Nm comp and telemed

telemedicine

narendra malhotrajaideep malhotra

neharika malhotra borarishabh bora

www.rainbowhospitals.orgwww.malhotrahospitals.com

What is TelemedicineWhat is Telemedicine

Telemedicine may be defined as the use of computers and telecommunication technologies to provide medical information and services from distant locations

3ITU-T Workshop on Standardization in E-

Health, Geneva, 23-25 May 2003

• Telemedicine comprises all medical actions which extend the action space of health care professional beyond the face-to-face relationship with the patient in the direct surroundings.

• It is medicine at a distance.This includes health care delivery, diagnosis, consultation, treatment, education and the transfer of related data.

Use of information and communication technologies:

i) To provide specialized health care consultation to patients in remote locations,

ii) To facilitate video-conferencing among health care experts for better treatment & care,

iii) To provide opportunities for continuing education of health

care personnel.

Objectives of Telemedicine

Relevance of Telemedicine

Inadequate infrastructure in rural/district hospitals

Large number of indoor/outdoor patients requiring referral for specialized care

Low-availability of Health Experts in district/remote hospitals

Dearth of adequate opportunities for training or continuing Medical Education for Doctors in Rural/Remote Health facilities.

Benefits of Telemedicine (I)Benefits to Patients:

Access to specialized health care services to under-served rural, semi-urban and remote areas,

Access to expertise of Medical Specialists to a larger population without physical referral,

Reduced visits to specialty hospitals for long term follow-up care for the aged and terminally ill patients.

Benefits to Physicians: Improved diagnosis and better

treatment management

Access to computerized, comprehensive data (text, voice, images etc.) of patients – offline as well as real time

Quick and timely follow-up of patients discharged after palliative care

Continuing education or training through video conferencing periodically

Benefits of Telemedicine (II)

Hospital and Insurance Benefits:

Significant reduction in unnecessary visits & hospitalization for specialized care at tertiary hospitals,

Earlier discharge of patients leading to shorter length of stay in hospitals,

Increase in the scope of services without creating physical infrastructure in remote hospitals

Benefits of Telemedicine (III)

9ITU-T Workshop on Standardization in E-Health, Geneva, 23-25 May 2003

Implementation challenge

Telemedicine : The Model Patient under treatment Physician treating the patient A remote telemedicine console

having audio visual and data conferencing facilitiesNodal HospitalNodal Hospital

Referral HospitalReferral Hospital

POTS / ISDN / LEASED LINE / VSAT

An expert / specialised doctor A central telemedicine server

having audio visual and data conferencing facility

Different types of services Telecardiology

Teleradiology

Telepathology

Telepsychiatry

Early Warning System [ Prevention and control of endemic and infectious diseases ]

ITU-T Workshop on Standardization in E-Health, Geneva, 23-25 May 2003

Benefits of E-Health

• Support for diagnostic (primary diagnostic, collaboration, 2nd opinion)

• Triage for evacuation of patients• Distant education• Enhancement of collaboration spirit• Diminution of isolation• Use of personal computers for health care.

Telemedicine in India•Existing system limited only to private hospital

• CORPORATE Group of Hospitals.

• RN Tagore Cardiac Hospital, Calcutta. (Asia Heart Foundation)

• No Telemedicine system for public health care

•Corporate Sectors Offering Telemedicine Systems• APPOLO & OTHER CORPORATE Groups

• Online Telemedicine System, Ahmedabad.

• WIPRO GE

• SIEMENS

Aim of the Telemedik SystemAim of the Telemedik System• Information management

– Patient information– Medical data (signs, symptoms, test reports, etc..)– Appointment scheduling– Archival and retrieval of patient records

• Low cost solution– Using ordinary telephone line

• Service to large population– Through public health care delivery systems

• Development of knowledge-based system– For decision support– For training and education

Why it is relevant to our society

Poor infrastructure

Non-availability of experts (disparate

distribution)

Low doctor-patient ratio (large population)

Lack of proper medical education Special attention required for Public Health Care System

Medical constraints and challenges

• Need and will of cooperation between medical sites;

• Complementary function of involved institutions and organizations;

• Acceptance of technology and change of working environment;

• Interoperability issues ignored.

Major Challenges

•Poor Data Communication Infrastructure.

•A Large Population Catered by Government Hospitals.

•System Features should be scalable.

