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Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Prof. S K Mishra, MS, FACSHead, Dept. of Endocrine Surgery &
Faculty I/C, SGPGI Telemedicine ProgrammeSanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS)
Lucknow,[email protected]
www.sgpgi-telemedicine.org
1Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Content
• Introduction: India Demography & Health DeliverySystem
• Brief review of Application of Telemedicine Projectaround the country
• m-Health in India• Application of Telemedicine technology in Health and
Medical Education by Premier Academic & CorporateMedical Institution of India
• Opportunities and Challenges• Participation of India in ITU-D Activities
2
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
3
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
India-Introduction
4
Total Area : 3 million sq. kmNo. of Provinces : 29Union Territories : 6Coastal line : 6,700 kmDiverse geography - inaccessible
hilly regions, islands, desert, coasts, tribal areas
Population - more than 1 billion (70% rural) Medical Experts: 70% urban
Lucknow
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Indian Health Scenario
• 620 million live in rural India (NCAER)• Bed-Population ratio 1:1333 (1991) Vs. ideal of 1:500• 2 million beds are required as against 0.7 million available• 700 hospitals of 250 beds each are required every year• Only 9% of 1 billion people are covered health schemes• Only 0.9% of GDP for health (WHO recommends 5%)• 5% of annual family income spent towards curative health
care.• Specialists relocating to sub-urban or rural areas
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Public Health care delivery in India
• Primary Healthcare centers
– 23,236 PHC & 46,026 Sub centers
• Secondary Healthcare centers
– 3,346 CHC 4,400 Dist. Hospitals & 1200
other Public Hospitals
• Tertiary Care & Teaching
– 275 Medical colleges, 205 Dental collegesThird International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Potential of ICT to improve Healthcare
• 66% of 1100 million are literate • 70% of India has access to TV coverage • 650,000 existing PCOs ® internet kiosks • 400,000 villages already have telephone connections• Mobile user in India 584.32 million as on 31st March
2010• Internet users in 16.18 million as on 31st March 2010• Hardware, software and brain ware all available
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
8
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Major Implementing Agencies
• Department of Information Technology (DIT) , Ministry of
Communication & IT, Govt. of India – terrestrial line
• Indian Space Research Organisation (ISRO) – Satellite
communication
• Ministry of Health and Family Welfare, Govt. of India
• Ministry of External Affairs, Govt. of India
• State Governments
• Medical Institutions (public & corporate)9Third International Conference on Communication Systems and Networks
(COMSNET 2011), January 4-8; Bangalore
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
State wise location of Telemedicine platforms
10
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Dept of Information Technology (DIT)Ministry of Communication & IT-
Since -1999 • Initiated some successful pilot projects• Selected specialty
– OncoNET Kerala– development of a Tele-Oncology System – Development & Application of Tele-radiology - West Bengal– Diagnosis & monitoring of Tropical diseases – West Bengal – General telemedicine system -various states
• Standardization activities in e-health/Telemedicine• Prepared a framework for IT Infrastructure for Health
http://www.mit.gov.in/default.aspx?id=709
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
West Bengal
Kerala
Nagaland
Mizoram Tripura
Tamil Nadu
Telemedicine Projects by DIT in various states of India
Punjab
Maharashtra
Uttar PradeshNew Delhi
Manipur
Himachal Pradesh
Haryana
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Application of Telemedicine Technology to provide Tele-health care during mela festival and disaster Year 2001 - DIT-SGPGIMS
• Religious Importance– Happen once in 12 Years– At the bank of confluence of
three holy rivers Ganges, Yamuna & Saraswati(Sangam)at holy city Prayagin the Northern India
– Pilgrims congregate and take Shahi Snans (Holy bath)
– Population:Circulatingpopulation -7 0 million
– Temporary population“Kalpavasees”-Five million
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Exchange of Health Information
• Daily discussion between DGHS, Lko& Medical College, Allahabad onpublic health activity
• Tele-consultation from SGPGI- 174 patients
• Results of stool culture, throatconjunctivae & wound swab-onlinetransmission & preventive measures
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Monitoring of Public Health
• Drinking water at State PH lab• OT test for chlorination• Microbiological examination at SGPGIMS-• Total sample Suspicious Fecal cont.
