing country like India

Sub-specialty Development

Based on

Case based Learning

&

Problem based Learning

28

Case Study on web based medical education around the world

www.websurg.com/m

Weblink: www.websurg.com

31http://www.orlive.com/

Case Study

Uttar Pradesh Telemedicine Network Project

32

Sanjay Gandhi Postgraduate Institute of Medical

Sciences (SGPGIMS) Initiatives

“Institutes with tradition of excellence have demonstrated abundantly

that research enhances the vitality of teaching,

teaching lifts the standards of service, and

service opens new avenues of investigation.”

www.sgpgi.ac.in

Patient-care, teaching and research

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1. SGPGIMS, Lucknow

2. CSMMU, Lucknow

3. MLN Medical College, Allahabad

4. GSVM Medical College, Gorakhpur

5. J. K. Cancer Institute, Kanpur

6. L.P.S. Institute of Cardiology, Kanpur

7. B.R.D. Medical College, Gorakhpur

8. R.L.B. Medical College, Jhansi

9. L.L.R.M. Medical College, Meerut

10. S.N. Medical College, Agra

11. UPRIMS, Saifai

12. IMS, BHU, Varanasi

13. JN Medical College, AMU, Aligarh

14. RML institute of Medical Sciences, Lucknow

15. RML Hospital, Lucknow

16. Balrampur Hospital, Lucknow

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Block Diagram for UP Medical College & District Telemedicine NetworkWAN Connectivity

35

Digital Lecture Theater

Tele-Consultation Facility eLearning & Digital Library

UP Medical College NetworkBlock Diagram for Medical College Level : WAN & LAN Connectivity

36

UP Medical College NetworkBlock Diagram of Digital Library at Medical College

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School of Telemedicine & Biomedical Informatics

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Knowledge Workflow @ STBMI

Green Valley Edius

FCP(final cut Pro)

Adobe Premiere

Maya

Online sharing

Streaming

Video Conferencing

Offline SharingDeveloped Content

Website

Editing Storage Sharing

Professional Camera

Video Conference

Hitech Digital Lecture Theater

Integrated Operation Theater

Data Center

Rack Servers

Streaming Server

Harvesting

39

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Data Server

Network Monitoring Hub

Production Control Unit

(PCR)

Hi-Tech Lecture Theatre

Integrated Operation Theatre

Video Conferencing Suite

Edit Stations

Broadcast Quality Studio

Camera

Knowledge Resources

Digital Medical Lecture Theatre Video Conferencing Suite

Integrated Digital Operation Theatre41

Content Development Facility

Voice Over Station

Sound Proof Edit RoomsLarge screen flat monitors

Production Control Room

PCR

42

Edit Stations

Edius Edit Station

Windows Platform

FCP (Final Cut Pro)

Apple Platform

43

Data Center (Health Knowledge Park)

&

U.P. State Telemedicine Network Monitoring Stations

U.P. State Telemedicine Network

Monitoring Stations

Data Center (Health Knowledge Park)

44

Proposed National Medical College

Telemedicine Network Architecture

45

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Medical Colleges

Apex Medical Institutions

National Resource Center

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Thank you

www.sgpgi-telemedicine.orgwww.sgpgi.ac.in 48