•Cost of the system should be scalable.

Telecommunication constraints

• Minimum requirement is reliable telephone line at 19.2KBit/s

• Simultaneous Internet access recommended

• ISDN permits more advanced solutions like video-conferencing

• xDSL for the future.

Few E-Health Standards applicable

• DICOM (Digital Communication Medicine) for medical imaging

• ITU H320/H120 for video-conferencing• Proprietary systems for “Store-And-Forward”• Proprietary interactive and collaborative systems

Digital Imaging Communications in Medicine (DICOM )

originally the ACR-NEMA developed by American College of Radiology (ACR)

and the National Electrical Manufacturer's Association (NEMA)

provides standardised formats for image capture and storage coupled with a common information model specifying service definitions and protocols for communication

Digital camera

Doctor / Patient

Scanner

Printer

ElectronicsMicroscop

ECG Machine

ElectronicsStethoscope

PSTN / Leased Line

/ ISDN / VSAT

Specialist Doctor

Digital Camera

Scanner

Printer

Web Cam

Nodal Center

Referral Center

System Schematic

Requirement SpecificationRequirement Specification

Nodal HospitalNodal Hospital

Referral HospitalReferral Hospital

• A patient getting treated• A Doctor• A remote telemedicine console having audio visual and data conferencing facilities

• An expert/ specialized doctor• A central telemedicine server having audio visual and data conferencing facility

POTS / ISDN

Sequence of OperationSequence of OperationPATIENT IN

Patient visits OPD Local Doctor checks up

Patient receives local treatment and not referred to telemedicine system

Patient referred to the Telemedicine system (some special investigations may be suggested)

Patient visits Telemedicine data-entry console.Operator entries patient record, data and images of test results, appointment date is fixed for online telemedicine session

Offline Data transferfrom Nodal Centre

Sequence of OperationSequence of Operation

Patient 1Patient 2Patient 3Patient 4

Online conference for the patient.

Patient, local doctors at the nodal hospital and specialist doctors at the referral hospital

Patient queue

IN OUT

Concept of “Store and Forward”

RadiographScanner

DocumentScanner

Hardware ConfigurationHardware Configuration

Digital camera

Referral Hospital

Nodal Hospital

PSTN/ISDN/VSAT link

Scanner

PrinterModem

Microscope and other medical instruments

Video Conference

Telephone

Software ModulesSoftware Modules

Offline Activities

Online Activities

Videoconferencing

• Interactive• Well suited for seminars or special case discussion• Less adapted and expensive for routine work• Requires ISDN

Second opinion telemedicine concept

Telemedicine Center

Digitalisation

Radiologist

Pathologist

Store & Forward Telemedicine

Internet/ISDN/Phone

Medical supervisionPatient Record and

Medical Images

Digitalisation

Private doctorSmall clinic

The Data The Data• Data related to a patient’s personal information• Data related to a patients medical information• Data for patient management in Telemedicine• Data related to the doctors• Data for system management

ImagesImages

Vector DataVector Data

GraphicsGraphics

Video Clip for second opinion

Data related to the doctors

• Doctor’s personal information

• Unique Identification key

Medical information on Internet

• Gives valuable on-line access to huge medical knowledge & databases.

• Lack of quality control-> www.hon.ch

• Language barrier. -> www.etho.org

Nodal Hospital

Referral Centre

Writers Bldg.State

Switching Centre

DM OFFICEDistrict

Switch Centre

2 Mbps Optic

al Link WBSWAN

512 Kbps Leased Line

Schematic Diagram for Proposed Telemedicine using WBSWAN

Telemedicine for Tropical Diseases

…. way forward

1. Hand-holding support to Hospital administration for 3-4 years for stabilization of telemedicine services.

2. Integration of Telemedicine activities with Health Management Information System for regular reporting (preferably web-based)

3. Including Telemedicine activities in the performance appraisal of individuals and institutions.

4. Introducing Telemedicine (concept, technical aspects and implementation arrangements) as part of medical education & continuing medical education.

“ Telemedicine: one small step for IT , a giant leap for Healthcare!” Paraphrasing Neil Armstrong,

At raibbow hospitals Agra , we are in the process of establishing a tele med depttfor second opinions and for reportings

THANK YOU FOR HEARING ME OUT

Nm comp and telemed

Health & Medicine

Transcript of Nm comp and telemed

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