149 31 05Sangam water: Total sample MPN/100 ml V. cholerae
9 >1100 in 5 None• Food samples– 24 vendor shops– Police line mess
15
Ayyagari A, Bhargava A, Agarwal R, Mishra SK, Mishra AK, Das SR, Shah R, Singh SK, PandeyA. Use of telemedicine in evading cholera outbreak in Mahakumbh Mela, Prayag, UP, India: an encouraging experience. Telemed J E Health;9(1):89-94, 2003
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Development and Application of Telemedicine for Tropical Diseases – Year 2002
• School of Tropical Medicine, Kolkata- Referral center
• Kooch Bihar District Hospital & Habra State General Hospital in West Bengal
• IIT, Kharagpur and Webel ECS Ltd. - Telemedik software
• Telecommunication - PSTN
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Development and Application of Telemedicine forRadiology for Govt. Hospitals of West Bengal– Year 2002
• Referral Center
– NRS Medical College & Hospital, Kolkata & Burdwan Medical College & Hospital, Burdwan
• Nodal Centers : Purulia District Hospital, Purulia , Suri District Hospital, Birbhum , Baharampur District Hospital, Murshidabad, Midnapur Medical College & Hospital, Midnapur
• Connectivity: 64/128 Kbps Leased line& WBSWAN as backbone
• Activities : Cases of Radiology, Cardiology, Medicine, Haematology
17
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Development of Telemedicine technology and its applications towards optimization of medical resources -Year 2002
• Networking of Three Premier Medical Institutions of the Country
• Using technology to set up a number of telemedicine networks connecting remote health centers with specialty hospitals
18
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow
All India Institute of Medical Sciences, New Delhi
Postgraduate Institute of Medical Education & Research,
Chandigarh
Mercury Telemedicine Software
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
OncoNET Kerala- Year 2003
• Regional Cancer Centre, Trivandrum• 5 peripheral centers linked • No. of Follow-up pts -13566 (yr 2004 onwards)• CMEs- 53 & Panel Discussion – 33• Nursing training prog – 41• Didactics talk – 13• Public Awareness campaigns - 14
www.rctvm.org
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Common Service Centers(CSCs)100,000 CSCs (80 services) in 600,000 villages
• e-governance, education, health, telemedicine, entertainment and other private services
• Health – Vaccination Schedule, Maternity Care,
Family Planning, Medicines, Ambulance Services, Hospital / PHCs information, Blood Bank, Life Saving Drugs, Doctor’s Database, Appointment with Doctors, E-Diagnostics, Medicines
http://www.csc-india.org/
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Common Service CentersImplementation Status till 31Mar10
21
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Indian Space Research OrganizationSince - 2001
• Satellite-Telemedicine
Network through Indian
Satellite System (INSAT)
• Collaboration with state
governments
• 439 nodes across the
country – 17 Mobile Vans
• Free satellite bandwidthwww.isro.org/scripts/telemedicine.aspx
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Rural Telemedicine Yr 2001
• Referral Hospital – Apollo Hospital at Chennai and Hyderabad
• Remote Hospital: – Apollo Rural Hospital at Aragonda village in the
Chittor district of Andhra Pradesh • Activities – Preventive healthcare program, tele-
consultation & tele-follow up • 40,000 consultations
23
http://www.telemedicineindia.com/KeyProjects.htm /
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Karnataka Telemedicine project Yr 2002
• Referral Hospital– Narayana Hrudayalaya, Bangalore
• Remote Hospital– District Hospital, Chamarajanagar– Vivekananda Memorial Trust Hospital at Saragur in south interior
Karnataka• Connectivity : Satellite• Activities : Tele-cardiology, woman and child health, orthopedics,
pathology, etc• 52,000 patients
24
Cardiac care: NH manages the cardiac care unit at the Chamarajanagar District Hospital
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Disaster ManagementAndaman & Nicobar Islands Telemedicine Project-Year 2004
• GB Pant Hospital & INHS Dhanvantariat Port Blair, Andaman Island and Bishop Richardson Hospital at Car Nicobar at 8 islands used during postTsunami disaster relief work
• GB Pant Hospital connected to Sri Ramachandra Medical College & Research Institute, Chennai for specialty consultation
• ISRO GRAMSAT Network• Patients need not to come to main land
for diagnosis, consultation and treatment
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Village Resource Centers (VRCs) ISRO initiatives
• A step closer to the grassroots • Communication and remote sensing satellite• Delivering the variety of space technology services
directly to the grassroots including telemedicine and tele-health education
• 550 villages in various states
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Village Resource Center
27
http://www.gisdevelopment.net/magazine/global/2008/august/30.htm
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Ministry of Health & FW, Govt. of India
• Integrated Disease Surveillance Project (IDSP)• OncoNET India• Tele-ophthalmology project• National Digital Medical Library Consortium
(ERMED)• National Rural Telemedicine Project• National Medical College Telemedicine Network
28
http://www.mohfw.nic.in/
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; BangaloreThird International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Disease Surveillance Integrated Disease Surveillance Project (IDSP)- Year 2004
• EDUSAT Satellite
• Decentralized state based surveillance
system for communicable & non
communicable diseases
• Improve the efficiency of surveillance
activities, detect disease trends,
evaluate control strategies of the
disease control programmes
Current status
• Data Centre - 750 locations
• Connectivity - 559 locations
• Training Centre
– NIC 218 / 400 sites
– ISRO 297 / 400 sites
• 38 Hi-End VC Equipments (Multi
conference 5 nodes) - between
CSU and States/UTs HQ
29
http://idsp.nic.in/
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Central Scheme: ONCONET India
• Under National Cancer Control Programme
• Nationwide Tele-oncology Network in India
• Connect 27 Regional Cancer Centres with 4 peripheral district hospitals/medical colleges for each RCC across the country
AllahabadAllahabadAllahabadAllahabadAllahabadAllahabadAllahabadAllahabadAllahabad
LucknowLucknowLucknowLucknowLucknowLucknowLucknowLucknowLucknow
GwaliorGwaliorGwaliorGwaliorGwaliorGwaliorGwaliorGwaliorGwalior
DelhiDelhiDelhiDelhiDelhiDelhiDelhiDelhiDelhi
ChandigarhChandigarhChandigarhChandigarhChandigarhChandigarhChandigarhChandigarhChandigarh
RohtakRohtakRohtakRohtakRohtakRohtakRohtakRohtakRohtak
ShimlaShimlaShimlaShimlaShimlaShimlaShimlaShimlaShimla
Shrinagar
AizwalAizwalAizwalAizwalAizwalAizwalAizwalAizwalAizwal
BikanerBikanerBikanerBikanerBikanerBikanerBikanerBikanerBikaner
HyderabadHyderabadHyderabadHyderabadHyderabadHyderabadHyderabadHyderabadHyderabad
RaipurRaipurRaipurRaipurRaipurRaipurRaipurRaipurRaipur
NagpurNagpurNagpurNagpurNagpurNagpurNagpurNagpurNagpur CuttakCuttakCuttakCuttakCuttakCuttakCuttakCuttakCuttak
BangaloreBangaloreBangaloreBangaloreBangaloreBangaloreBangaloreBangaloreBangalore ChennaiChennaiChennaiChennaiChennaiChennaiChennaiChennaiChennaiKanchipuram
PondicherryPondicherryPondicherryPondicherryPondicherryPondicherryPondicherryPondicherryPondicherry
ThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuram
MumbaiMumbaiMumbaiMumbaiMumbaiMumbaiMumbaiMumbaiMumbai
KolkataKolkataKolkataKolkataKolkataKolkataKolkataKolkataKolkata
GuwahatiGuwahatiGuwahatiGuwahatiGuwahatiGuwahatiGuwahatiGuwahatiGuwahatiPatnaPatnaPatnaPatnaPatnaPatnaPatnaPatnaPatna
AhmadabadAhmadabadAhmadabadAhmadabadAhmadabadAhmadabadAhmadabadAhmadabadAhmadabad
ImphalImphal
ONCONET INDIA
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Central Scheme: Tripura Tele-ophthalmology Project
• Tripura Tele-ophthalmology (Vision) Centres set up in Blocks toprovide eye-care to patients at door-steps
• Linked to IGM Hospital through Tele-medicine infrastructure.• Started in April 2007; 35 Centres set up so far• 5 Blocks (Korbook, Jampui Hills, Dasda, Chawmanu and Bishalgarh)
yet to be covered.• Over 71,000 patients screened upto August 10, of which 5,092 patients
referred to Referral Hospital (IGM Hospital)• Average number of patients per Centre per month: around 100.• National e-Governance Gold Award for 2009.
31
http://www.ilfsindia.com/projects1.asp?Category=2&Project=12&subLink=125
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
National Rural Telemedicine Project under National Rural Health Mission
• Design, development and implementation of– Low cost rural telemedicine infrastructure– Village Tele-ambulance System and rural emergency
healthcare services / Trauma care module– Rural Health Knowledge Resource through web portal and
e-CME module– Technology platform for harvest, compilation, storage
(Data Base) at Regional District Hub and Central DataCenter at MOH & FW, archive and distribution acrossnetwork
32
www.mohfw.nic.in/National%20Rural%20Telemedicine%20Network%20for%20India-...
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
UP State Telemedicine Network
• Department of Medical Education, Govt. of U.P. took a policy decision tosetup U.P. Medical Colleges Telemedicine Network.
• School of Telemedicine & Biomedical Informatics, SGPGIMS, Lucknowentrusted the job of designing the technical architecture and Systemrequirement
• National Co-operative Consumer Federation of India Ltd. (NCCF) wasidentified to implement the project.
• The pilot phase has been completed with deployment of telemedicineinfrastructure in Medical Colleges at Allahabad, Kanpur and Meerut.
• After technical trials and training the project is operational since September2010.
• Currently the Clinical Grand Round held every week at SGPGI is gettingshared with all three medical colleges.
• Two conference/workshop held at SGPGI was similarly shared. Bothreceived wide acclaim from the users.
33Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
1. SGPGIMS, Lucknow2. CSMMU, Lucknow3. MLN Medical College, Allahabad4. GSVM Medical College, Gorakhpur5. J. K. Cancer Institute, Kanpur6. L.P.S. Institute of Cardiology, Kanpur7. B.R.D. Medical College, Gorakhpur8. R.L.B. Medical College, Jhansi9. L.L.R.M. Medical College, Meerut10. S.N. Medical College, Agra11. UPRIMS, Saifai12. IMS, BHU, Varanasi13. JN Medical College, AMU, Aligarh14. RML institute of Medical Sciences, Lucknow15. RML Hospital, Lucknow16. Balrampur Hospital, Lucknow
34
Nodes Activated in Phase I
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Block Diagram for UP Medical College Telemedicine Network #1
WAN Connectivity
35Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Design of UP Medical College Network #2WAN & LAN Connectivity
36Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Design of the System & Network at each medical college #3Digital Library
37Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Ministry of External Affairs Project, GoI
SAARC Telemedicine Network• Implementing Agency:
Telecommunications Consultants India Ltd. (TCIL)
• Connectivity: Satellite & fiber optic network
• Networking of one/two hospitals in each of the SAARC countries with 3-4 Super Specialty hospitals in India
• Current Status: JDWNRH, Bhutan , Indira Gandhi Child Hospital, Kabul, Afghanistan & Patan Hospital, Kathmandu, Nepal with SGPGIMS, Lucknow & PGIMER, Chandigarh with academic activities
Pan-African e Network Project• Implementing Agency: TCIL• 53 countries of the African Union • Connectivity: Satellite & fibre optic
network • Activities: tele-healthcare & tele-
education• Current status: 3 African countries
joined the project
38http://www.tcil-india.com/new/html/26feb.htm
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
39
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; BangaloreThird International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Review of mHealth projects in IndiaName of the Project Reference Link
Freedom HIV/AIDS Project http://www.freedomhivaids.in/FreedomHivAids.htm
Community Accessible & Sustainable Health System (Ca:sh
http://www.medialabasia.in/healthcare.html
Shared Resource for Rural Health Management & Information Infrastructure
http://www.medialabasia.in/healthcare.html
Mobile-Based Primary Healthcare Management System
http://www.w3.org/2008/02/MS4D_WS/papers/cdac-mobile-healthcare-paper.pdf
Mobile Care, Support & Treatment Manager (MCST)
http://www.freedomhivaids.in/mCST.htm
Mobile Phones for Health Monitoring http://www.lboro.ac.uk/service/publicity/newsreleases/2007
The Acute Encephalitis Syndrome Surveillance Information (AESSI)
http://unpan1.un.org/intradoc/groups/public/documents
Handhelds for Health http://handheldsforhealth.org
Tamil Nadu Health Watch http://unpan1.un.org/intradoc/groups/public/documents/UN/UNPAN030003.pdf
Ericsson and Apollo Hospital Initiative http://www.ericsson.com/ericsson/press/releases/20080605-1225191.shtml
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Sanjeevani – Mobile Telemedicine Unit(CDAC-TVM., MCCS, Kannur, RCC TVM. , ISRO); DIT Funded
41Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
42
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Telemedicine at SGPGIMS, Lucknow
• Started – 1999
• Total Nodes - 21
• Tele-communication link
– ISDN, VSAT, Fiber
Optic, Global IP
• SAARC Telemedicine
Network Project
• IDSP Project
43
SGPGIMS, Lucknow
Patient care, teaching, training & research
National Resource CenterSchool of Telemedicine & Biomedical Informatics
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
44
PGIMER, Chandigarh
IG Medical College, Shimla
AIIMS, Delhi
Base Hospitals, Almora & Srinagar
Dist. Hospital , Raibarelli
RIMS, Imphal
VSS Medical College, Burla
MKCG Medical College Berhampur
SRMC, Chennai
CMC, Vellore
AIMS, Kochi
SCB Medical , Cuttack
Railway Hospital, Izzat Nagar, Bareli 8 Northeastern
states (NIC)
PBDS Post Graduate Institute of medical
Science, Rohtak
National Network Partners
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
SAARC & Overseas Partners
Oregon Health & Science University, Portland, USA
Ranguel University, Tolouse, France
Holy Family Hospital, Rawalpindi, Pakistan
I G Child Hospital, Kabul, Afghanistan
JDWNR Hospital, Thimphu, Bhutan
45
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Telemedicine Initiatives
• Application & Research project
• Consultancy, project planning and implementation of network in states
• Tele-health care & Distant Education in Medicine
• Tele-mentoring
• Research &Development• Organizational Activities• Telemedicine Awareness • National & International
collaboration in policy initiatives, technical knowledge exchange
• Training & structured courses in telemedicine
46
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Tele-microbiology Tele-pathology
Tele-consultation
Snap shot - Telemedicine Activities at SGPGIMS
Tele-education Tele-health care
Capacity Building Policy Initiatives & Consultation47
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
R & DSnap shot
IP Based Intra-operative Tele-consultation Module
Low cost portable Telemedicine Unit
Internet based Mobile Telemedicine Van
Telemedicine Software
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
• 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 Medical Colleges of Orissa State (n=620pts)
49
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
• Balrampur and Civil Hospital, Lucknow (20 kms) – Year 2000 using PSTN
• Pithoragarh District Hospital, Pithoragarh(500 kms. Hilly area) & Sushila TewariForest 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 District Hospitals
Screen Shot of one of the Tele-radiology Opinion transmitted to one of District Hospital in
Uttaranchal region50
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
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
51
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Tele-follow up – Snap Shots
Dept of Endocrine Surgery
Dept of Nuclear Medicine
Dept of Rheumatology52
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Post-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
53
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
UP Tele-radiotherapy Network Project (2007-ongoing)
• Funding Agency - Department of Bio-technology
• Network Partners - Chhatarpati Sahuji Maharaj
Medical University, Lucknow
• No. of Tele-education sessions - 176
54
Mahapatra Ashok Kumar, Mishra Saroj Kanta, Kapoor Lily, Singh Indra Pratap, “Critical Issues in Medical Education and the Implications for Telemedicine Techology”. Journal of Telemedicine & eHealth, VOL. 15, No. 6, P 592-596, August 2009
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Post-graduate students of medical colleges-Snap shots - Virtual Classroom
55
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
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
56
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
District Hospital Doctors – Snap shots
57Mahapatra 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
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Para-medical Healthcare - n=106 sessions
• Orissa 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
58
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Para-medical Healthcare Professionals
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Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
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
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Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Knowledge Sharing - Snap Shots
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Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Tele-mentoring
• Emergency situations• Skill development
– Laparoscopic surgery– Complex surgical procedures
• Institutions Involved – SGPGIMS, Lucknow– AIMS, Kochi
• Telecommunication link– VAST – 512 kbps
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Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
LocalCablenetwork
Video conferencing unit
512 Kbps
512Kbps
Tele-mentoring
AIMS, Kochi
2500 Km
SGPGIMS, Lko
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Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Tele-mentoringSnap shots of surgical field
64
Telementoring 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
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
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
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Sub-specialty Development
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Case Study : National Resource Center (NRC) for Telemedicine
School of Telemedicine and Biomedical Informatics, SGPGIMS, Lucknow
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Network Backbone of SGPGI, Lucknow
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Integrated Hospital Network
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
HD Surgical e-content Process
Green Valley Edius
FCP(final cut Pro)
Adobe Premiere
Maya
Online sharing
Streaming
Video Conferencing
Offline SharingDeveloped Content
Website
Editing Storage Sharing
Professional Camera (02)
Video Conference (04)
Hitech Digital Lecture Theater (01)
Integrated Operation Theater (01)
Data CenterEquipped with Latest Blade Servers
Rack Servers
Streaming ServerBoth Apple & IBM Servers
Raid Configuration
Harvest
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Creation
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Collections
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Network Monitoring & Data Storage
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Integrated Operation Theatre System
• Integrated Operation Theatre System– Various Video Sources
• In-Light Camera• Endoscopic camera• PTZ Camera etc.
• Data Center as Video Archival and Distribution Center
• Upgraded Hi-Speed Hospital Network i.e 10G Network
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
In-light Camera and various light sources
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Touch Panel to Control Various Video Sources
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Video Hub
VC • Polycom Codec
Switcher • Matrix Switcher
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Video Router inside OT
Recorder •SDC Ultra
Control •SIDNE
Router • Infinity 2
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Video Edit and Capture Stations
• Editing Stations– Canopus Edius 4.5
(Windows)– Final Cut Pro
(Apple Mac)• Voice Over Booth
– Apple Platform• Ingest capture stations
using– B4m Production Suite
with clients in Apple Mac Plate form
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Software used
• Adobe Collection, including Flash, Premiere etc.• Maya - modeling & animated e-contents• Offline Surgical Video Editing
– Edius, FCP• Live Video Ingest - B4M Production Suite• Live Surgery DVD - SDC Ultra (Stryker Digital
OT Integration) or similar solutions by other vendors
• Educational portal – Dream Weaver, Flash, XML
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Hardware for Capturing & Archiving Surgical Videos
• Live Conference were recorded using SonyXDCAM, and professional studio videocameras for grabbing the quality contentmoreover in HD format.
• For Audio and Video Streaming Servers likeStarbak and Polycom RSS-2000 needed tostore the content.
• Audio streaming is best used while Tele-Educational and CME sessions.
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Sharing HD Surgical Knowledge
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Editing Stations
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Data Storage
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
All India Institute of Medical Sciences (AIIMS), New Delhi
• Total Nodes – 50
• Pan African e-Network &
SAARC Telemedicine
Network Project
• Activities – Tele-
education & healthcare
85
http://www.aiims.edu/aiims/tel-med/tm-inauguration5.htm/
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
• Total Nodes -10
• Pan African e-Network & SAARC
Telemedicine Network Project
• Activities – Tele-education & healthcare
86http://pgimer.nic.in/code/telecentre/html/e-
health.htm
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Amrita Institute of Medical Sciences, Kochi
• Total Nodes – 166• 1 Mobile telemedicine – tele-
ophthalmology, tele-general medicine, tele-gastroenterology, tele-cardiology
• Emergency Medical Center at Pampa
• Activities: Tele-healthcare, Tele-surgery, Tele, CMEs, Tele-Health (Public), Distance Education
• Telemedicine solution provider
87http://www.amritatech.com/telemedicine.htm
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Christian Medical College, Vellore
• Total Nodes –7
• Connectivity – ISDN/ VSAT
• Activities: Tele-healthcare,
Tele, CMEs, Demonstration
Distance Medical Education
http://clin.cmcvellore.ac.in/otherwebsite/mission_support/Telemedicine.asp
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Telemedicine at Corporate Hospitals
Apollo Telemedicine Network Foundation
• Total nodes – 130• 1 Mobile telemedicine – Tele-
general medicine• Pan African e-Network Project • Aragonda, Government of Gujarat,
Aditya Birla Group, KudankulamNuclear Power Project
• Telemedicine consultancy and software providers
Sri Ramchandra Medical College, Chennai
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www.telemedicineindia.com
• Total nodes – 100• 1 Mobile telemedicine – Tele-
general medicine• Services: Tele-Diagnosis, Tele-
Consultation, Tele-follow ups ,Expert’s Opinion, Public Awareness programs, Tele- CME, Guest Lectures, Tele-Conferences, National Workshops Clinical Society Meetings (Surgeons), Live Surgeries, Capacity Building
• Telemedicine @ Southern Railway, Chennai
http://www.srmc.edu/telemedicine.htm
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Tele-OnconetRegional Cancer Centre,
Thiruvananthapuram
• Total nodes-5• Connectivity – VSAT• Activities: Tele-Follow up, Tele-
CME, Panel Discussions, NursesTraining programs, talks bydoctors of RCC, CancerAwareness
Tata Memorial Hospital, Mumbai
• Total Nodes: 8• Connectivity: VSAT• Activities: Tele-consultation /
Follow up and CME • Platform- Data Sharing, VC,
Tele-pathology / Radiology
90http://www.rcctvm.org/Telemedicine.htm http://tmc.gov.in/misc/aboutus.htm
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Tele-onconetUP Tele-radiotherapy Network
• Total Nodes – 2 (1st Phase)
• Connectivity: ISDN
• Activities : Tele-education & Tele-CME
RCC, Adyar , Chennai
• Total nodes: 7
• Connectivity: ISDN & VSAT
• Activities: Tele-consultation & Tele-follow up
91
http://www.cancerinstitutewia.in/
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Tele-cardiology
Asia Heart Foundation Kolkata & Narayana Hrudayalaya,
Bangalore• Total Nodes: 20• Pan African e-Network• Connectivity : VSAT/ ISDN/ PSTN• Activities: Tele-consultation & VC,
TTECG, Tele-CME
Fortis healthcare Network & Escort Heart Institute,
New Delhi • Total Nodes: 12 satellite/heart
command centers
92
www.narayanahospitals.com/tele_medicine_centers.html
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Mobile Tele-ophthalmologyShankara Nethralaya, Chennai
Total Mobile Unit: 4 (Karnataka, Andhra Pradesh, Tamil Nadu & Maharashtra)
• Connectivity: VSAT• Activities: Eye check up, tele-
consultation, educating the local community about eye care, Teaching and Training for local Ophthalmologist / General Physicians / Optometrists / Opticians / Nurses and teachers
• Tele-education & Tele-CMEs – nodes -3
Aravind Tele-Ophthalmology Network
• Mobile Unit: 1• Connectivity :VSAT• Activities: Diabetic Retinopathy
Assessment & Grading Over Network
93
http://www.sankaranethralaya.org/tele_mobile.htm www.aravind.org/Telemedicine/mobilevan.htm
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
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Opportunities and Challenges
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Opportunities
• Vast and diverse geography with dominantrural population
• Disparity in healthcare infrastructure• Low cost local technical solution & ICT
expertise• Fast adoption of Mobile technology• Successful pilot projects• Policy on adoption of ICT in service delivery
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Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Challenges 1
• National e Health Policy • Evaluation & Identification of Best Telemedicine
Practices• Confidentiality & Security of Personal Health Record• Credentials and competence of the remote physician• Legal, ethical and social issues yet to be addressed• Broadband internet yet to reach rural areas • NGN like Wi Max and 3G yet to be launched
96
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Challenges 2
• E-health adoption by stake holders• e-Health Program sustainability Models • Inter-operability of e Health system• Integration into prevailing Health System• Development of National e-Health
Observatory• Capacity Building in e-health System• Research & Development in e-health
technology and system appropriate for local situation with global impact
97
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98
Participation of India in ITU-D Q14 2/2 Activities
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
2nd APT Telemedicine Workshop
25- 26 February 2004New Delhi, India
• Experience with Endocrine Surgery Tele-clinic, Saroj K Mishra, Biswa N. Mohanty, Ashok K Verma, Amit Aggarwal, GauravAggarwal
• Human Resource Development in the Field of e Health Technology, Saroj K Mishra
• Maha Kumbh Mela, Saroj K Mishra
• Moral, ethical, legal and other issues in telemedicine, V K Kapoor
3rd APT Telemedicine Workshop
27-28 January2005Malaysia
• Towards building a National Network of Medical College for Distance Learning through ICT, Kartar Singh
• Current Status of E-health in India, S K Mishra
• Tsunami, Indian Ocean, Dec 26, 2004, Impact on Indian sub-continent & Telemedicine Interventions - S K Mishra
99
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
4th APT Telemedicine Workshop
25-26th January2006Islamabad, Pakistan
• Telemedicine practice in extreme geographic environment: Uttaranchal State Telemedicine Network Project – A Case Study, Lily Kapoor, Rajesh Basnet, RepuDaman Chand, Sandeep Singh, Pankaj Joshi, Maneesh Semwal, Durgapal, K S Negi, Ragesh Shah, S K Mishra, Kartar Singh
• India Country Report on Telemedicine & e-health, KartarSingh, S K Mishra
• Continuing Medical Education (CME) Network: Current Position in India, Kartar Singh, S K Mishra
5th APT Telemedicine Workshop
6-9 February 2007Chiangmai, Thailand
• Developing Core Competence in Telemedicine & e-health –SGPGI, Lucknow Initiative, S K Mishra
• Current Telemedicine Infrastructure, Network, Applications in India, S K Mishra
• Short term analysis of impact of telemedicine technology enabled follow-up of surgical patients, S K Mishra
100
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Participation of India In APTSnap Shots
101
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
PSC/APT Workshop, Okinawa,15-16, June 2007Okinawa, JAPAN
• Analysis of Telemedicine Project deployed in Sub-Himalayan Region in the Indian state of Uttaranchal, Lily Kapoor, Rajesh Basnet, Repu Daman Chand, Sandeep Singh, Varad Pradhan,
Pankaj Joshi, Maneesh Semwal, Durgapal, K S Negi, RageshShah, S K Mishra
• Bridging the Knowledge and Skill Gap in Healthcare: SGPGIMS, Lucknow, India Initiatives, A K Mahapatra, S K Mishra
102
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
ITU Rapporteurs Grp Meeting 25-26th June 2004
Tokai University, Japan
• Telemedicine Initiative in India, S K Mishra
Q10-1/2: Communications for Rural & Remote areasITU-D Study Groups, Rapporteurs Group Meeting
20-21 June 2005 Tokyo, Japan
• Telemedicine Application in Surgery : Indian Experience and Update on Telemedicine Activities in India, S K Mishra
• Outcome of case study (project completed) on Field Telemedicine Application in Indian Setting, S K Mishra
• Tsunami, Indian Ocean, Dec 26, 2004: Impact on Indian sub-continent and telemedicine interventions
103
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
• Current Telemedicine Infrastructure, Network, Applications in India, S K Mishra
• e-Health: India Country Report, S K Mishra
• Capacity Building in e-Health in a Developing Country –Indian Initiatives, A K Mahapatra, Lily Kapoor, IndraPratap Singh, Repu Daman Chand, S K Mishra
Q142-/2 ITU-D Rapporteurs Meeting17-18, June 2007Okinawa, Japan
Q-14-2/2 Rapporteurs Grp Meeting3rd-4th July, 2008
Tokyo, Japan
104
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Participation of India in ITU-D ActivitiesSnap shots
105
Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore
Thank you
www.nrct.in | www.telemedindia.org | www.stbmi.ac.in | www.sgpgi-telemedicine.org
School of Telemedicine & Biomedical Informatics
National Resource Center